Journal of Robotic Surgery最新文献

The Deep Pelvic Endometriosis Index (dPEI) is a preoperative MRI-based score initially validated to predict surgical outcomes in patients undergoing laparoscopic treatment for deep pelvic endometriosis (DPE). Its applicability in robotic-assisted laparoscopy (RAL) has not yet been established. This study aimed to evaluate whether the dPEI can predict surgical outcomes following RAL for DPE. From February 2019 to December 2024, a retrospective analysis from a prospective database including patients undergoing RAL for DPE at Tenon Hospital, Paris, was performed. Preoperative staging was based on MRI and the dPEI scoring system, which evaluates the involvement of different anatomical compartments by deep endometriosis. Patients were classified into three categories: mild endometriosis (dPEI ≤ 2), moderate endometriosis (dPEI 3-4), and severe endometriosis (dPEI ≥ 5). Surgical outcomes including operative time, hospital stay, postoperative complications using the Clavien-Dindo classification and voiding dysfunction were assessed. A hundred and seventy patients were included. Overall complication rate was 24.7%, including 7.7% Clavien-Dindo grade > II. De novo voiding dysfunction occurred in 10.6% of patients, lasting > 1 month in 4.1%. dPEI categories showed a positive correlation with longer operative time (Spearman's ρ = 0.40, p < 0.001) and increased hospital stay (Spearman's ρ = 0.43, p < 0.001) and were also significantly associated with higher rates of grade > II complications (OR = 13.1; 95% CI [1.54-111.3], p = 0.02) and high incidence of voiding dysfunction (OR = 5.9; 95% CI [1.48-23.5], p = 0.01). Involvement of lateral compartments was associated with high operative time, hospital stay, and de novo voiding dysfunction. Our results support the dPEI as a useful preoperative tool for predicting surgical outcomes after RAL for DPE. Its use can improve patient counseling, and shared decision-making, particularly in cases of severe disease (dPEI ≥ 5).

Robot-assisted orthopedic surgery has garnered significant attention, yet comprehensive bibliometric and visualization analyses in this field remain scarce. This study aims to systematically map and visualize the global research landscape of robot-assisted orthopedic surgery. Employing bibliometric analysis methods and a suite of visualization tools-including CiteSpace, VOSviewer, and Scimago Graphica-this study systematically examined literature on orthopedic robotic surgery published in the Science Citation Index Expanded (SCIE) core collection from 2005 to 2024, analyzing global research trends across multiple dimensions. These dimensions encompass annual publication volume, collaborative networks among countries/regions and institutions, journal co-occurrence, keyword co-occurrence and clustering, research evolution pathways, and emerging keywords. A total of 820 articles on orthopedic robotics were included from 2005 to 2024. Analysis indicates exponential growth in global orthopedic robotic surgery research, with annual publications increasing from 5 in 2005 to 185 in 2024. The United States (338 articles), China (152 articles), and the United Kingdom (94 articles) emerged as core publishing nations. Institutional collaborations formed four major clusters: North America, Europe, Asia-Pacific, and industry-academia-research partnerships. Key influential journals in orthopedic robotic surgery include the Journal of Arthroplasty, Journal of Knee Surgery & Sports Traumatology & Arthroscopy, International Journal of Computer-Assisted Radiology and Surgery, and International Journal of Orthopaedic Knee Surgery. Research hotspots are highly concentrated in three key areas: prosthesis stability and long-term survival in robot-assisted total hip arthroplasty (THA); precise alignment and soft tissue balance in robot-assisted total knee arthroplasty (TKA); and accurate navigation and safe placement of pedicle screws in robot-assisted spinal surgery. Emerging keywords indicate recent research emphasis on "lumbar spine," "national joint registries," "patient matching," and "total hip." Orthopedic robotic surgery research is currently undergoing rapid development, with technology integration, precision, and personalization emerging as primary future directions. This study provides a reference framework for researchers to track field trajectories and optimize research planning, while also offering theoretical support for clinical practice and technological innovation.

Robotic-assisted bariatric surgery has shown sustained growth in recent years. However, evidence on its performance in the context of medical tourism is limited. This study describes the implementation of a robotic bariatric surgery program in a highly specialized center, analyzing the evolution of operative times and the learning curve of the surgical team. Observational, retrospective, and descriptive study that included all patients undergoing robotic-assisted bariatric surgery between January 2023 and May 2025. Demographic, clinical, and surgical variables were recorded, including total surgery time, docking time, and console time. Comparisons between years were made using ANOVA and Tukey's test, considering p < 0.05 as statistically significant. Ninetyfour cases were analyzed with a mean age of 42.8 (SD: 11.3) years and body mass index of 41.8 (SD: 7.7) kg/m²; 84% were women. Sleeve gastrectomy was the most frequent procedure (56.4%). The average docking, surgery and console times were 7.6 (SD: 3.0), 111.6 (SD: 51.0) and 69.6 (SD: 49.3) minutes, respectively. A significant decrease in docking time was observed over the years (p < 0.001), with no significant differences in surgical or console times. The progressive implementation of bariatric robotic surgery in a context of medical tourism is feasible. During the initial years of experience, a significant reduction in docking time was observed, while console and total operative times did not show statistically significant changes, similar to other international centers.

Background: Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an advanced surgical technique. However, direct comparisons between Chinese and American robotic systems are limited.

Objective: Exploratory comparison of surgical accuracy and short-term clinical outcomes between Chinese HURWA and American MAKO robotic systems in total knee arthroplasty.

Methods: A prospective exploratory cohort study was conducted from September 2023 to January 2024. Eighty-five patients were assigned to undergo RA-TKA with either the HURWA system (n = 43) or the MAKO system (n = 42) based on the sequential clinical introduction of the systems. The primary outcomes were radiographic accuracy, including the restoration of the mechanical axis within ± 3°. Secondary outcomes encompassed surgical efficiency metrics and patient-reported clinical scores (WOMAC, HSS, VAS) assessed preoperatively and at one-year postoperatively.

Results: All included patients have completed surgery and follow-up.The two systems achieved a comparable and high proportion of mechanical axis restoration within ± 3° (HURWA: 86.05% vs. MAKO: 90.48%). The HURWA system demonstrated a significant advantage in osteotomy time (6.03 ± 2.35 vs. 8.06 ± 2.73 min, P < 0.001). Both groups exhibited substantial and comparable improvements in all clinical outcome scores at the one-year follow-up. The HURWA system, as an open-platform design, offered flexibility in prosthesis selection, while the MAKO system demonstrated a highly standardized workflow.

Conclusion: This exploratory comparison indicates that the HURWA system achieves favorable and comparable one-year clinical outcomes and radiographic alignment to the MAKO system in TKA, with distinct advantages in osteotomy efficiency and implant flexibility. These preliminary findings support the clinical potential of HURWA as a viable option, though definitive conclusions regarding its equivalence require validation through larger, long-term studies.

Robotic approach to hepatectomy has shown promise in recent times. The aim of our study was to identify the impact of various patient variables on outcomes from robotic major and minor hepatectomy. Data on 167 consecutive robotic hepatectomy procedures at our institution was retrospectively analyzed. Perioperative outcomes were analyzed for both minor and major hepatectomy. For major hepatectomy (n = 66), factors associated with increased operative time included cirrhosis (301 vs. 257 min) and obesity (310 vs. 261 min). Estimated blood loss (EBL) was worse in patients with underlying cirrhosis (242 vs. 161 mL), obesity (215 vs. 148mL) and tumor size ≥ 10 cm (232 vs. 136mL). Length of hospital stay (LOS) was also longer with age ≥ 70 years (5.9 vs. 4.5 days), cirrhosis (5.6 vs. 4.6 days) and malignant tumor pathology (5.1 vs. 3.8 days). Similarly, increased postoperative complications were seen with cirrhosis and tumor size ≥ 10 cm. For minor hepatectomy (n = 101), operative time was longer in patients with cirrhosis (139 vs. 105 min), obesity (141 vs. 115 min) and posterior-superior (PS) liver resection (168 vs. 104 min). Similarly, EBL was higher in cirrhotic patients (163 vs. 58mL) and those with PS resection (152 vs. 64mL). Longer LOS was observed in elderly patients (2.9 vs. 2.0 days), cirrhosis (2.9 vs. 2.1 days) and PS resection (2.8 vs. 2.1 days). Our study offers a comprehensive understanding of the impact of clinicopathologic factors on outcomes and can be utilized as a guide to appropriate patient selection, especially for surgeons starting a robotic hepatectomy practice.

To compare early and late complications rates after robot-assisted radical cystectomy for muscle invasive bladder tumors and certain high-risk non-muscle-invasive tumors according to the type of reconstruction. We conducted a single-center retrospective study including 109 patients who underwent robot-assisted radical cystectomy between 2008 and 2022. Patients were divided into two groups based on urinary diversion: extracorporeal Bricker ileal conduit (n = 74) or orthotopic neobladder (n = 35). Complications were graded by the Clavien-Dindo classification. Multivariate analysis identified independent risk factors for morbidity and mortality. Operative time was significantly longer for neobladder reconstruction (320 vs. 291 min, p = 0.047), as was hospital stay (14 vs. 10 days, p < 0.001). Early complications (< 30 days) occurred in 59.6% of patients, with a higher rate of minor complications in the neobladder group (57.1% vs. 28.4%, p = 0.006). There was no significant difference in major complications (Clavien III-V) or late complications (> 30 days), which affected 47.7% of patients. Operative time was an independent risk factor for major complications (OR = 1.15 per additional 15 min). Neobladder reconstruction was associated with increased early morbidity, mainly minor, without impact on late morbidity or mortality. Urinary diversion choice should be guided by patient profile and expected functional benefits.

To evaluate the effectiveness of a phased active warming protocol in preventing intraoperative hypothermia during Da Vinci robot-assisted radical resection for rectal cancer. A single-center retrospective cohort analysis examined patients undergoing Da Vinci robot-assisted rectal cancer resection from January 1, 2022, through December 31, 2024. Using 1:1 propensity score matching, patients receiving phased active warming protocol were matched with those under routine thermal care. Variables for matching encompassed age, sex, body mass index, American Society of Anesthesiologists classification, surgical duration, and anesthesia time. Primary outcome measured was intraoperative hypothermia incidence (core temperature below 36 °C). Secondary outcomes covered mean core temperature, postoperative shivering evaluated through Bedside Shivering Assessment Scale, surgical site infection rates, blood transfusion needs, hospital stay duration, and perioperative costs. Following propensity score matching, each group contained 144 patients (total n = 288). Hypothermia occurrence dropped markedly in the intervention cohort (26 cases [18.1%] versus 70 cases [48.6%], p < 0.001). End-of-surgery core temperature showed higher values in the intervention cohort (36.4 ± 0.5 °C compared to 35.8 ± 0.6 °C, p < 0.001). Shivering after surgery (BSAS score of 1 or greater) demonstrated reduced frequency in the intervention cohort (18 patients [12.5%] versus 50 patients [34.7%], p < 0.001). Wound infection rates decreased in the intervention cohort (6 cases [4.2%] versus 17 cases [11.8%], p = 0.022). Hospital stays shortened for the intervention cohort (8.2 ± 2.1 days compared to 10.5 ± 3.4 days, p < 0.001). The phased active warming approach substantially decreased hypothermia occurrence and enhanced perioperative outcomes in Da Vinci robot-assisted rectal cancer resection patients, demonstrating clinical value warranting widespread adoption.