Christopher D'Ambrosia, Estella Y. Huang, Nicole H. Goldhaber, Henrik Christensen, Ryan C. Broderick, Lawrence G. Appelbaum
Background
This study tested the measurement of operator physiology during performance on robot-assisted surgery simulations to determine if these signals can identify errors and classify high and low performers.
Methods
57 participants performed digital simulations on da Vinci Xi system. Simulation videos, electrocardiogram (EKG), and electroencephalography (EEG) were analysed using linear mixed effects models.
Results
Relative to non-error intervals, errors elicited significant differences in EKG and EEG measures, including high-frequency power, interbeat interval and ratio of theta-to-alpha EEG power. High and low performers differed significantly in several of these measures, while classification models were accurate for the detection of errors (85.7%) and performance groups (96.3%), and using physiological signals leading up to errors, could accurately predict upcoming errors (85.7%).
Conclusions
Noninvasive recording of physiology can differentiate error from non-error intervals and performance groups, leading to the possibility that online physiology can develop into training or early warning systems.
{"title":"Physiological Detection of Intraoperative Errors During Robot-Assisted Surgery","authors":"Christopher D'Ambrosia, Estella Y. Huang, Nicole H. Goldhaber, Henrik Christensen, Ryan C. Broderick, Lawrence G. Appelbaum","doi":"10.1002/rcs.70090","DOIUrl":"https://doi.org/10.1002/rcs.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study tested the measurement of operator physiology during performance on robot-assisted surgery simulations to determine if these signals can identify errors and classify high and low performers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>57 participants performed digital simulations on da Vinci Xi system. Simulation videos, electrocardiogram (EKG), and electroencephalography (EEG) were analysed using linear mixed effects models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Relative to non-error intervals, errors elicited significant differences in EKG and EEG measures, including high-frequency power, interbeat interval and ratio of theta-to-alpha EEG power. High and low performers differed significantly in several of these measures, while classification models were accurate for the detection of errors (85.7%) and performance groups (96.3%), and using physiological signals leading up to errors, could accurately predict upcoming errors (85.7%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Noninvasive recording of physiology can differentiate error from non-error intervals and performance groups, leading to the possibility that online physiology can develop into training or early warning systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fabio Ausania, Filippo Landi, Carolina González-Abós, John B. Martinie, Dionisios Vrochides, Matthew Walsh, Shanaz M. Hossain, Steven White, Viswakumar Prabakaran, Laleh G. Melstrom, Yuman Fong, Giovanni Butturini, Laura Bignotto, Valentina Valle, Yuntao Bing, Dianrong Xiu, Gregorio Di Franco, Francisco Sanchez-Bueno, Nicola de'Angelis, Alexis Laurent, Giuseppe Giuliani, Graziano Pernazza, Alessandro Esposito, Roberto Salvia, Francesca Bazzocchi, Ludovica Esposito, Andrea Pietrabissa, Luigi Pugliese, José Rios, Andrea Coratti, Luca Morelli, Pier C. Giulianotti
Background
Minimally invasive spleen-preserving distal pancreatectomy (MI-SPDP) provides superior outcomes compared with open surgery, with robotic techniques showing better short-term results than laparoscopic techniques, particularly in obese patients. This study aimed to evaluate the impact of the surgical approach on postoperative pancreatic fistula (POPF) incidence in obese patients undergoing MI-SPDP.
Methods
A retrospective analysis of obese patients from 16 international centres compared robotic (R-SPDP) and laparoscopic (L-SPDP) approaches. Perioperative outcomes and factors associated with clinically relevant POPF were analysed using univariate and multivariate methods.
Results
Among 130 patients (57L-SPDP, 73R-SPDP), POPF incidence was significantly lower in the robotic group (15.1% vs. 42.1%; p = 0.001). The Comprehensive Complications Index was also lower (8% vs. 15%; p = 0.002). Laparoscopic approach (OR = 4.0), pancreatic body transection (OR = 2.6), and non-stapler stump closure (OR = 3.2) were independently associated with higher POPF rates.
Discussion
Robotic MI-SPDP reduces POPF in obese patients. Transection at the pancreatic neck and stapler-based closure can improve outcomes.
与开放手术相比，微创保脾远端胰腺切除术（MI-SPDP）提供了更好的结果，机器人技术比腹腔镜技术显示出更好的短期效果，特别是在肥胖患者中。本研究旨在评估手术入路对MI-SPDP肥胖患者术后胰瘘（POPF）发生率的影响。方法回顾性分析来自16个国际中心的肥胖患者，比较机器人（R-SPDP）和腹腔镜（L-SPDP）入路。采用单因素和多因素方法分析围手术期结局和临床相关POPF相关因素。结果在130例患者（57L-SPDP, 73R-SPDP）中，机器人组的POPF发生率显著低于前者(15.1% vs. 42.1%；p = 0.001)。综合并发症指数也较低(8% vs. 15%；p = 0.002)。腹腔镜入路（OR = 4.0）、胰体横断（OR = 2.6）和非吻合器残端闭合（OR = 3.2）与较高的POPF发生率独立相关。机器人MI-SPDP降低肥胖患者的POPF。胰颈横断及吻合器缝合可改善预后。
{"title":"Minimally Invasive Spleen-Preserving Distal Pancreatectomy in Obese Patients: Factors Related to Clinically Relevant Pancreatic Fistula","authors":"Fabio Ausania, Filippo Landi, Carolina González-Abós, John B. Martinie, Dionisios Vrochides, Matthew Walsh, Shanaz M. Hossain, Steven White, Viswakumar Prabakaran, Laleh G. Melstrom, Yuman Fong, Giovanni Butturini, Laura Bignotto, Valentina Valle, Yuntao Bing, Dianrong Xiu, Gregorio Di Franco, Francisco Sanchez-Bueno, Nicola de'Angelis, Alexis Laurent, Giuseppe Giuliani, Graziano Pernazza, Alessandro Esposito, Roberto Salvia, Francesca Bazzocchi, Ludovica Esposito, Andrea Pietrabissa, Luigi Pugliese, José Rios, Andrea Coratti, Luca Morelli, Pier C. Giulianotti","doi":"10.1002/rcs.70091","DOIUrl":"https://doi.org/10.1002/rcs.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Minimally invasive spleen-preserving distal pancreatectomy (MI-SPDP) provides superior outcomes compared with open surgery, with robotic techniques showing better short-term results than laparoscopic techniques, particularly in obese patients. This study aimed to evaluate the impact of the surgical approach on postoperative pancreatic fistula (POPF) incidence in obese patients undergoing MI-SPDP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of obese patients from 16 international centres compared robotic (R-SPDP) and laparoscopic (L-SPDP) approaches. Perioperative outcomes and factors associated with clinically relevant POPF were analysed using univariate and multivariate methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 130 patients (57L-SPDP, 73R-SPDP), POPF incidence was significantly lower in the robotic group (15.1% vs. 42.1%; <i>p</i> = 0.001). The Comprehensive Complications Index was also lower (8% vs. 15%; <i>p</i> = 0.002). Laparoscopic approach (OR = 4.0), pancreatic body transection (OR = 2.6), and non-stapler stump closure (OR = 3.2) were independently associated with higher POPF rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Robotic MI-SPDP reduces POPF in obese patients. Transection at the pancreatic neck and stapler-based closure can improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/rcs.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eliane Weinbrenner, Mykola Gorbachuk, Kathrin Machetanz, Florian Grimm, Linda Oberle, Sophie S. Wang, Marcos Tatagiba, Georgios Naros
Background
In frame-based stereotaxy, the design of the frame limits trajectory selection, e.g., to the temporal lobe and posterior fossa. We hypothesise that frame-less neuronavigation and robotic technology might have expanded these stereotactic corridors.
Methods
We analysed 376 frame-based, neuronavigated and robotic brain biopsies. We analysed entry (EP) and target (TP) point coordinates, trajectory lengths (TL) and angles (α1,α2), skin-to-skin time (STS), diagnostic yield and morbidity.
Results
Robotics liberated TP and EP selection, enabling trajectories not applicable with the frame. There was an increased application of lateral trajectories (reducing α1) while decreasing TL. There was a significant STS reduction attributable to a modification of the surgical approach (twist drill vs. burr hole).
Conclusions
Robotics modified trajectory selection and the surgical approach. Duration and invasiveness of brain biopsies were decreased without affecting diagnostic yield or morbidity. This may represent a clinical benefit of robotics compared with frame-based and frame-less stereotaxy.
{"title":"The Silent Transformation of Stereotactic Brain Biopsies After the Introduction of Robotics","authors":"Eliane Weinbrenner, Mykola Gorbachuk, Kathrin Machetanz, Florian Grimm, Linda Oberle, Sophie S. Wang, Marcos Tatagiba, Georgios Naros","doi":"10.1002/rcs.70087","DOIUrl":"https://doi.org/10.1002/rcs.70087","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In frame-based stereotaxy, the design of the frame limits trajectory selection, e.g., to the temporal lobe and posterior fossa. We hypothesise that frame-less neuronavigation and robotic technology might have expanded these stereotactic corridors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 376 frame-based, neuronavigated and robotic brain biopsies. We analysed entry (EP) and target (TP) point coordinates, trajectory lengths (TL) and angles (<i>α</i><sub>1</sub>,<i>α</i><sub>2</sub>), skin-to-skin time (STS), diagnostic yield and morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Robotics liberated <i>TP</i> and <i>EP</i> selection, enabling trajectories not applicable with the frame. There was an increased application of lateral trajectories (reducing <i>α1</i>) while decreasing <i>TL</i>. There was a significant <i>STS</i> reduction attributable to a modification of the surgical approach (twist drill vs. burr hole).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Robotics modified trajectory selection and the surgical approach. Duration and invasiveness of brain biopsies were decreased without affecting diagnostic yield or morbidity. This may represent a clinical benefit of robotics compared with frame-based and frame-less stereotaxy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/rcs.70087","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurate detection of surgical instruments is essential for robot-assisted surgery. Existing methods face challenges in both accuracy and real-time performance, limiting their clinical applicability.
Methods
We propose UK-YOLOv10, a novel framework that integrates two innovations: the uni-fusion attention module (UFAM) for enhanced multi-scale feature representation, and the C2fKAN module, which employs KAN convolution to improve classification accuracy and accelerate training.
Results
On the M2CAI16-Tool-Locations dataset, UK-YOLOv10 achieves detection accuracy of 96.7%, an [email protected] of 96.4%, and an [email protected]:0.95 of 0.605, outperforming YOLOv10 by 3%, 2.2% and 3.6%, respectively. Generalisation on COCO2017 resulted in an [email protected]:0.95 of 0.386.
Conclusion
UK-YOLOv10 significantly improves surgical instrument detection and demonstrates strong potential for robot-assisted surgeries.
{"title":"UK-YOLOv10: Deep Learning-Based Detection of Surgical Instruments","authors":"Li Zhang, Guanqun Guo, Wenjie Wang","doi":"10.1002/rcs.70083","DOIUrl":"https://doi.org/10.1002/rcs.70083","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Accurate detection of surgical instruments is essential for robot-assisted surgery. Existing methods face challenges in both accuracy and real-time performance, limiting their clinical applicability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We propose UK-YOLOv10, a novel framework that integrates two innovations: the uni-fusion attention module (UFAM) for enhanced multi-scale feature representation, and the C2fKAN module, which employs KAN convolution to improve classification accuracy and accelerate training.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>On the M2CAI16-Tool-Locations dataset, UK-YOLOv10 achieves detection accuracy of 96.7%, an [email protected] of 96.4%, and an [email protected]:0.95 of 0.605, outperforming YOLOv10 by 3%, 2.2% and 3.6%, respectively. Generalisation on COCO2017 resulted in an [email protected]:0.95 of 0.386.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>UK-YOLOv10 significantly improves surgical instrument detection and demonstrates strong potential for robot-assisted surgeries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144492887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arslanhan, G., Özcan, Z. S., Şenay, Ş., Baştopçu, M., Karaağaç, A., Koçyiğit, M., Değirmencioğlu, A., Alis, D., and Alhan, C. 2025. “Robotic Assisted Minimally Invasive Coronary Revascularisation: Midterm Results.” The International Journal of Medical Robotics and Computer Assisted Surgery, 21(3): e70071. https://doi.org/10.1002/rcs.70071.
Dr. Halim Ulugöl who has contributed to the cases and to the article writing process was mistakenly not added to the initial author list. This was corrected and the correct author list is as follows:
Gökhan Arslanhan, Zeynep Sıla Özcan, Şahin Şenay, Murat Baştopçu, Anıl Karaağaç, Muharrem Koçyiğit, Halim Ulugöl, Aleks Değirmencioğlu, Deniz Alis, Cem Alhan
In Table 3, the reoperation for bleeding is given as 1 patient out of 150 patients and its respective ratio was given as 0.006% instead of 0.66%. This was also corrected.
We apologize for this error.
Arslanhan， G.， Özcan， Z. S.， Şenay， Ş。， batopu， M., Karaağaç， A., Koçyiğit， M., Değirmencioğlu， A., Alis， D., Alhan， C. 2025。机器人辅助微创冠状动脉血管重建术：中期结果。国际医学机器人与计算机辅助外科杂志，21(3):e70071。https://doi.org/10.1002/rcs.70071.Dr。对案件和文章撰写过程做出贡献的哈利姆Ulugöl被错误地排除在最初的作者名单之外。更正后，正确的作者名单如下：Gökhan Arslanhan， Zeynep Sıla Özcan， Şahin Şenay, Murat batopu, Anıl Karaağaç， Muharrem Koçyiğit, Halim Ulugöl, Aleks Değirmencioğlu, Deniz Alis， Cem alhan表3中，150例患者中因出血再手术1例，其相应比例为0.006%，而不是0.66%。这也被纠正了。我们为这个错误道歉。
{"title":"Correction to “Robotic Assisted Minimally Invasive Coronary Revascularisation: Midterm Results”","authors":"","doi":"10.1002/rcs.70086","DOIUrl":"https://doi.org/10.1002/rcs.70086","url":null,"abstract":"<p>Arslanhan, G., Özcan, Z. S., Şenay, Ş., Baştopçu, M., Karaağaç, A., Koçyiğit, M., Değirmencioğlu, A., Alis, D., and Alhan, C. 2025. “Robotic Assisted Minimally Invasive Coronary Revascularisation: Midterm Results.” <i>The International Journal of Medical Robotics and Computer Assisted Surgery</i>, 21(3): e70071. https://doi.org/10.1002/rcs.70071.</p><p>Dr. Halim Ulugöl who has contributed to the cases and to the article writing process was mistakenly not added to the initial author list. This was corrected and the correct author list is as follows:</p><p>Gökhan Arslanhan, Zeynep Sıla Özcan, Şahin Şenay, Murat Baştopçu, Anıl Karaağaç, Muharrem Koçyiğit, Halim Ulugöl, Aleks Değirmencioğlu, Deniz Alis, Cem Alhan</p><p>In Table 3, the reoperation for bleeding is given as 1 patient out of 150 patients and its respective ratio was given as 0.006% instead of 0.66%. This was also corrected.</p><p>We apologize for this error.</p>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/rcs.70086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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。
{"title":"Robotic Versus Total Laparoscopic Splenectomy With Pericardial Devascularisation for Portal Hypertension: A Retrospective Cohort Study","authors":"Zhen Ma, Hongbin Cui, Lei Gaoi, Bin Ma, Puyi He, Yang Yu, Yunpeng Wang, Yanling Ma, Hao Chen","doi":"10.1002/rcs.70085","DOIUrl":"https://doi.org/10.1002/rcs.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>TRSPD significantly reduced intraoperative blood loss (175 vs. 436 mL, <i>p</i> = 0.004) despite longer operative duration (400 vs. 256 min, <i>p</i> = 0.001). Zero conversions occurred with TRSPD versus 3 conversions with TLSPD (<i>p</i> = 0.02). Postoperatively, TRSPD accelerated gastrointestinal recovery (2.1 vs. 3.5 days, <i>p</i> = 0.02) and shortened drainage duration (4.0 vs. 6.2 days, <i>p</i> = 0.02). Both techniques normalised haematologic indices, reduced portal vein diameter (<i>p</i> < 0.05), and resolved varices without major complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Clinical and Economic Assessment of Robot-Assisted Radical Prostatectomy With the Hinotori Surgical System: Insights From a Japanese Single-Centre Study","authors":"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","doi":"10.1002/rcs.70084","DOIUrl":"https://doi.org/10.1002/rcs.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We investigated the clinical and economic outcomes of robot-assisted radical prostatectomy (RARP) using the hinotori surgical system (H-RARP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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, <i>p</i> < 0.001), pathological T stage (coefficient: 0.023, <i>p</i> = 0.030), and postoperative hospital stay (coefficient: 0.028, <i>p</i> < 0.001) were significant factors affecting medical costs; in contrast, the type of robot-assisted surgical system was not a significant factor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>H-RARP offers clinical outcomes comparable to those of D-RARP while maintaining equivalent medical costs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/rcs.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Paediatric Robotic Transperitoneal Heminephroureterectomy in Complete Duplicated Systems: Early and Long-Term Outcomes","authors":"Donatella Di Fabrizio, Thomas P. Cundy, Azad S. Najmaldin","doi":"10.1002/rcs.70082","DOIUrl":"https://doi.org/10.1002/rcs.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We present outcomes for paediatric robotic heminephroureterectomy from a prospective single-surgeon series.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Children who underwent this operation between July 2007 and March 2017 were reviewed from a prospective database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In children, heminephroureterectomy is well suited to a robotic approach with favourable outcomes in our experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144323606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Robotic Submesocolic Left Adrenalectomy: The Evolution of Delbet Approach","authors":"Monica Ortenzi, Andrea Santini, Andrea Balla, Diletta Corallino, Giovanni Lezoche, Mario Guerrieri, Danila Azzolina","doi":"10.1002/rcs.70080","DOIUrl":"https://doi.org/10.1002/rcs.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The left adrenal gland is prone to being approached with several access points. This study presents a series of robotic submesocolic left adrenalectomies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Operative time was statistically longer in the LP group (<i>p</i> < 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 (<i>p</i> = 0.023) and within the LP procedures (<i>p</i> < 0.001), but not in the RB procedures (<i>p</i> = 0.386). Length of stay was shorter in the SM group (<i>p</i> = 0.024).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The RB SM approach to the left adrenal gland is a safe and feasible.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/rcs.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"A Miniature Flexible Scanning Device for Gastrointestinal Endomicroscopy","authors":"Xingfeng Xu, Jianshuo Liu, Siyang Zuo","doi":"10.1002/rcs.70081","DOIUrl":"https://doi.org/10.1002/rcs.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ex vivo tissue scanning achieved an area of 11.4 mm<sup>2</sup>. In vivo animal experimental results revealed the device's capacity to scan and mosaic an area of 5.05 mm<sup>2</sup>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50311,"journal":{"name":"International Journal of Medical Robotics and Computer Assisted Surgery","volume":"21 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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