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Abstract Robot-assisted surgery has evolved into a crucial treatment for prostate cancer (PCa). However, from its appearance to today, brain-computer interface, virtual reality, and metaverse have revolutionized the field of robot-assisted surgery for PCa, presenting both opportunities and challenges. Especially in the context of contemporary big data and precision medicine, facing the heterogeneity of PCa and the complexity of clinical problems, it still needs to be continuously upgraded and improved. Keeping this in mind, this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa, encompassing the stages of emergence, promotion, development, maturity, and intelligence. Initially, safety concerns were paramount, but subsequent research and engineering advancements have focused on enhancing device efficacy, surgical technology, and achieving precise multi modal treatment. The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions. In the future, robot-assisted surgery for PCa will move towards intelligence, promising improved patient outcomes and personalized therapy, alongside formidable challenges. To guide future development, we propose 10 significant prospects spanning clinical, research, engineering, materials, social, and economic domains, envisioning a future era of artificial intelligence in the surgical treatment of PCa.

Robot-assisted surgery has evolved into a crucial treatment for prostate cancer (PCa). However, from its appearance to today, brain-computer interface, virtual reality, and metaverse have revolutionized the field of robot-assisted surgery for PCa, presenting both opportunities and challenges. Especially in the context of contemporary big data and precision medicine, facing the heterogeneity of PCa and the complexity of clinical problems, it still needs to be continuously upgraded and improved. Keeping this in mind, this article summarized the 5 stages of the historical development of robot-assisted surgery for PCa, encompassing the stages of emergence, promotion, development, maturity, and intelligence. Initially, safety concerns were paramount, but subsequent research and engineering advancements have focused on enhancing device efficacy, surgical technology, and achieving precise multi modal treatment. The dominance of da Vinci robot-assisted surgical system has seen this evolution intimately tied to its successive versions. In the future, robot-assisted surgery for PCa will move towards intelligence, promising improved patient outcomes and personalized therapy, alongside formidable challenges. To guide future development, we propose 10 significant prospects spanning clinical, research, engineering, materials, social, and economic domains, envisioning a future era of artificial intelligence in the surgical treatment of PCa. [ABSTRACT FROM AUTHOR]

Abstract Background To determine the safety and efficacy of robot‐assisted minimally invasive esophagectomy (RAMIE) for locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoimmunotherapy (NCI). Methods Data from patients who underwent RAMIE between January 2020 and June 2022 were retrospectively analyzed. The oncological and operative outcomes of the NCI and surgery‐only (S) groups were compared by both unmatched and 1:1 propensity score‐matched (PSM) analysis. Results A total of 201 patients with ESCC who underwent three‐incision RAMIE were included in this study (143 patients in the S group and 58 patients in the NCI group). Of the 58 patients who underwent NCI, a pathologically complete response (pCR) (ypT0N0) was identified in 14 (24.1%) patients. The patients in the NCI group were younger than those in the S group (p = 0.017), and had more advanced cT (p 0.05). However, the NCI group exhibited a lower rate of pulmonary complications than the S group (3.6% vs. 14.5%, p = 0.047). No significant difference between the groups was found for other complications (all p > 0.05). Conclusion These findings indicate that NCI could result in a high pCR rate without increased complications in locally advanced ESCC. RAMIE is safe and feasible in patients with ESCC after NCI.

Background: To determine the safety and efficacy of robot‐assisted minimally invasive esophagectomy (RAMIE) for locally advanced esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoimmunotherapy (NCI). Methods: Data from patients who underwent RAMIE between January 2020 and June 2022 were retrospectively analyzed. The oncological and operative outcomes of the NCI and surgery‐only (S) groups were compared by both unmatched and 1:1 propensity score‐matched (PSM) analysis. Results: A total of 201 patients with ESCC who underwent three‐incision RAMIE were included in this study (143 patients in the S group and 58 patients in the NCI group). Of the 58 patients who underwent NCI, a pathologically complete response (pCR) (ypT0N0) was identified in 14 (24.1%) patients. The patients in the NCI group were younger than those in the S group (p = 0.017), and had more advanced cT (p < 0.001) and cN stage diseases (p = 0.002). After 1:1 PSM of the confounders, 55 patients were allocated to each of the NCI and S groups. No significant differences were found in oncological and operative results, including surgical blood loss, operative time, and lymph node harvest (all p > 0.05). However, the NCI group exhibited a lower rate of pulmonary complications than the S group (3.6% vs. 14.5%, p = 0.047). No significant difference between the groups was found for other complications (all p > 0.05). Conclusion: These findings indicate that NCI could result in a high pCR rate without increased complications in locally advanced ESCC. RAMIE is safe and feasible in patients with ESCC after NCI. [ABSTRACT FROM AUTHOR]

With its superior ergonomic design, high-definition three-dimensional visual field, mechanical arms that transcend human wrist mobility, and ability to eliminate hand tremors caused by surgeon fatigue, the robotic surgical system introduces unparalleled precision and adaptability into intricate surgical procedures within confined areas, particularly the anorectal region. This makes it a strong competitor to laparoscopic-assisted, minimally invasive transanal surgery. The application of robotic surgery has been successfully demonstrated in the resection of complex rectal tumors, total rectal mesentery resection, and fistula repair. These procedures have resulted in notable improvements in surgical precision, safety, and patients' postoperative quality of life. Despite the continued presence of challenges, including prolonged operation time and high cost, the long-term benefits and positive impact on patients' quality of life have become increasingly evident. This article presents a comprehensive overview of the development of robotic-assisted minimally invasive transanal surgery, its evolving application, and the remaining controversies surrounding its use.

Abstract Introduction Anastomosing hemangioma in the adrenal area is extremely rare. We report a large anastomosing hemangioma in the adrenal area that underwent robot‐assisted adrenalectomy. Case presentation A 49‐year‐old man with left back pain underwent magnetic resonance imaging (MRI) that revealed a tumor in the left adrenal area; it was diagnosed as nonfunctional endocrinologically. However, the major axis of the tumor increased from 64 to 72 mm during the 4‐month period. Robot‐assisted left adrenalectomy was performed. Although the large tumor adhered to the surrounding tissues, it was safely resected by the effective use of an extra robotic arm. An anastomosing hemangioma was diagnosed since there were no malignant findings. Conclusion Robotic surgical systems may serve as an effective treatment option for large adrenal tumors, and our report is the first robot‐assisted adrenalectomy performed on an anastomosing hemangioma.

Objective: The aim of this study was to demonstrate the ability of the Versius Surgical System to successfully and safely complete cholecystectomy. Background: The system has been developed in-line with surgeon feedback to overcome limitations of conventional laparoscopy to enhance surgeon experience and patient outcomes. Here we present results from the cholecystectomy cohort from a completed early clinical trial, which was designed to broadly align with Stage 2b of the Idea, Development, Exploration, Assessment, Long-term follow-up framework for surgical innovation. Methods: Procedures were performed between March 2019 and September 2020 by surgical teams consisting of a lead surgeon and operating room (OR) assistants. Male or female patients aged 18 years and over and requiring cholecystectomy were enrolled. The primary endpoint was the rate of unplanned conversion from robot-assisted surgery to conventional laparoscopic or open surgery. Adverse events (AEs) and serious AEs were adjudicated by video review of the surgery and patient study reports by an independent Clinical Expert Committee. Results: Overall, 134/143 (93.7%) cholecystectomies were successfully completed using the device. Of the 9 (6.3%) conversions to another surgical modality, 7 were deemed to be related to the device. A total of 6 serious AEs and 3 AEs occurred in 8 patients (5.6%), resulting in 4 (2.8%) readmissions to hospital within 30 days of surgery and 1 death. Conclusions: This study demonstrates cholecystectomy performed using the device is as safe and effective as conventional laparoscopy and supports the implementation of the device on a wider scale, pending instrument modifications, in alignment with Idea, Development, Exploration, Assessment, Long-term follow-up Stage 3 (Assessment). [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to demonstrate the safe and effective use of the Versius surgical system (CMR Surgical, Cambridge, UK) in robot-assisted total laparoscopic hysterectomy. This surgical robot was developed iteratively with input from surgeons to improve surgical outcomes and end-user experience. We report data from the gynecology cohort of an early clinical trial designed in broad alignment with IDEAL-D (Idea, Development, Exploration, Assessment, Long-term follow-up - Devices) stage 2b (Exploration).Material and Methods: The study is registered in the Indian clinical trials register (CTRI/2019/02/017872). Adult women requiring total hysterectomy who provided informed consent and met the eligibility criteria underwent procedures at one of three hospitals in India. Five surgeons performed robot-assisted total laparoscopic hysterectomies using the device from March 2019 to September 2020. The primary endpoint was rate of unplanned conversion to conventional laparoscopic or open surgery. Adverse events were adjudicated by an independent clinical events committee using endoscope video recordings and clinical notes.Results: In total, 144 women underwent surgery (median age: 44 years [range: 28-78]; median body mass index 25.8 kg/m2 [range: 14.3-47.8]). The rate of unplanned conversion to conventional laparoscopy was 2/144 (1.4%); neither conversion was device related. No surgery was converted to open. In total, 13 adverse events occurred among seven (4.9%) patients, comprising seven serious adverse events and six adverse events. One serious adverse event was deemed device-related. Two patients were readmitted to hospital within 30 days; both made a full recovery. No patients died within 90 days of surgery.Conclusions: The device provides a safe and effective option for total laparoscopic hysterectomy; these findings support its continued implementation in larger patient cohorts and expansion in other major minimal access indications. [ABSTRACT FROM AUTHOR]

IntroductionThe aims of this study were to evaluate (1) grasping forces with the application of a tactile feedback system in vivo and (2) the incidence of tissue damage incurred during robotic tissue manipulation. Robotic-assisted minimally invasive surgery has been shown to be beneficial in a variety of surgical specialties, particularly radical prostatectomy. This innovative surgical tool offers advantages over traditional laparoscopic techniques, such as improved wrist-like maneuverability, stereoscopic video displays, and scaling of surgical gestures to increase precision. A widely cited disadvantage associated with robotic systems is the absence of tactile feedback.Methods and procedureNineteen subjects were categorized into two groups: 5 experts (six or more robotic cases) and 14 novices (five cases or less). The subjects used the da Vinci with integrated tactile feedback to run porcine bowel in the following conditions: (T1: deactivated tactile feedback; T2: activated tactile feedback; and T3: deactivated tactile feedback). The grasping force, incidence of tissue damage, and the correlation of grasping force and tissue damage were analyzed. Tissue damage was evaluated both grossly and histologically by a pathologist blinded to the sample.ResultsTactile feedback resulted in significantly decreased grasping forces for both experts and novices (P  0.05 in all subjects).ConclusionThe in vivo application of integrated tactile feedback in the robotic system demonstrates significantly reduced grasping forces, resulting in significantly less tissue damage. This tactile feedback system may improve surgical outcomes and broaden the use of robotic-assisted minimally invasive surgery.

Objective To compare the postoperative recovery of patients receiving robotic laparoscopic insulinoma enucleation before and after implementing enhanced recovery after surgery (ERAS) protocol. Methods Anesthetic data of patients who received robotic laparoscopic insulinoma enucleation from January 2013 to March 2016 in Peking Union Medical College Hospital were collected and analyzed. All patients were be divided into routine group and ERAS group. Results The study enrolled 68 patients, whose obesity rate was 69.1%. The intraoperative fluid volume of ERAS group was lower than that of the routine group (P＜0.05), while the difference of urine output was not significant. The maximum peak airway pressure of ERAS group was also lower than that in the routine group(P＜0.05). The postoperative hospital stay length of ERAS group was shorter (P＜0.05). The postoperative complications were uncommon in the ERAS group. Conclusions ERAS protocol can shorten the hospital stay length of patients receiving robotic laparoscopic insulinoma enuleation and postoperative complications are likely to be reduced.

The robotic surgical system has been widely used in surgeries in various fields for its advantages over human eyes and hands with a magnified, stereoscopic view, flexible manipulation and ability to filter tiny tremors. The application of the robotic surgical system in vascular surgery is still in its infancy, and many issues concerning the operation techniques and safety need to be explored, especially in terms of the indications, key techniques, standardized procedures and management of intra- and post-operative complications. Of greater importance are the promotion of clinical studies that compare robotic surgical system versus open or laparoscopic surgery in vascular surgery and the collection and analysis of the long-term follow-up data. The evidence obtained from these studies will facilitate the wide application of robotic surgical system in vascular surgery. In addition, the defects in the current robotic surgical system need be improved, such as the lack of tactile feedback, the large size of the mechanical arm, and the interference between the arms. The era of robotic surgery has come, which urges greater efforts in both technical development and clinical studies of the robotic surgical system.

Objective: to compare short-term and long-term results of laparoscopic and robotic mesorectal excisions.Material and methods. Our multi-center cohort study based on prospectively collected data included patients with rectal cancer (RC) who underwent laparoscopic and robotic surgeries between 2010 and 2016. Study participants were divided into 3 groups: laparoscopic surgery group (L), 1st robotic surgery group (R1, surgeries were performed during the 1st year after the implementation of the equipment) and 2nd robotic surgery group (R2, surgeries were performed later). We evaluated the quality of mesorectal excision conducted using laparoscopic and robotic surgical techniques on different stages of their implementation. Additionally, we estimated intra- and postoperative complications, duration of surgery, intraoperative blood loss, overall survival and relapse-free survival.Results. Our groups consisted of 101 (L), 31 (R1) and 82 (R2) patients. Median surgery duration was 235 (110–465), 270 (130–420) and 193 (105–365) min in groups L, R1 and R2 respectively. The frequency of complications in these groups was 12 (11.9 %), 8 (25.8 %) and 9 (11.0 %) respectively. The frequency of R0-resections was 95.0 % (L), 90.3 % (R1) and 98.8 % (R2). The G2–3 mesorectal excision was performed in 87.9 % (L), 96.9 % (R1) and 96.1 % (R2) patients. Relapses were registered in 8 (8.6 %), 2 (6.5 %), and 2 (2.6 %) patients from groups L, R1 and R2 respectively. We observed no differences in relapse-free survival across the groups R1 and R2 (р = 0.131), L and R1 (р = 0.088), L and R2 (р = 0.794).Conclusions. Robotic surgery can safely be used in patients with RC; however, it should be implemented into routine practice under the supervision of an expert within special training programs. The use of a robotic surgical system with an optimized docking system controlled by an experienced specialist allows reducing the duration of rectal surgery, does not increase the risk of postoperative complications and ensures a higher quality of mesorectal excision.

Introduction: To provide an update on the current status of robotic systems for surgery and the companies that produce these systems. Methods: A non‐systematic literature review was performed by using the PubMED/MEDLINE electronic search engines. Existing patents for robotic companies and devices were researched by using the Google search engine. Results: Since the da Vinci Surgical System's patent expired, we have been able to predict the future of robotic companies based on the various robotic systems being developed. Currently, various attempts are being made to create consoles, robotic arms, cameras, handles, and instruments and to implement specific functions (e.g. haptic feedback, eye tracking). Herein, the benefits and limitations of each technology are identified, and likely future developments are described. Conclusions: The robotic surgical systems are continually being developed by various companies around the world. New technologies have been increasingly implemented to improve on the capabilities of previously established systems and surgical ergonomics. Future studies may need to evaluate the strengths and weaknesses of each robotic surgical system. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery has become the standard option for gastrointestinal surgeries. However, laparoscopic procedures require extended training times and are difficult for inexperienced surgeons. Robot-assisted laparoscopic surgery facilitates easy adaptation of laparoscopic procedures, but robotic surgical systems are expensive. In addition, their cost has remained high because there is currently only one manufacturer of commercially available systems. Recently, a new Korean robotic surgical system, Revo-i, has been developed. The aim of this study was to evaluate the feasibility and safety of Revo-i by performing robotic cholecystectomy in a porcine model.Methods: After approval by the Institutional Animal Care and Use Committee of Yonsei University Health System, cholecystectomy was performed in four pigs using the Revo-i robotic surgical system. Operative time and perioperative complications were recorded, and all animals were observed for postoperative complications for 2 weeks after surgery RESULTS: Robotic cholecystectomy was completed successfully and without gallbladder perforation in all cases. The mean operative time was 78 ± 12 min, the mean docking time was 4.5 ± 2.52 min, and the mean console time was 49.8 ± 14.17 min. There were no perioperative complications, and none of the animal used for the in vivo models exhibited abnormal behavior during the postoperative observation period.Conclusions: These preliminary results verify the safety and efficacy of robotic cholecystectomy using the Revo-i robotic surgical system. Human trials are slated to begin accordingly. [ABSTRACT FROM AUTHOR]

Background: Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children's Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget METHODS: Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ.Results: The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin).Conclusions: Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital. [ABSTRACT FROM AUTHOR]

This paper proposes a surgical manipulator with workspace-conversion ability for both minimally invasive surgery (MIS) and open surgery. The focus of the proposed surgical manipulator is on its potential use in places such as battlefields, army camps, and rural areas rather than in civilian hospitals. The proposed surgical manipulator has a workspace for MIS with a virtual remote center of motion and has a workspace for open surgery like that of an articulated manipulator. The mechanism of the surgical manipulator is proposed and implemented in this paper. A new distal rolling joint with two spiral wire ropes is also implemented. Several experiments to validate the feasibility of the surgical manipulator were carried out. Two fundamentals of laparoscopic surgery tasks were performed to compare the performance of the surgical manipulator with other MIS systems. The workspace conversion from MIS to open surgery was implemented. The workspace-conversion ability enables the surgical manipulator to attach or detach the surgical tool unit without human assistance or an assistant robot. [ABSTRACT FROM PUBLISHER]

This paper describes a teleoperated surgical manipulator with an additional degree of freedom (d.o.f.). If the surgical manipulator has the same number of d.o.f. as a human arm, intuitive movements of the surgical manipulator will be achieved and the movements of the surgical manipulator will be easily predictable. The proposed surgical manipulator affords 7-d.o.f. joints using a cable–pulley mechanism. The surgical manipulator has upper and lower arms akin to a human arm, and has an elbow joint as an additional d.o.f. joint. In addition, a remote controller was developed to measure the human arm position and deliver the angle data of the 7-d.o.f. joints to the surgical manipulator by TCP/IP communication. The calculated joint angles from the remote controller have a linear relationship with the measured angles from a human arm. The tracking experiment was performed and an approach angle to the surgical site was measured using a liver model. The proposed manipulator has a wider angle range compared to that of a conventional surgical tool. The surgical manipulator can also perform surgical tasks near the bottom of the liver model. [ABSTRACT FROM AUTHOR]