Journal of Robotic Surgery最新文献

Background: Introduction of single-port (SP) technology into centers with a consolidated multi-port experience in robot-assisted partial nephrectomy (MP-RAPN) represents a conceptual shift rather than a natural transition. We analyzed the early institutional adoption of the SP platform, assessing its impact on case complexity, perioperative outcomes, and determinants of surgical selection within a purely off-clamp RAPN framework compared with the established MP standard.

Material and methods: All consecutive RAPN performed at our tertiary referral center between May 2024 and October 2025 were analyzed (n = 372). All procedures were performed using a standardized off-clamp technique, irrespective of tumor features. After SP platform introduction, cases were stratified as multi-port (MP, n = 294) or single-port (SP, n = 78). Baseline, anatomical, and perioperative variables were prospectively collected. Tumor complexity was graded using the RENAL score, and renal function was assessed through serial eGFR measurements. Continuous and categorical variables were analyzed with Mann-Whitney U and χ²/Fisher tests; SMD > 0.20 denoted clinical imbalance. Univariable and multivariable Firth logistic regression identified independent predictors of SP adoption.

Results: Baseline characteristics were similar (each p > 0.2), except for tumor size and RENAL score, which were lower in SP cases (2.8 vs. 4.1 cm; 6.4 vs. 7.8; each p < 0.001). Perioperative outcomes-including hemoglobin drop, transfusion rate, complications, and hospital stay-were equivalent (each p > 0.05). SP tumors showed higher Fuhrman 1 (20.5% vs. 4.9%, p = 0.008) and pT1a stage (78.8% vs. 52.9%, p = 0.003). A lower RENAL score (OR 0.64, p < 0.001) independently predicted SP selection (C-index = 0.77).

Conclusions: In a center routinely performing purely off-clamp RAPN, adoption of the single-port robotic platform proved technically feasible and oncologically safe, achieving perioperative and functional outcomes equivalent to the multi-port approach during its early institutional phase.

The evaluation of authors in bibliometric studies has traditionally relied on straightforward quantitative indicators such as publication counts, total citations, and composite measures like the h-index. Although these metrics offer convenient and comparable ways to assess productivity, they do not fully capture the increasingly complex and collaborative nature of modern scientific work. This review examines how bibliometric studies published in the Journal of Robotic Surgery have presented "top authors" and suggesting more informative strategies for author-level assessment. A systematic review of all bibliometric articles published in the journal up to December 2025 was conducted. Studies were included if their abstracts contained the terms "bibliometric," "top 100 most cited," or "top 50 most cited," and only original research and review articles were analyzed. Twenty-eight (n-28) studies met the criteria. Across these papers, the number of publications and total citations were the most frequently reported metrics, while indices such as the h-index, g-index, and m-index appeared far less consistently. More advanced composite indicators-including the HG-composite and Q2-index-were entirely absent, despite offering more balanced evaluations by integrating cumulative output, influence, and career duration. Co-authorship network analysis was comparatively underutilized in the reviewed studies. Such analyses can help reveal collaboration patterns, identify influential author clusters, and highlight central contributors or bridges connecting different subfields-insights that are not captured by citation-based measures alone. Incorporating network structures and cluster-level exploration could therefore provide a clearer understanding of authors' roles and scholarly influence within robotic surgery research. Taken together, these findings suggest that current bibliometric studies primarily focus on basic productivity measures, with less frequent use of advanced metrics or analyses of collaboration patterns. Incorporating additional approaches-such as composite indicators, co-authorship networks, and research cluster profiling-could offer a more comprehensive and informative view of author contributions, helping to better reflect the complexity of scholarly impact in the field.

The aim of this study was to compare short term clinical outcomes for patients having robotic or laparoscopic diverticular resection in the elective setting. This was a single center cohort study of consecutive patients having elective minimally invasive left-sided diverticular resection between February 2018 and March 2025 for symptomatic inflammation, stricture, abscess or fistula. All robotic procedures were carried out using the DaVinci Xi system (Intuitive Surgical). The primary outcome was rate of open conversion. Secondary outcomes included operative time, blood loss, stoma formation, duration of patient-controlled analgesia, time to gut function, length of stay and complications. Seventy-two patients were included, 40 in the robotic group and 32 in the laparoscopic group. Open conversion rate, blood loss and patient-controlled analgesia use were significantly reduced in patients having robotic compared to laparoscopic surgery, at the cost of operative time. Robotic surgery was an independent predictor of lower conversion rate, lower blood loss and higher operative time in regression models. Robotic surgery for elective diverticular resection may enable a greater proportion of patients to benefit from minimally invasive approach without the need for open conversion.

Robotic-assisted thoracic surgery (RATS) lobectomy has diffused rapidly as an alternative to video-assisted thoracoscopic surgery (VATS) for resectable non-small cell lung cancer (NSCLC). A growing but heterogeneous evidence base-including prospective cohorts, meta-analyses, economic models, learning-curve studies and one large randomized trial-permits an updated synthesis to guide clinicians and policy makers. We conducted a focused, reproducible literature search of Cochrane CENTRAL, PubMed/MEDLINE and Embase through 15 August 2025 using terms that included "robotic lobectomy," "RATS," "VATS," "non-small cell lung cancer," "randomized," "meta-analysis," "cost" and "learning curve." We prioritized randomized evidence, prospective comparative cohorts, high-quality meta-analyses, multicenter registries, and full economic evaluations published 2020-2025. Primary outcomes were perioperative (operative time, blood loss, conversion, complications, length of stay), nodal harvest and pathologic upstaging, disease-free and overall survival, quality of life (QOL), cost and learning-curve metrics. We present a transparent search strategy, selection criteria, and synthesized quantitative findings drawn from high-impact sources. The RVlob randomized controlled trial (n = 320) showed non-inferiority of robotic to VATS lobectomy for 3-year overall survival (RAL 3-yr OS 94.6% v VAL 91.5%; HR 0.65, 95% CI 0.33-1.28; noninferiority P = 0.0029). Observational multicenter cohorts (including a large JAMA Network Open study, n ≈ 1,088) found broadly comparable clinical outcomes but longer adjusted operative duration for RATS (median + 20.6 min). Pooled prospective data (Frontiers 2023; pooled n = 614) reported lower estimated blood loss with RATS (MD - 17.14 mL, 95% CI - 29.96 to - 4.33) and greater numbers of lymph-node stations sampled (MD + 1.07 stations, 95% CI 0.79-1.36). Learning-curve synthesis suggests technical proficiency at ≈ 25 cases (mean 25.3 ± 12.6) with convergence of operative times and outcomes thereafter. Cost-effectiveness analyses are heterogeneous: Heiden et al. (Ann Thorac Surg, 2022) reported modest per-case cost increases for RATS with ICERs that depend heavily on perspective and assumptions, while early RCT economic analyses (RAVAL early results / RPL-4 pathway) have reported ICERs in the range of ≈$15k per QALY under favorable assumptions. RATS lobectomy is oncologically non-inferior to VATS at mid-term follow-up and achieves perioperative safety comparable to VATS; it is associated with lower intraoperative blood loss, more extensive nodal station sampling in some series, and longer operative times early in adoption. Cost-effectiveness is context-sensitive and improves with higher case volumes, shorter OR times, and lower disposable instrument costs. Standardized lymphadenectomy, transparent learning-curve reporting, and longer randomized follow-up remain priorities.

The adoption of robotic-assisted thoracoscopic surgery for lung cancer has steadily increased; however, the learning curve and influence of prior video-assisted thoracoscopic surgery (VATS) experience remain underexplored. This study investigates the impact of prior VATS experience on the learning trajectory of robotic anatomic lung resection. We conducted a retrospective, single-center study analyzing 341 consecutive robotic anatomic lung resections performed by three surgeons between January 2018 and December 2024 at a tertiary referral hospital. Three thoracic surgeons with varying VATS experience-A (1,500 cases), B (350 cases), and C (50 cases)-were included. Learning curves were assessed using cumulative sum analysis for operative time, complication rates, lymph node yield, and postoperative hospital stay. Change points were identified, and early versus late-phase outcomes were compared. All surgeons demonstrated significant reductions in operative time after reaching their respective cumulative sum thresholds (cases 54, 35, and 34 for Surgeons A, B, and C, respectively). While Surgeon A exhibited early procedural stability, Surgeons B and C showed more rapid improvement with experience. Lymph node yield increased significantly for Surgeon B (p = 0.002) and marginally for Surgeon C (p = 0.074). Complication rates and hospital stay showed modest increases in the later phase, which were not consistently statistically significant and appeared to be associated with a shift toward more complex cases. Although prior VATS experience supports initial operative consistency, it does not necessarily shorten the robotic learning curve. Instead, case volume and intensity of robotic exposure appear more critical. These findings underscore the need for structured training programs emphasizing high case density and progressive complexity to optimize robotic surgical proficiency.

Urological surgeons have been shown to suffer with significant musculoskeletal (MSK) discomfort during their careers directly attributed to their work. Robot-assisted surgery (RAS) is believed to offer superior ergonomics to traditional forms of surgery but concerns still exist around their use. This systematic review collates the currently available literature on the ergonomic outcomes of RAS in urology and offers comparison to other surgical modalities. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines formed the basis of this review, and the study protocol was registered in PROSPERO (CRD420250650617). A thorough database search was conducted in MEDLINE/PubMed and EMBASE, with twenty-two articles eventually included in the review. Data analysis included a narrative synthesis, and sub-group meta-analysis where data homogeneity allowed. Overall, RAS offers a more ergonomic environment for urological procedures than laparoscopic, open, or endoscopic surgery. Questionnaire-based studies demonstrated favourable use among urological surgeons, although numerous issues persist such as neck and back pain. Postural and muscular assessments similarly showed improvements in ergonomy for RAS. However, prolonged poor ergonomic joint positions, and moderate activation of upper body muscles were noted in all forms of surgery. Task load indexes demonstrated lower physical demand among RAS. While RAS offers a superior ergonomic environment to minimally invasive and open surgical techniques in urology, numerous challenges still exist. Continued study is needed, and formal ergonomic assessments should become standard protocol for any emerging robotic systems to ensure that proper ergonomy is maintained across a diverse surgical population.