International Journal of Medical Robotics and Computer Assisted Surgery最新文献_第6页

Robotic Versus Total Laparoscopic Splenectomy With Pericardial Devascularisation for Portal Hypertension: A Retrospective Cohort Study 机器人与全腹腔镜脾切除术合并心包断流术治疗门静脉高压：一项回顾性队列研究

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-24 DOI: 10.1002/rcs.70085

Zhen Ma, Hongbin Cui, Lei Gaoi, Bin Ma, Puyi He, Yang Yu, Yunpeng Wang, Yanling Ma, Hao Chen

Background

This study compared the feasibility, efficacy, and safety of robotic splenectomy with pericardial devascularisation (TRSPD) versus total laparoscopic splenectomy with pericardial devascularisation (TLSPD) in patients with portal hypertension (PHT) complicated by splenomegaly, hypersplenism, and oesophagogastric varices.

Methods

A retrospective cohort analysis was conducted on 17 patients undergoing minimally invasive splenectomy with pericardial devascularisation between 2022 and 2024. Outcomes included operative metrics, postoperative recovery, and portal hypertension resolution.

Results

TRSPD significantly reduced intraoperative blood loss (175 vs. 436 mL, p = 0.004) despite longer operative duration (400 vs. 256 min, p = 0.001). Zero conversions occurred with TRSPD versus 3 conversions with TLSPD (p = 0.02). Postoperatively, TRSPD accelerated gastrointestinal recovery (2.1 vs. 3.5 days, p = 0.02) and shortened drainage duration (4.0 vs. 6.2 days, p = 0.02). Both techniques normalised haematologic indices, reduced portal vein diameter (p < 0.05), and resolved varices without major complications.

Conclusions

TRSPD demonstrates superior intraoperative safety and faster recovery compared with TLSPD while achieving equivalent therapeutic efficacy for portal hypertension. Robotic approaches may optimise the minimally invasive management of complex portosplenic vascular pathologies.

本研究比较了机器人脾切除术合并心包断流术（TRSPD）与全腹腔镜脾切除术合并心包断流术（TLSPD）治疗门脉高压（PHT）合并脾肿大、脾功能亢和食管胃静脉曲张的可行性、有效性和安全性。方法回顾性分析2022 ~ 2024年间行微创脾切除术合并心包断流术的17例患者。结果包括手术指标、术后恢复和门静脉高压缓解。结果尽管手术时间较长（400 vs 256 min, p = 0.001），但TRSPD显著减少术中出血量（175 vs 436 mL, p = 0.004）。TRSPD组为0例，TLSPD组为3例（p = 0.02）。术后TRSPD加速胃肠恢复（2.1 vs. 3.5天，p = 0.02），缩短引流时间（4.0 vs. 6.2天，p = 0.02）。两种技术均使血液学指标正常化，门静脉直径减小(p <；0.05)，静脉曲张消退，无重大并发症。结论与TLSPD相比，TRSPD术中安全性更高，恢复速度更快，治疗门静脉高压症的效果相当。机器人入路可以优化复杂门脾血管病变的微创治疗。

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引用次数: 0

Clinical and Economic Assessment of Robot-Assisted Radical Prostatectomy With the Hinotori Surgical System: Insights From a Japanese Single-Centre Study 机器人辅助根治性前列腺切除术与Hinotori手术系统的临床和经济评估：来自日本单中心研究的见解

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-21 DOI: 10.1002/rcs.70084

Kotaro Obayashi, Jun Akatsuka, Takuya Nishino, Mami Takadate, Hiroya Hasegawa, Hikaru Mikami, Hayato Takeda, Yuki Endo, Yuka Toyama, Takeshi Yamada, Yoichiro Yamamoto, Go Kimura, Yukihiro Kondo

Background

We investigated the clinical and economic outcomes of robot-assisted radical prostatectomy (RARP) using the hinotori surgical system (H-RARP).

Methods

The analysis was conducted on 76 and 68 patients who underwent RARP using the da Vinci surgical system (D-RARP) and H-RARP, respectively. Safety, oncological, and functional outcomes were compared between H-RARP and D-RARP. Risk factors influencing medical costs in RARP were identified via linear regression analysis.

Results

Except for longer operative time in H-RARP, clinical outcomes were comparable. The median medical costs per case were $12,426.8 for D-RARP and $12,548.9 for H-RARP. Operative time (coefficient: 0.0002, p < 0.001), pathological T stage (coefficient: 0.023, p = 0.030), and postoperative hospital stay (coefficient: 0.028, p < 0.001) were significant factors affecting medical costs; in contrast, the type of robot-assisted surgical system was not a significant factor.

Conclusions

H-RARP offers clinical outcomes comparable to those of D-RARP while maintaining equivalent medical costs.

我们研究了使用hinotori手术系统（H-RARP）的机器人辅助根治性前列腺切除术（RARP）的临床和经济效果。方法对76例和68例采用达芬奇手术系统（D-RARP）行RARP的患者进行分析。比较了H-RARP和D-RARP的安全性、肿瘤学和功能结果。通过线性回归分析确定影响RARP医疗费用的危险因素。结果除H-RARP手术时间较长外，两组临床结果具有可比性。每例D-RARP患者的平均医疗费用为12426.8美元，H-RARP患者的平均医疗费用为12548.9美元。操作时间(系数：0.0002,p <；0.001)、病理T分期（系数：0.023,p = 0.030）、术后住院时间(系数：0.028,p <；0.001)是影响医疗费用的显著因素；相比之下，机器人辅助手术系统的类型并不是一个重要因素。结论H-RARP的临床效果与D-RARP相当，同时保持相同的医疗费用。

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引用次数: 0

Paediatric Robotic Transperitoneal Heminephroureterectomy in Complete Duplicated Systems: Early and Long-Term Outcomes 儿童机器人经腹膜肾输尿管切除术在完全重复系统：早期和长期的结果

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-20 DOI: 10.1002/rcs.70082

Donatella Di Fabrizio, Thomas P. Cundy, Azad S. Najmaldin

Background

We present outcomes for paediatric robotic heminephroureterectomy from a prospective single-surgeon series.

Methods

Children who underwent this operation between July 2007 and March 2017 were reviewed from a prospective database.

Results

There were 32 heminephroureterectomy (28 upper, 4 lower) for ureterocele (13), reflux (7), ectopic ureter (11), ureteric atresia (1). Co-morbidities (urological anomalies, recurrent infection, previous abdominal scarring) were common. Concomitant non-robotic procedures took place in 50%. Mean console time was 101 ± 30.2 min, hospital stay 29.5 ± 10.3 h. There were no conversions, intraoperative complications, and no remnant moiety function loss. Excision of diseased moiety calyces was complete in 30 (94%), incomplete in 2 (6%) who subsequently developed asymptomatic small marginal cysts. Eleven (34%) had total-ureterectomy, the remaining 21 (66%) were left with a ureteric stump. Postoperatively 3 (9%) females with residual stump (2 ureterocele, 1 bladder neck ectopia) and other urological anomalies underwent surgery (stump excision + reimplant refluxing remnant moiety ureter) for recurrent infection.

Conclusion

In children, heminephroureterectomy is well suited to a robotic approach with favourable outcomes in our experience.

背景：我们介绍了一项前瞻性单外科医生系列的儿童机器人半肾输尿管切除术的结果。方法从前瞻性数据库中回顾2007年7月至2017年3月期间接受该手术的儿童。结果输尿管囊肿（13例）、反流（7例）、输尿管异位（11例）、输尿管闭锁（1例）行输尿管半切32例（上输尿管28例，下输尿管4例）。合并症（泌尿系统异常，复发性感染，既往腹部瘢痕）是常见的。50%的患者进行了非机器人手术。平均控制台时间为101±30.2 min，住院时间为29.5±10.3 h。无转归，术中并发症，无残余部分功能丧失。30例（94%）完全切除病变部分肾盏，2例（6%）不完全切除，随后发展为无症状的小边缘囊肿。11例（34%）行全输尿管切除术，其余21例（66%）留下输尿管残端。术后3例（9%）女性残端（2例输尿管膨出，1例膀胱颈异位）及其他泌尿系统异常因复发感染而行手术（残端切除+再植入返流残段输尿管）。结论根据我们的经验，儿童半肾输尿管切除术非常适合机器人入路，效果良好。

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引用次数: 0

Robotic Submesocolic Left Adrenalectomy: The Evolution of Delbet Approach 机器人结肠膜下左肾上腺切除术：Delbet入路的演变

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-17 DOI: 10.1002/rcs.70080

Monica Ortenzi, Andrea Santini, Andrea Balla, Diletta Corallino, Giovanni Lezoche, Mario Guerrieri, Danila Azzolina

Introduction

The left adrenal gland is prone to being approached with several access points. This study presents a series of robotic submesocolic left adrenalectomies.

Materials and Methods

Intraoperative and post-operative outcomes of robotic (RB) and laparoscopic (LP) submesocolic (SM) access to the adrenal gland were compared. Subsequently, these were compared to left adrenalectomy performed using the anterior approach (AT).

Results

Operative time was statistically longer in the LP group (p < 0.001). There was no statistical difference for postoperative complications. After the propensity matching, there was a correlation between the BMI and the onset of post-operative complications (OR = 1.01). The operative time was significantly longer in the AT group both overall (p = 0.023) and within the LP procedures (p < 0.001), but not in the RB procedures (p = 0.386). Length of stay was shorter in the SM group (p = 0.024).

Conclusions

The RB SM approach to the left adrenal gland is a safe and feasible.

左肾上腺容易通过几个接入点进入。本研究提出了一系列的机器人结肠膜下左肾上腺切除术。材料与方法比较机器人（RB）和腹腔镜（LP）结肠膜下（SM）进入肾上腺的术中、术后结果。随后，将这些与采用前路（AT）进行的左肾上腺切除术进行比较。结果LP组手术时间更长，差异有统计学意义(p <；0.001)。两组术后并发症发生率无统计学差异。倾向匹配后，BMI与术后并发症发生率存在相关性（OR = 1.01）。AT组总的手术时间（p = 0.023）和LP组的手术时间(p <；0.001)，但在RB过程中没有（p = 0.386）。SM组患者住院时间较短（p = 0.024）。结论RB - SM入路是一种安全可行的左肾上腺入路。

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引用次数: 0

A Miniature Flexible Scanning Device for Gastrointestinal Endomicroscopy 一种用于胃肠道内镜检查的微型柔性扫描装置

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-14 DOI: 10.1002/rcs.70081

Xingfeng Xu, Jianshuo Liu, Siyang Zuo

Background

Probe-based confocal laser endomicroscopy (pCLE) offers real-time optical biopsy of the gastrointestinal mucosa, promising early detection of gastrointestinal cancer. However, its limited field-of-view necessitates a flexible device for expansive scanning and mosaicking of cancerous regions.

Methods

This work presents a novel 4 degree-of-freedom flexible scanning device with a 3 mm outer diameter and a 2.2 mm working channel. The positioning accuracy of the scanning mechanism was recorded as 3.94° in yaw, 4.23° in pitch, 0.17 mm in linear, and 0.69 mm in rotational motions.

Results

Ex vivo tissue scanning achieved an area of 11.4 mm². In vivo animal experimental results revealed the device's capacity to scan and mosaic an area of 5.05 mm².

Conclusions

This design is compatible with endomicroscopic probes and optimises the endoscope deployment. Comprehensive mechanical evaluations and scanning experiments demonstrated the device's clinical potential in gastrointestinal cancer diagnosis.

基于探针的共聚焦激光内镜（pCLE）提供了实时的胃肠道粘膜光学活检，有望早期发现胃肠道肿瘤。然而，其有限的视野需要一个灵活的设备，以扩大扫描和镶嵌癌区域。方法设计了一种外径为3mm、工作通道为2.2 mm的4自由度柔性扫描装置。扫描机构的定位精度为横摆3.94°，俯仰4.23°，直线0.17 mm，旋转0.69 mm。结果离体组织扫描面积为11.4 mm2。体内动物实验结果显示，该设备的扫描和镶嵌面积为5.05平方毫米。结论该设计与内镜探头兼容，优化了内镜部署。综合力学评估和扫描实验证明了该装置在胃肠道癌症诊断中的临床潜力。

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引用次数: 0

Dimensional Synthesis of 6-DOF Parallel Robot for Intra-Operative Radiation Therapy 术中放射治疗六自由度并联机器人的尺寸综合

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-06-04 DOI: 10.1002/rcs.70076

Baoying Peng, Yushuo Zhu, Chuanmeng Niu

Background

In order to meet the kinematic requirements of large range of motion, payload, and stiffness of Intra-Operative Radiation Therapy robots, a 6-degree-of-freedom (DOF) parallel platform (Stewart-Gough mechanism) is introduced and a dimensional synthesis study is carried out.

Methods

The kinematic and static stiffness models of the 6-DOF parallel robot for Intra-Operative Radiation Therapy are derived around a virtual isocentric control point. Under the premise of ensuring the positional accuracy, the optimal dimensions of the initial rod length, the radius of the fixed base and movable platform, and the circumferential angle of the 6-DOF parallel platform are obtained by using the multi-objective optimization method combining the non-dominated sorting genetic algorithm and the global 4criterion with the working space, stiffness, and load as the optimization objectives.

Results

A full-size prototype was built, and experiments on payload, range of motion, modality, and harmonic response were carried out.

Conclusions

The results show that the theoretical stiffness model has high accuracy, and the dimensional synthesised 6-DOF parallel platform can meet the clinical requirements of Intra-Operative Radiation Therapy in terms of workspace, stiffness and payload, as well as position accuracy.

Trial Registration

The equipment in this study has not yet obtained a medical device registration certificate, and the 6-DOF parallel robot for Intra-Operative Radiation Therapy experiments were conducted using a self-developed model, which has not yet been subjected to clinical trials.

为了满足术中放疗机器人大运动范围、大载荷、大刚度的运动学要求，引入了一种6自由度并联平台（Stewart-Gough机构），并进行了尺寸综合研究。方法以虚拟等心控制点为中心，建立六自由度放射治疗并联机器人的运动学和静刚度模型。在保证定位精度的前提下，以工作空间、刚度和载荷为优化目标，采用非支配排序遗传算法和全局4准则相结合的多目标优化方法，得到了初始杆长、固定底座和活动平台半径、六自由度并联平台周向角的最优尺寸。结果建立了全尺寸样机，进行了载荷、运动范围、模态和谐波响应实验。结论理论刚度模型精度较高，尺寸合成的6-DOF并联平台在工作空间、刚度、载荷、位置精度等方面均能满足术中放射治疗的临床要求。本研究设备尚未取得医疗器械注册证，术中放射治疗实验用6自由度并联机器人采用自行研制的模型，尚未进行临床试验。

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引用次数: 0

Robot-Assisted Colectomy for Left-Sided Colon Cancer: Comparison of da Vinci SP and Single-Site Platforms 机器人辅助左侧结肠癌结肠切除术：达芬奇SP与单点平台的比较

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-05-29 DOI: 10.1002/rcs.70079

Kyeong Eui Kim, Woon Kyung Jeong, Seong Kyu Baek, Sung Uk Bae

Background

To compare the clinicopathological and cosmetic outcomes of robotic colectomy using the da Vinci SP and Single-Site for left-sided colon cancer.

Methods

The study included 31 and 52 patients who underwent robotic colectomy using the SP and Single-Site, respectively, between July 2011 and July 2023. The Patient Scar Assessment Questionnaire (PSAQ) was used to assess cosmetic outcomes.

Results

Patients who underwent colectomy using the SP had a shorter wound length, less bleeding, and fewer port usages compared with those who underwent colectomy using the Single-Site. The SP group required fewer analgesics on post-operative day 2, showed a shorter time to flatulence, sip water and soft diet, and a shorter hospital stay. Total PSAQ scores for the SP group were superior to those of the Single-Site group.

Conclusions

Robotic colectomy for left-sided colon cancer using the SP presents better short-term recovery, requires fewer analgesics and has better cosmetic outcomes than Single-Site.

研究背景：比较达芬奇机器人结肠切除术和单侧结肠切除术治疗左侧结肠癌的临床病理和美容效果。方法本研究纳入2011年7月至2023年7月期间分别采用SP和Single-Site进行机器人结肠切除术的31例和52例患者。患者疤痕评估问卷（PSAQ）用于评估美容效果。结果与单站点结肠切除术患者相比，使用SP的患者伤口长度更短，出血更少，端口使用更少。SP组术后第2天需要的镇痛药较少，出现胀气、喝水和软性饮食的时间较短，住院时间较短。SP组的PSAQ总分优于单位点组。结论采用SP进行左侧结肠癌机器人结肠切除术，短期恢复效果好，需要的镇痛药物少，美容效果好。

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引用次数: 0

Retroperitoneal Versus Transperitoneal Robot Assisted Partial Nephrectomy: A Prospective Controlled Non-Randomized Single Centre Study Non-Inferiority Design 后腹膜与经腹膜机器人辅助部分肾切除术：一项前瞻性对照非随机单中心研究非劣效设计

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-05-27 DOI: 10.1002/rcs.70077

Rene Mager, Igor Tsaur, Thomas Höfner, Mohamed Kamal Gheith, Gregor Duwe, Maximilian Haack, Jonathan Azar, Brahim Aboulmaouahib, Stefanie Ziewers, Peter Sparwasser, Lisa Frey, Anita Thomas, Axel Haferkamp

Background

The value of the retroperitoneal (R-RAPN) compared with the conventional transperitoneal (T-RAPN) approach in robot-assisted partial nephrectomy has not been finally clarified. The current work's objective was to prospectively investigate R-RAPN versus T-RAPN.

Methods

The study was designed as a prospective, controlled, non-randomized study with a non-inferiority design. The primary endpoint was Trifecta achievement. The sample size calculation required 141 T-RAPN and 94 R-RAPN.

Results

When the recruitment target of 141 was reached in the T-RAPN arm, only 34 R-RAPN had been performed, so the study was terminated early. Trifecta as the main outcome parameter was achieved in 82% of the R-RAPN and 76% of the T-RAPN groups, so no sign for inferiority could be detected (p = 0.6).

Conclusions

In this prospective study, there was no evidence of inferiority of R-RAPN compared to T-RAPN for the Trifecta endpoint. R-RAPN may be an individually advantageous alternative to T-RAPN for selected patients.

Trial Registration

The study was registered in the German Clinical Trials Register (DRKS00028619).

背景在机器人辅助部分肾切除术中，腹膜后（R-RAPN）入路与常规经腹膜（T-RAPN）入路的比较价值尚未最终明确。目前的工作目的是前瞻性地研究R-RAPN与T-RAPN。方法采用前瞻性、对照、非随机、非劣效性设计。主要终点是triecta的疗效。样本量计算需要141个T-RAPN和94个R-RAPN。结果当T-RAPN组达到141个募集目标时，仅进行了34个R-RAPN，因此研究提前终止。trecta作为主要结局参数在82%的R-RAPN组和76%的T-RAPN组中实现，因此没有检测到劣效性的迹象（p = 0.6）。结论：在这项前瞻性研究中，没有证据表明R-RAPN与T-RAPN相比在Trifecta终点具有劣势。对于特定的患者，R-RAPN可能是T-RAPN的一种有利的替代方案。该研究已在德国临床试验注册中心（DRKS00028619）注册。

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引用次数: 0

Stereo Endoscopic Camera Pose Optimal Estimation by Structure Similarity Index Measure Integration 基于结构相似度测度积分的立体内窥镜相机位姿优化估计

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-05-25 DOI: 10.1002/rcs.70078

Ruoqi Lian, Wei Li, Junchen Hao, Yanfang Zhang, Fucang Jia

Background

Accurate endoscopic camera pose estimation is crucial for real-time AR navigation systems. While current methods primarily use depth and optical flow, they often ignore structural inconsistencies between images.

Methods

Leveraging the RAFT framework, we process sequential stereo RGB pairs to extract optical flow and depth features for pose estimation. To address structural inconsistencies, we refine the weights for both 2D and 3D residuals by computing SSIM indices for the left and right views, as well as pre- and post-optical flow transformations. The SSIM metric is also used in the loss function.

Results

Experiments on the StereoMIS dataset demonstrate our method's improved pose estimation accuracy compared to rigid SLAM methods, showing a lower accumulated trajectory error (ATE-RMSE: 18.5 mm). Additionally, ablation experiments achieved an 11.49% reduction in average error.

Conclusion

The pose estimation accuracy has been improved by incorporating SSIM. The code is available at: https://github.com/lianrq/pose-estimation-by-SSIM-Integration.

准确的内窥镜相机姿态估计是实时AR导航系统的关键。虽然目前的方法主要使用深度和光流，但它们经常忽略图像之间的结构不一致性。方法利用RAFT框架，对序列立体RGB对进行处理，提取用于姿态估计的光流和深度特征。为了解决结构不一致性，我们通过计算左视图和右视图的SSIM指数以及前后光流变换来细化2D和3D残差的权重。SSIM度量也用于损失函数。结果在StereoMIS数据集上的实验表明，与刚性SLAM方法相比，我们的方法提高了姿态估计精度，显示出更低的累积轨迹误差（late - rmse: 18.5 mm）。此外，烧蚀实验的平均误差降低了11.49%。结论结合SSIM提高了姿态估计的精度。代码可从https://github.com/lianrq/pose-estimation-by-SSIM-Integration获得。

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引用次数: 0

MF-ResUnet: A 3D Liver Image Segmentation Method Based on Multi-Scale Feature Fusion MF-ResUnet：基于多尺度特征融合的三维肝脏图像分割方法

IF 2.3 3区医学 Q2 SURGERY

International Journal of Medical Robotics and Computer Assisted Surgery

Pub Date : 2025-05-21 DOI: 10.1002/rcs.70068

Jun Qin, Yang Li, Guihe Qin

Background

Due to the variable shapes of the liver parenchyma, minimal voxel intensity differences with adjacent organs, and discontinuous liver boundaries, automatic liver segmentation from computerised tomography images poses significant challenges.

Methods

In this study, we propose a 3D liver segmentation method based on multiscale feature fusion. This network employs SE channel attention to recalibrate liver features. Additionally, it utilises an AMF module for multiscale feature fusion to obtain rich spatial information. Furthermore, we introduce the NGAB module to address the deteriorating effects of dilated convolutions as the dilation rate increases, contributing to enhanced feature representation and improving accuracy in liver segmentation.

Results

Experimental results on the publicly available LiTS2017 dataset and 3DIRCADb dataset show that our proposed framework achieves a DSC of 0.977 and 0.967 in liver segmentation, respectively.

Conclusions

The proposed method can adequately capture multiscale characteristics, showing promising prospects for automatic liver segmentation.

由于肝实质形状多变，与邻近器官体素强度差异极小，以及肝脏边界不连续，从计算机断层扫描图像中自动分割肝脏提出了重大挑战。方法提出一种基于多尺度特征融合的三维肝脏分割方法。该网络利用SE通道关注来重新校准肝脏特征。利用AMF模块进行多尺度特征融合，获取丰富的空间信息。此外，我们引入了NGAB模块来解决扩张卷积随着扩张率的增加而恶化的影响，有助于增强特征表示并提高肝脏分割的准确性。结果在公开的LiTS2017数据集和3DIRCADb数据集上的实验结果表明，我们提出的框架在肝脏分割方面的DSC分别达到了0.977和0.967。结论该方法能充分捕捉多尺度特征，在肝脏自动分割中具有广阔的应用前景。

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引用次数: 0