Journal of Robotic Surgery最新文献

With more robotic platforms approved for clinical use, interest in assessing skill transferability has increased. Skill transfer has yet to be studied amongst trainees in early stages of robotic training. This systematic review evaluated skill transferability of robotic platforms amongst trainees in simulated settings. The systematic review was conducted according to PRISMA guidelines. Five databases were searched from inception until 20 January 2025. Inclusion criteria had studies using simulation-based modalities, more than one robotic platform, and objective metrics or global rating scales for skills assessment. Search identified 609 unique studies. Five studies were included. Platforms analysed were Da Vinci X, Si and single-port system, Hugo RAS and CMR Versius. Consistent performances were seen across platforms amongst novices and experts, whilst intermediates exhibited reduced scores (GEARS - 2.9). Prior robotic surgical experience was the main driver for better baseline performance and skills progression. Skill transferability was demonstrated in cross-platform simulated training amongst experts and novices, indicating that core robotic surgical skills can be applied across systems. Less evidence of skill transfer in intermediate-level participants suggests that those still consolidating their technical proficiency may be more sensitive to platform-specific differences. Console design variations appeared to influence transferability. Incorporating cross-platform training could enhance trainees' understanding of the fundamental principles of robotic surgery, equipping them with more adaptable skillsets suited to various platforms. This has important implications for surgical training, as during the trainees' learning phase, they should be aware of the potential decline in technical performance when transitioning between platforms.

This study aims to systematically examine how minimally invasive thymectomy-covering both video-assisted and robotic-assisted methods-compares with open thymectomy in terms of perioperative safety and effectiveness for treating large thymomas. We thoroughly searched several databases for relevant studies, including randomized controlled trials and cohort studies, published up until October 2025. Data on perioperative factors, including surgical duration, blood loss, length of hospitalization, complications, and recurrence rates, were extracted and analyzed using random-effects models in STATA 18. Seven studies involving 12,880 patients were included. open surgery showed significantly more blood loss (WMD = 110.43, 95% CI 105.83-115.03; P < 0.05), longer hospital stays (WMD = 2.04, 95% CI 1.38-2.7; P < 0.05) compared to MIT. No notable difference in surgical duration was observed. Moreover, minimally invasive thymectomy (MIT) was associated with a reduced rate of recurrence after surgery (OR = 0.54, 95% CI 0.35-0.84; P < 0.05) as well as fewer postoperative complications (OR = 0.27, 95% CI 0.19-0.39; P < 0.05). MIT offers significant advantages over open surgery for large thymomas, including reduced blood loss, shorter hospital stays, and lower rates of complications and recurrence, though operative time was similar. Further large-scale studies are needed to confirm these findings and assess long-term efficacy.

The Hugo™ Robotic-Assisted Surgery (RAS) system is an emerging robotic platform; evidence on its performance for extraperitoneal robot-assisted radical prostatectomy (eRARP) remains limited. Between June 2023 and September 2024, 100 patients with prostate cancer underwent eRARP using the Hugo™ RAS system. Preoperative, intraoperative, pathological and postoperative data were collected prospectively. To assess temporal trends related to platform adoption, the cohort was divided into the first 50 and last 50 cases and learning-curve dynamics were analyzed (including CUSUM for console time). We report 12-month follow-up. Across the entire series, the median operative duration was 252.5 min (Q1-Q3 200-290), with no instances of intraoperative conversion or intraoperative complications. Major postoperative events classified as Clavien-Dindo grade III or higher were observed in 2% of patients. At the 12-month assessment, an undetectable PSA (< 0.1 ng/mL) was documented in 80% of individuals, social continence (≤ 1 pad per day) in 87%, and erectile function recovery in 51%. Overall positive surgical margin (PSM) rate was 40%, with clinically significant PSM (≥ 3 mm or multifocal) of 21%. Comparison of two groups revealed a learning effect: median operative time decreased from 275 to 210 min (p < 0.00001); docking time improved modestly (p = 0.0271). Both clinically significant PSMs (28%→14%) and overall complication rates (26%→4%, p = 0.0006) declined in the second cohort. In this prospective, single-center series, eRARP using the Hugo™ RAS system was feasible and safe. A learning-curve effect produced substantially shorter operative times and fewer complications, while oncological and functional outcomes were preserved. Longer follow-up and larger multicenter studies are needed to verify long-term equivalency with well-established robotic platforms.

As the utilisation of transoral robotic surgery (TORS) continues to rise, there is a growing need to evaluate the risks of perioperative complications. Post-TORS haemorrhage represents the most severe complication associated with TORS, however currently there is no consensus for managing these patients. This review assessed the extent of post-TORS haemorrhage in head and neck cancer (HNC) patients and evaluated current approaches for achieving haemostasis following post-TORS haemorrhage. A comprehensive search of Medline, Embase & Web of Science was conducted, to identify articles published from the databases' inception to January 2025. Severity, incidence & management strategies employed in these studies were examined, in addition to risk factors associated with post-TORS haemorrhage. 28 studies met our inclusion criteria. The pooled average bleeding incidence for HNC patients following TORS was 7.24%, with the median day for initial bleeding episode occurring post-operative day 6. Classification of post-TORS haemorrhage severity was documented for 28.5% of reported bleeds, highlighting the need to adopt a classification system. Management strategies for achieving haemostasis varied significantly between institutions, and granularity with respect to airway management was poorly reported. Currently, consensus regarding an appropriate stepwise approach to managing post-TORS haemorrhage remains contested, as highlighted by the varied nature of haemostatic management techniques employed across a range of institutions in the included literature. As data becomes more readily available a standardised approach to classification of haemorrhage severity will be possible and consensus on haemostatic techniques can be made, which will support the creation of best practice guidelines.

Background: Robot-assisted surgery (RAS) has revolutionized minimally invasive surgery through enhanced dexterity, precision, and three-dimensional visualization. However, as surgeons become physically separated from the operative field, new risks emerge, including staff injuries, arm collisions, communication failures, and diminished situational awareness. This review aimed to synthesize current evidence on ergonomic, cognitive, and non-technical factors influencing staff safety in RAS.

Methods: A narrative review synthesized English-language studies published until 2025 on staff safety, arm interference, and non-technical skills (NTS) in RAS. Literature was searched in PubMed, Scopus, and Embase using terms such as robotic surgery, bedside assistant, arm collision, injury, workflow disruption, human factors, and NTS. Eligible publications included case reports, observational studies, ergonomic analyses, and educational frameworks. Data were grouped into four domains: (1) ergonomic and cognitive challenges, (2) staff injuries and near-misses, (3) NTS deficits, and (4) educational countermeasures.

Results: RAS introduces ergonomic and cognitive stressors (restricted workspaces, multiple arms, limited visibility, and loss of tactile feedback), causing injuries such as hand entrapment and arm collisions. FDA MAUDE registry reported over 1,300 injuries and 8,000 device malfunctions, approximately 10% involving staff. Cognitive analyses showed console surgeons' visual immersion reduced team awareness and coordination. Curricula focus on console skills but underemphasize NTS. Interventions such as dual-console mentoring, simulation-based teamwork, and structured NTS coaching improved awareness and reduced workload stress.

Conclusions: RAS enhances precision but introduces human-factor risks. Sustainable safety requires integrating ergonomics, NTS, and communication into robotic training through simulation, feedback, and reflection-ensuring innovation supports both performance and humanity.

Accurate assessment of coronal alignment is essential for total knee arthroplasty (TKA) planning. The Coronal Plane Alignment of the Knee (CPAK) classification integrates mechanical alignment and joint line obliquity into nine phenotypes, but its reliability depends on measurement accuracy. This study aimed to compare the accuracy and reliability of CPAK classification and coronal alignment parameters obtained from computed tomography (CT) and long-leg standing radiographs. A prospective comparative study was conducted on 100 patients undergoing primary TKA for degenerative arthritis. Each patient underwent standardized long-leg standing radiographs and full-limb CT scans using MAKO robotic planning software. Measurements included the arithmetic hip-knee-ankle (aHKA) angle, lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and joint line obliquity (JLO). CPAK classification was determined from aHKA and JLO values. Two independent observers recorded all parameters. Inter-modality differences were analyzed using paired t-tests, and reliability was assessed using intraclass correlation coefficients (ICC) and Cohen's kappa. A total of 100 patients were analyzed, with complete datasets for 86 patients. CT consistently produced different values for HKA, LDFA, and MPTA compared with radiographs (p < 0.001), while aHKA, JLO and CPAK classifications showed no significant difference. Both modalities demonstrated excellent interobserver reliability (ICC > 0.88) and near-perfect CPAK agreement (κ = 0.86-0.88) measurement without altering overall CPAK phenotype classification. CT-based measurements provide greater precision and reproducibility for coronal alignment parameters compared with radiographs. However, CPAK classification remains largely consistent between modalities, validating its robustness across imaging techniques. CT offers precise value for preoperative planning, particularly in robotic-assisted workflows or complex deformities, while radiographs remain adequate for routine phenotyping. Level II - Prospective comparative study.

Introduction: Laparoscopic total extraperitoneal (TEP) and robotic transabdominal preperitoneal (TAPP) repairs have emerged as alternatives to open surgery, but direct comparisons of their outcomes remain limited. This study compared the short- and long-term outcomes of robotic TAPP (R-TAPP) versus laparoscopic TEP (L-TEP) for inguinal hernia repair.

Methods: A search of PubMed, Embase, and Web of Science was conducted from inception to October 2025, without language restrictions. Meta-analyses were performed using pooled effect sizes with 95% confidence intervals (CI), and trial sequential analysis (TSA) evaluated the conclusiveness of evidence.

Results: Six studies with a total of 992 patients (510 R-TAPP, 482 L-TEP) were included. R-TAPP demonstrated significantly longer operative time (MD: 17.76 min; 95% CI: 3.83 to 31.70; p = 0.01), and a slightly longer hospital stay (MD: 0.16 days; 95% CI: 0.03 to 0.29; p = 0.01), though the latter was likely not clinically meaningful. Sensitivity and trial sequential analyses suggested a significant reduction in postoperative pain with R-TAPP, with TSA confirming robust evidence for lower pain scores (median unbiased estimate MD: -1.59; 95% CI: -2.41 to -0.76; p < 0.001). No significant differences were observed in recurrence rates, seroma formation, urinary retention, or wound infection.

Conclusion: Robotic TAPP inguinal hernia repair offers comparable safety and efficacy to laparoscopic TEP, with potential benefits in reducing postoperative pain but requires longer operative time and hospital stay. Both techniques demonstrate similar rates of recurrence and complications. Further randomized trials with an extended follow-up are recommended to confirm these findings and inform best practices.

Background: Robotic liver resection (RLR) presents technical challenges due to the lack of standardized procedures and limited opportunities for hands-on training. To overcome these limitations, we developed a swine model designed to facilitate stepwise education across various RLR techniques. This model was supplemented with surgical videos to provide detailed procedural guidance.

Methods: A standardized single-day curriculum was implemented using a swine model to simulate key components of RLR. Training included non-anatomical and anatomical resections using the extrahepatic Glissonean approach, parenchymal transection guided by indocyanine green fluorescence or ischemic demarcation, and advanced procedures such as hilar dissection, biliary reconstruction, and portal vein anastomosis. All procedures were recorded and edited into instructional videos. Multiple workshops were conducted through the Korean Association of Liver Surgery.

Results: The swine model reliably reproduced key robotic liver surgery techniques, providing realistic tissue handling, stable operative exposure, and effective practice of parenchymal transection using both harmonic and bipolar energy devices. The accompanying educational videos highlighted key procedural steps and enhanced conceptual understanding. Survey responses from participating surgeons demonstrated improved technical confidence, better understanding of robotic liver anatomy and transection techniques, and increased clinical adoption of RLR.

Conclusions: This swine-based educational model provides a practical, high-fidelity, and reproducible environment for structured RLR training. When integrated with instructional surgical videos, it offers a comprehensive educational tool that supports early-career surgeons in achieving proficiency in robotic liver surgery.