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Our study investigates the potential correlation between generational differences, like age and previous experience with digital innovations, such as video games and smartphones, and the performance on the Da Vinci Skills Simulator, the cornerstone of robotic surgery training. Thirty participants were involved from three age groups: Generation Alpha, Generation Z, and Generation X. None had prior robotic surgical experience. Participants performed the Wrist Articulation 1 task on the Da Vinci Skills Simulator after two practice rounds. Analysis of performance metrics and statistical tests were conducted to assess the differences between groups. Additionally, participants had completed a survey on their habits related to video gaming, smartphone, and computer usage. A trend was observed where performance declined with age, meaning that Generation Alpha performed the most successfully compared to the other generations, although the difference was not statistically significant (p = 0.51). However, significant differences were found in Glass Movement (GM) by Generation Z showing superior precision, making less errors (p = 0.019). The study found no correlation between simulator performance and early or frequent exposure to smartphones or video games. Interestingly, frequent two-thumb typing on smartphones correlated with better performance in the GM metric (p = 0.006). Generation Z demonstrated greater precision in handling the simulator, reflecting that robotic surgery training might be best to be started at the beginning of residency programs. Young doctors using two-thumb typing develop robotic surgery skills faster. Further studies are needed to determine whether this quicker learning would also lead to better skills later on. [ABSTRACT FROM AUTHOR]

Abstract The introduction of the “da Vinci S HD Surgical System” marked a significant shift towards robotic surgeries in Japan. However, initial high costs and lack of efficacy data posed barriers to its widespread adoption. By 2023, more than 570 da Vinci units were operational in Japan, highlighting the growing acceptance of robotic surgery despite these challenges. This study aimed to investigate the prevalence and regional disparities in the adoption of robot-assisted laparoscopic prostatectomy (RALP) across Japan using diagnosis procedure combination data. This retrospective observational study analyzed data from 2857 urban and 4184 regional hospitals across 47 prefectures in Japan. The study focused on the number of RALP procedures, da Vinci systems, and certified urological surgery proctors. Multiple regression analysis was performed to identify significant factors influencing RALP adoption. Urban areas demonstrated a higher prevalence of RALP procedures and more da Vinci systems compared to regional areas, with urban hospitals performing an average of 937 RALP procedures compared to 195.5 in regional hospitals. The number of certified urological surgeons also showed significant urban-regional disparities, contributing to the overall imbalance. Our findings highlight substantial regional disparities in access to robot-assisted surgery in Japan, with urban areas benefiting from better access to advanced medical technologies and specialist training. Addressing these disparities will require targeted policies to improve the dissemination of robotic surgery systems and enhance training opportunities in regional cities.

With the advent of minimally invasive surgeries, robot-assisted techniques have gained popularity because they overcome various shortcomings of standard laparoscopic surgeries. Despite the associated costs and limitations among the pediatric population, surgeon comfort due to the ergonomic design, in combination with enhanced three-dimensional high-fidelity imaging and tissue handling, may offer better surgical and postoperative outcomes. However, robotic surgeries require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel. Anesthesiologists should become well versed with these changes by learning the basic features of robotic surgical systems to offer appropriate anesthetic care and promote patient safety. In this original case report, we present a 3-year-old child posted for robot-assisted left heminephrectomy and excision of the lower megaureter. It provides instructive significance for anesthesia management, especially taking into account the age of the patient and associated concerns.

To automate surgical (sub-)tasks in robotic surgery, the knowledge of the exact pose of the instrument is mandatory. The application of Optical Coherence Tomography (OCT) to the problem of pose measurement appears promising due to its advantages of 3D imaging and micron-scale resolution. To investigate this, 175 image sequences of the EndoWrist Round Tip Scissor Tool were acquired with an OCT system. The images differ in the opening angles of the scissor blades and the rotation angles of the entire instrument about its central axis. These image sequences were further processed through computer vision methods of the individual images followed by point cloud generation. For pose estimation, an Iterative Closest Point algorithm was implemented to register the acquired point clouds to reference point clouds created from the instrument CAD file. The implemented algorithm was able to determine the opening angle with an overall error of 2∘ ± 1.3∘ and the rotation angle with a standard deviation between several runs of 0.6∘ ±2.8∘. However, the overall processing time of (39 ± 17)s on a standard PC leaves room for further investigations.

Surgical robotic tools are being developed for a variety of surgical procedures that are executed within small workspaces. Novel designs of miniaturized cable-actuated surgical tools for cleft palate repair have previously been developed. However, the behavior and significance of friction within these tools are largely unknown. A study was conducted to investigate the friction in a pulleyless 3 mm diameter wristed instrument. The wrist utilizes cable guide channels that allow for miniaturization at the cost of increased friction. An experimental rig was developed to measure friction within the wrist link mechanism when the tool is positioned at various pitch angles. A strong relationship between the cable tension and the tool's pitch angle was found as a result of friction. The cable tension increased as the pitch angle approached extreme values (percent increases in the cable tension of 33% and 67.3% at a pitch of 90° and −90°, respectively). However, the resultant cable tension was below the failure strength of the cable, indicating that the design is feasible. The results of this study would be useful to those considering the design of miniature robotic surgical tools that are cable-driven. Significant tool reduction can be achieved by employing static guide channels for the cables, forgoing the use of additional moving components like pulleys while maintaining cable tension well within its break strength. Future work in the design and optimization of novel miniaturized wrist mechanisms should consider frictional effects and their impact on mechanism function. [ABSTRACT FROM AUTHOR]

With the advent of minimally invasive surgeries, robot‑assisted techniques have gained popularity because they overcome various shortcomings of standard laparoscopic surgeries. Despite the associated costs and limitations among the pediatric population, surgeon comfort due to the ergonomic design, in combination with enhanced three‑dimensional high‑fidelity imaging and tissue handling, may offer better surgical and postoperative outcomes. However, robotic surgeries require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel. Anesthesiologists should become well versed with these changes by learning the basic features of robotic surgical systems to offer appropriate anesthetic care and promote patient safety. In this original case report, we present a 3‑year‑old child posted for robot‑assisted left heminephrectomy and excision of the lower megaureter. It provides instructive significance for anesthesia management, especially taking into account the age of the patient and associated concerns. [ABSTRACT FROM AUTHOR]

Background: Robotic assistance in thyroidectomy is a developing field that promises enhanced surgical precision and improved patient outcomes. This study investigates the impact of the da Vinci Surgical System on operative efficiency, learning curve, and postoperative outcomes in thyroid surgery. Methods: We conducted a retrospective cohort study of 104 patients who underwent robotic thyroidectomy between March 2018 and January 2022. We evaluated the learning curve using the Cumulative Sum (CUSUM) analysis and analyzed operative times, complication rates, and postoperative recovery metrics. Results: The cohort had a mean age of 36 years, predominantly female (68.3%). The average body mass index (BMI) was within the normal range. A significant reduction in operative times was observed as the series progressed, with no permanent hypoparathyroidism or recurrent laryngeal nerve injuries reported. The learning curve plateaued after the 37th case. Postoperative recovery was consistent, with no significant difference in hospital stay duration. Complications were minimal, with a noted decrease in transient vocal cord palsy as experience with the robotic system increased. Conclusion: Robotic thyroidectomy using the da Vinci system has demonstrated a significant improvement in operative efficiency without compromising safety. The learning curve is steep but manageable, and once overcome, it leads to improved surgical outcomes and high patient satisfaction. Further research with larger datasets and longer follow-up is necessary to establish the long-term benefits of robotic thyroidectomy. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a chronic condition affecting 6–10% of women of reproductive age, with endometriosis-related pain and infertility being the leading symptoms. Currently, the gold standard treatment approach to surgery is conventional laparoscopy (CL); however, the increasing availability of robot-assisted surgery is projected as a competitor of CL. This study aimed to compare the perioperative outcomes of robot-assisted laparoscopy (RAL) and CL in endometriosis surgery. Objectives: We aimed to compare the effectiveness and safety of these two procedures. Methods: A systematic search was conducted in three medical databases. Studies investigating different perioperative outcomes of endometriosis-related surgeries were included. Results are presented as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Results: Our search yielded 2,014 records, of which 13 were eligible for data extraction. No significant differences were detected between the CL and RAL groups in terms of intraoperative complications (OR = 1.07, CI 0.43–2.63), postoperative complications (OR = 1.3, CI 0.73–2.32), number of conversions to open surgery (OR = 1.34, CI 0.76–2.37), length of hospital stays (MD = 0.12, CI 0.33–0.57), blood loss (MD = 16.73, CI 4.18–37.63) or number of rehospitalizations (OR = 0.95, CI 0.13–6.75). In terms of operative times (MD = 28.09 min, CI 11.59–44.59) and operating room times (MD = 51.39 min, CI 15.07–87.72;), the RAL technique remained inferior. Conclusion: RAL does not have statistically demonstrable advantages over CL in terms of perioperative outcomes for endometriosis-related surgery. [ABSTRACT FROM AUTHOR]

Objectives: Transoral robotic surgery (TORS) is an effective technique for patients with oropharyngeal malignancies. Recent advancements have allowed for the use of the Single Port (SP) system from Intuitive Surgical. Here, we present the first documented case series describing the parameters and techniques used to treat patients with parapharyngeal space (PPS) tumors using the da Vinci SP robotic system from Intuitive Surgical. Materials and methods: Two patients treated with the da Vinci SP platform at Houston Methodist Hospital for PPS tumors were identified. Their preoperative, operative, and postoperative courses and the operative setup and techniques were documented. Results: The two patients experienced a favorable operative and post-operative course, for which pathology revealed pleomorphic adenomas in both cases. One patient experienced a recurrence of her tumor 12 months postoperatively, which was managed with adjuvant radiotherapy and revision surgery. Both patients are disease-free at 6 and 3 months after treatment concluded. Conclusion: SP TORS is a novel and safe approach for addressing benign PPS tumors and should be considered for these patients. Further research should provide further information on the benefit of this approach compared to standard operative techniques.

Surgical robotic tools are being developed for a variety of surgical procedures that are executed within small workspaces. Novel designs of miniaturized cable-actuated surgical tools for cleft palate repair have previously been developed. However, the behavior and significance of friction within these tools are largely unknown. A study was conducted to investigate the friction in a pulleyless 3 mm diameter wristed instrument. The wrist utilizes cable guide channels that allow for miniaturization at the cost of increased friction. An experimental rig was developed to measure friction within the wrist link mechanism when the tool is positioned at various pitch angles. A strong relationship between the cable tension and the tool’s pitch angle was found as a result of friction. The cable tension increased as the pitch angle approached extreme values (percent increases in the cable tension of 33% and 67.3% at a pitch of 90° and −90°, respectively). However, the resultant cable tension was below the failure strength of the cable, indicating that the design is feasible. The results of this study would be useful to those considering the design of miniature robotic surgical tools that are cable-driven. Significant tool reduction can be achieved by employing static guide channels for the cables, forgoing the use of additional moving components like pulleys while maintaining cable tension well within its break strength. Future work in the design and optimization of novel miniaturized wrist mechanisms should consider frictional effects and their impact on mechanism function.

The emergence and application of surgical robots is a major breakthrough in contemporary minimally invasive surgery. Since Da Vinci surgical system was introduced into China, the number of operations has grown rapidly, especially in the past decade, its efficacy and safety have been widely recognized. In the field of gastrointestinal surgery, robots are the most widely used in gastric cancer surgery. Compared to traditional laparoscopic surgery, robot surgery has made significant progress in terms of technology, with more precise operations, convenient lymph node dissection, and narrow space operations. However, it also faces shortcomings such as long surgical time and high costs. This article aims to review the development of robotic gastrointestinal cancer surgery and systematically summarize its advantages and disadvantages, and propose prospects for future development trends.

Background: We compared surgeons' workload, physical discomfort, and neuromusculoskeletal disorders (NMSDs) across four surgical modalities: endoscopic, laparoscopic, open, and robot-assisted (da Vinci Surgical Systems). Methods: An electronic survey was sent to the surgeons across an academic hospital system. The survey consisted of 47 questions including: (I) Demographics and anthropometrics; (II) The percentage of the procedural time that the surgeon spent on performing each surgical modality; (III) Physical and mental demand and physical discomfort; (IV) Neuromusculoskeletal symptoms including body part pain and NMSDs. Results: Seventy-nine out of 245 surgeons completed the survey (32.2%) and 65 surgeons (82.2%) had a dominant surgical modality: 10 endoscopic, 15 laparoscopic, 26 open, and 14 robotic surgeons. Physical demand was the highest for open surgery and the lowest for endoscopic and robotic surgeries, (all p < 0.05). Open and robotic surgeries required the highest levels of mental workload followed by laparoscopic and endoscopic surgeries, respectively (all p < 0.05 except for the difference between robotic and laparoscopic that was not significant). Body part discomfort or pain (immediately after surgery) were lower in the shoulder for robotic surgeons compared to laparoscopic and open surgeons and in left fingers for robotic surgeons compared to endoscopic surgeons (all p < 0.05). The prevalence of NMSD was significantly lower in robotic surgeons (7%) compared to the other surgical modalities (between 60 and 67%) (all p < 0.05). Conclusions: The distribution of NMSDs, workload, and physical discomfort varied significantly based on preferred surgical approach. Although robotic surgeons had fewer overall complaints, improvement in ergonomics of surgery are still warranted. [ABSTRACT FROM AUTHOR]

Subcutaneous emphysema (SE), a complication of robotic gastrectomy (RG), occurs when the gas used to establish pneumoperitoneum escapes and enters the soft tissue. SE typically does not result in major clinical problems, but massive SE can have life-threatening consequences. Hence, developing adequate preventive methods against postoperative SE is essential. We aimed to determine whether an existing protective device, the LAP PROTECTOR™ (LP), can be used to reduce the incidence of SE after RG. We analyzed the data of 194 patients who underwent RG at our hospital between August 2016 and December 2022. Since September 2021 (the 102nd patient), we have used the LP (FF0504; Hakko Medical, Hongo, Tokyo, Japan) at the trocar site, as this was expected to reduce the incidence of SE. The primary endpoint of this study was the efficacy of the LP in reducing the incidence of clinically relevant SE (defined as SE extending into the cervical area) a day after RG. Univariate analysis revealed that sex, body mass index (BMI), and LP usage differed significantly between patients with and without postoperative SE. Logistic regression analysis revealed that male sex (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.15–0.72, P < 0.001), high BMI (OR: 0.13, 95% CI: 1.23–4.45, P = 0.009), and LP usage (OR: 0.11, 95% CI: 0.04–0.3, P < 0.001) were preventive factors independently associated with a lower incidence of clinically relevant SE. Placing an LP at the trocar site may be a safe and effective method of preventing SE after RG. [ABSTRACT FROM AUTHOR]

Objective To explore the nursing cooperation process of robot-assisted laparoscopic oral mucosa repair and reconstruction of the ureter. Methods The nursing cooperation of 30 cases of robot-assisted laparoscopic oral mucosa repair and reconstruction of ureter in the Urology Department from December 2020 to December 2021 were analyzed. Intraoperative precision nursing cooperation and postoperative follow-up visits were carried outto ensure the success of surgery and safety of patients during perioperative period. Results The operation was successfully completed in 30 patients, and the overall average success rate was 95. 6%. The effect of medical and nursing cooperation was satisfactory, and no postoperative complications occurred during the short and medium-term follow-up. Conclusion Adequate preoperative preparation, reasonable operating room layout, and skilled intraoperative cooperation are considerable issues of improving the efficiency of the surgeon's operation and are an important part of the successful completion of the operation. (目的 探讨机器人辅助腹腔镜下口腔黏膜修复重建输尿管术的护理配合流程。方法 收集2020年12月—2021年12月行机器人辅助腹腔镜下口腔黏膜修复重建输尿管术治疗的30例患者的临床资料, 总结护理经验, 分析护理要点。结果 30例患者顺利完成手术, 总体平均成功率为 95. 6%。医护配合效果满意, 中短期随访无术后并发症发生。结论 充分的术前准备, 合理的手术间布局, 熟练的术中配合, 有助于能提高术者手术效率, 是确保手术顺利完成的重要环节。)

Objective：This study aims to explore the safety and feasibility of neoadjuvant chemotherapy combined with Da Vinci robotic surgery for advanced gastric cancer. Methods：The respective cross ⁃ sectional study was conducted. There were 151 patients retrospectively analyzed，who underwent radical gastrectomy after two cycles of neoadjuvant chemotherapy (SOX) in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from July 2018 to July 2022，and 120 cases were finally included according to the inclusion and exclusion criteria. According to mode of operation，all patients were divided into Da Vinci robotic radical gastrectomy group (robot group，60 cases) and laparoscopic radical gastrectomy group (laparoscopy group，60 cases) . The general data， perioperative surgery related indexes and postoperative rehabilitation were compared between two groups. Results：There was no significant difference between the two groups in age，body mass index，tumor size，tumor location，surgical scope，digestive tract reconstruction mode，preoperative clinical stage (cTNM) ，pathological stage (ypTNM) ，cell differentiation degree，tumor regression grade，complete remission and partial remission (P > 0.05) . There were significant differences between the two groups in operation time，estimated intraoperative bleeding and abdominal incision length (P＜0.05) . There were significant differences between the two groups in postoperative pain score，the time of first fluid diet，the time of first ventilation，the time of drainage tube extubation，the time of postoperative hospitalization and the cost of hospitalization (P < 0.05) . There were also significant differences in C⁃reactive protein， leukocyte count，neutrophil count，serum prealbumin，interleukin (IL) ⁃ 6 and procalcitonin between the two groups (P < 0.05) . However，there was no significant difference in the incidence rate of postoperative complications，readmission within 30 days after surgery，and secondary surgery within 30 days after surgery between the two groups (P > 0.05) . In the robot group，the estimated amount of surgical bleeding，the length of abdominal incision，the score of postoperative pain，the time of first liquid diet，the time of first ventilation，the time of extraction of abdominal drainage tube，and the time of postoperative hospitalization were better than those in the laparoscope group，but the operation time and hospitalization cost were significantly worse than those in the laparoscope group. Conclusion：For advanced gastric cancer，the strategy of preoperative neoadjuvant chemotherapy combined with Da Vinci robotic surgery is safe and feasible，and the incidence of postoperative complications is similar to laparoscopic surgery. So，Da Vinci robotic surgery system is a new candidate for advanced gastric cancer. [ABSTRACT FROM AUTHOR]

Robotic reconstructive surgery has been performed since 2012 at our institution. The purpose of this study was to report our 10-year experience with robot-assisted reconstructive surgery and compare the clinical outcomes of different robotic models. Medical records of 41 patients who had chest or breast reconstruction during October 2012 ∼ May 2021 were reviewed retrospectively. Different robotic models were evaluated and compared in terms of surgical technique, demographic variables, postoperative complication, and operative parameters. esthetic assessments were performed by four plastic surgeons to evaluate symmetry, scar formation, and general esthetic features based on patients' photographs. Overall, out of 41 robot-assisted reconstructive surgeries, 13 were performed with the Da Vinci Si model, 18 with the Da Vinci Xi model, and 10 with the Da Vinci Sp model. The docking time, robot operation time, and hospitalization time were shorter for surgeries, which used the Da Vinci Sp model than other models. All other complications and operative parameters showed no significant difference. Improved esthetic outcome was achieved for all patient groups. Group Sp had the most favorable score, followed by Group Xi and Group Si, although there were no statistical implications. Ever since the introduction of the Da Vinci model in 2012, we have successfully implemented the robot-assisted reconstructive surgery. Surgical technique improved over the last 10 years. With the introduction of the Sp model, we are now at the stage of further developing the surgical technique and establishing the robotic reconstructive surgery. [ABSTRACT FROM AUTHOR]

Robotic cholecystectomy (RC) using the da Vinci surgical system has been introduced as a potential alternative to the gold standard laparoscopic cholecystectomy (LC) for gallbladder removal. This systematic review aims to evaluate and compare the postoperative outcomes (operative time, bile leak, and postoperative complications) and cost-effectiveness between da Vinci RC and LC. A comprehensive search of electronic databases, including EMBASE, MEDLINE, Cochrane Library, and PubMed, used Medical Subject Headings terms and Boolean operators to identify relevant studies. Comparative trials assessing postoperative outcomes and costs between RC and LC were included. Data were extracted independently by researchers and analyzed using the RevMan 5.4 software (The Cochrane Collaboration, London, UK). The analysis included six studies with a total of 1,013 patients, comprising three randomized controlled trials (RCTs) and three cohorts conducted across Switzerland, Taiwan, the USA, and Italy. Results showed that LC had a significantly shorter operation duration than RC (standardized mean difference: 0.27; 95% CI, 0.05-0.49; p = 0.01). No significant differences were observed between RC and LC in terms of bile leak rates (odds ratio, 0.37; 95% CI, 0.06-2.21; p = 0.27) or postoperative complications (odds ratio, 0.50; 95% CI, 0.18-1.37; p = 0.18). Cost analysis revealed that RC was more cost-effective than LC (standardized mean difference, 3.16; 95% CI, 0.39-5.93; p = 0.03), with substantial heterogeneity noted among the studies. The findings suggest that RC does not provide significant clinical advantages over LC in postoperative outcomes and incurs higher costs. Due to the heterogeneity and the limited number of RCTs included, a major multicenter RCT is recommended to validate these results further. In conclusion, LC remains the preferred approach due to its shorter operative time and cost-effectiveness, with no significant differences in clinical outcomes compared to da Vinci RC. Further research with larger, multicenter trials is warranted to confirm these findings and guide clinical decision-making., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tawde et al.)

Background: This study investigated the impact of surgical modalities on surgeon wellbeing with a focus on burnout, job satisfaction, and interventions used to address neuromusculoskeletal disorders (NMSDs)., Methods: An electronic survey was sent to surgeons across an academic integrated multihospital system. The survey consisted of 47 questions investigating different aspects of surgeons' wellbeing., Results: Out of 245 thoracic and abdominopelvic surgeons, 79 surgeons (32.2 ​%) responded, and 65 surgeons (82 ​%) were able to be categorized as having a dominant surgical modality. Compared to robotic surgeons, laparoscopic (p ​= ​0.042) and open (p ​= ​0.012) surgeons reported more frequent feelings of burnout. The number of surgeons who used any treatment/intervention to minimize the operative discomfort/pain was lower for robotic surgeons than the other three modalities (all p ​< ​0.05)., Conclusions: NMSDs affect different aspects of surgeons' lives and occupations. Robotic surgery was associated with decreased feelings of burnout than the other modalities., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objective: The introduction of the Hugo RAS system represents a recent innovation in robotic surgery. The potential benefits and limitations of this system and its integration into clinical practice in urology have yet to be fully delineated. Our objective was to assess surgical, early oncological, and functional outcomes in studies comparing robot-assisted radical prostatectomy (RARP) performed with the new Hugo RAS system and the well-established da Vinci surgical system., Methods: We conducted a systematic review and meta-analysis using PubMed, Web of Science, Scopus, and Embase databases. Eligible studies compared RARP outcomes in adult males between the Hugo RAS and da Vinci systems. The main endpoints were analyzed using a random-effects model, including perioperative outcomes (surgical times, estimated blood loss, length of hospital stay, Clavien-Dindo grade ≥2 complications), oncological outcomes (positive surgical margins and postoperative prostate-specific antigen), and functional outcomes (continence status and erectile function)., Key Findings and Limitations: Nine studies involving 1185 patients (478 Hugo RAS and 707 da Vinci) were included. Significant differences in pooled baseline characteristics included higher body mass index for the da Vinci cohort (p = 0.035) and a higher rate of palpable disease in the Hugo RAS cohort (p = 0.036). Docking time was significantly longer for the Hugo RAS, with a median difference of 6.1 min (95% confidence interval 3.9-8.2; I 2  = 68.6%; p < 0.001; three studies). Overall, there were no significant differences in perioperative, oncological, and functional outcomes between the two systems., Conclusions and Clinical Implications: Despite the preliminary nature of the evidence, this systematic review and meta-analysis show comparable surgical and clinical outcomes for RARP performed with the Hugo RAS system and the da Vinci robotic platform., Patient Summary: We reviewed studies comparing the use of two different surgical robots for removal of the prostate. The results suggest that surgical and clinical outcomes with the new Hugo RAS robot are comparable to those with the established da Vinci robot for this procedure., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Purpose: Semantic segmentation and activity classification are key components to create intelligent surgical systems able to understand and assist clinical workflow. In the operating room, semantic segmentation is at the core of creating robots aware of clinical surroundings, whereas activity classification aims at understanding OR workflow at a higher level. State-of-the-art semantic segmentation and activity recognition approaches are fully supervised, which is not scalable. Self-supervision can decrease the amount of annotated data needed. Methods: We propose a new 3D self-supervised task for OR scene understanding utilizing OR scene images captured with ToF cameras. Contrary to other self-supervised approaches, where handcrafted pretext tasks are focused on 2D image features, our proposed task consists of predicting relative 3D distance of image patches by exploiting the depth maps. By learning 3D spatial context, it generates discriminative features for our downstream tasks. Results: Our approach is evaluated on two tasks and datasets containing multiview data captured from clinical scenarios. We demonstrate a noteworthy improvement in performance on both tasks, specifically on low-regime data where utility of self-supervised learning is the highest. Conclusion: We propose a novel privacy-preserving self-supervised approach utilizing depth maps. Our proposed method shows performance on par with other self-supervised approaches and could be an interesting way to alleviate the burden of full supervision. [ABSTRACT FROM AUTHOR]

Summary: Background: Elective splenectomy has various indications and can be performed open or minimally invasively. Laparoscopic splenectomy (LS) is popular but has limitations. Some studies suggest potential superiority of robotic splenectomy (RS) over LS. As such, we conducted a systematic review to determine whether RS has greater positive perioperative outcomes in comparison to LS in the adult population. Methods: We searched for studies that reported perioperative outcomes and compared RS to LS in the adult population. Outcome measures were operative time, conversion to open surgery, postoperative complications, mortality, length of stay, blood loss and cost analysis. A simple, unpaired two-tailed student's t‑test was used to compare outcomes between the RS and LS patient groups. Results: After full-text analysis of 47 papers, three studies met the inclusion criteria. The studies involved 72 patients (28 in the RS group, 44 in the LS group). RS demonstrated no significantly reduced blood loss in comparison to LS (p = 0.13). RS had no cases converting to open surgery and no postoperative complications in comparison to LS. No significant difference was found between RS and LS with regards to LOS (p = 0.89) and cost benefit (p = 0.74). RS had a higher operative time in comparison to LS which was not statistically significant (p = 0.45). Conclusion: The RS approach may be associated with lower blood loss and a lower risk of conversions. There was no statistical difference between RS and LS with regards to length of stay (LOS) and cost. RS takes longer to perform in comparison to LS. [ABSTRACT FROM AUTHOR]

The introduction of robotic surgery in hospitals has raised much debate given the various effects on care, costs, education and medical advancement. Purchasing discussions are often approached with more questions than answers and there is a need for reports that provide a case for whether or not such technologies are advantageous from multiple perspectives, and offer insights into ways such devices can be introduced into a hospital setting. This report provides an evidence-based review of a university-affiliated tertiary care hospital's 12-year experience with robotic surgery in gynecologic oncology and delves into the various takeaways and challenges of implementing robotic surgery. Key findings were that robotic surgery significantly reduced complication rates, lengths of hospital stays for patients and overall hospital costs. Key obstacles were large upfront costs and the need for significant leadership and collaboration. Ongoing challenges to evaluating robotics include assessing long-term survival data, making comparisons with concurrently changing hospital conditions and determining how data can be generalized to other departments and institutions. [ABSTRACT FROM AUTHOR]

Abstract Pancreaticoduodenectomy, so‐called “Whipple operation,” is a time‐consuming and technically demanding complex operation. Traditionally, this procedure has been performed most usually by open approach, which results in a large and painful wound. With the introduction of laparoscopic and robotic surgery, minimally invasive surgery (MIS) has emerged as a worldwide trend to improve wound cosmesis and to minimize wound pain. Although MIS for pancreaticoduodenectomy has also been attempted at some centers, the role of MIS, either robotic or laparoscopic approach, has not been well‐established for complex pancreaticoduodenectomy. Given that laparoscopic pancreaticoduodenectomy has been limited by its technical complexity and the high level of advanced laparoscopic skills required for pancreatic reconstruction, a robotic surgical system is introduced to overcome several limitations related to the laparoscopic approach. Providing high‐quality three‐dimensional (3‐D) vision, high optical magnification, articulation of robotic instruments, greater precision with suture targeting, and elimination of surgeon tremor, robotic surgical systems innovatively perform more delicate and complex procedures involving extensive dissection and suturing techniques such as pancreaticoduodenectomy. Although associated with longer operative time, robotic pancreaticoduodenectomy (RPD) has been claimed to have the benefits of less delayed gastric emptying, less blood loss, shorter length of postoperative stay, and lower wound infection rate, as compared with the traditional open pancreaticoduodenectomy (OPD). Moreover, RPD seems to be not only technically feasible but also justified without compromising the survival outcomes for pancreatic head and ampullary adenocarcinomas. Therefore, RPD could be recommended not only to surgeons but also to patients in terms of surgical feasibility, surgical outcomes, and patient satisfaction.

In recent decade, pediatric liver transplantation has developed rapidly in China due to the improvement of surgical techniques and postoperative management, which has been applied from several domestic liver transplantation centers to more than 10 provinces, cities and autonomous regions. The annual quantity of pediatric liver transplantation has exceeded 1 000 for 3 consecutive years, ranking first across the world. The technique of pediatric liver transplantation has been gradually oriented to precision medicine. The development of pediatric liver transplantation mainly focuses on the "grafts". In this article, the development characteristics and trends of pediatric liver transplantation were elucidated from the perspectives of different types of liver transplantation that expanded the source of donor liver, including split liver transplantation, auxiliary liver transplantation, Domino liver transplantation and liver transplantation with hyper-reduced grafts, as well as the application of minimally invasive surgical and microsurgical anastomosis techniques in pediatric liver transplantation, which represented by laparoscopic surgery and Da Vinci surgical system, aiming to provide reference for further improving the long-term survival rate of grafts and the quality of life of the recipients. [ABSTRACT FROM AUTHOR]

Radical prostatectomy (RP) is the gold standard for the surgical treatment of localized prostate cancer, presenting better results than radiotherapy especially for high-risk patients. Although it has clinical and technical benefits compared with open and laparoscopic techniques, the robotic-assisted RP is not publicly funded in Brazil. The objective of this study was to calculate the cost-effectiveness of the robotic-assisted RP from the Brazilian public system perspective. A state transition model was built to simulate the life of a patient undergoing RP. A total of 3 arms were compared: robotic-assisted, laparoscopic, and open surgeries. The assumed time horizon was 20 years; discounts were applied to both costs and health outcomes. Events and transition probabilities were obtained in the literature, and costs were obtained in official government databases. The results were reported as incremental cost-utility ratios. Robotic-assisted surgery was found to be costlier but more effective than both open and laparoscopic techniques, resulting in Brazilian reals 4518 per quality-adjusted life-year and Brazilian reals 3631 per quality-adjusted life-year incremental cost-effectiveness ratios, respectively. This study gives relevant inputs for decision making regarding the inclusion of robotic-assisted RP in the Brazilian public formularies. The study demonstrates that the technology is cost-effective even when considering willingness-to-pay thresholds lower than the traditionally used ones. • This study aimed to estimate the incremental cost-utility ratio of the robotic-assisted radical prostatectomy compared with the open and laparoscopic techniques in Brazil. To our knowledge, this is the first study to be published with this objective even though the theme has already been under evaluation by the Brazilian Health Technology Assessment National Agency (Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde). • This study not only gives inputs for decision making about the adoption of robotic-assisted surgery at the local level but also presents a novel methodology for calculating the cost-effectiveness of radical prostatectomies for treating localized prostate cancer. Currently published studies with the same intent used complex microsimulation modeling that was not easily replicable. Our study proposed a methodology based on a simple state transition model that can be easily replicated with a broadly used software (Microsoft Excel) and does not require advanced programming skills or extraordinary processing power. [ABSTRACT FROM AUTHOR]

Background: The da Vinci Si version robot lacks a vascular stapler that can be controlled by the operating surgeon at the surgical console when dividing pulmonary vessels. Therefore, to initiate and safely perform robotic anatomical lobectomy for lung cancer, it is important to develop a safe method for introducing a surgical stapler. Methods: We performed a retrospective study of the first 42 consecutive patients who underwent robotic lobectomy for lung cancer at Nippon Medical School Hospital between January 2019 and December 2020. Results: Up to case 18, we performed robot-assisted thoracoscopic surgery (RATS) lobectomy by using a four-arm approach with two assistant ports. For dividing pulmonary vessels, the surgical stapler was introduced through the assist ports. However, since this is not the port position usually used in videoassisted thoracoscopic surgery (VATS), there were many difficult situations. For RATS lobectomy case 19 and all subsequent cases, we utilized a total port approach that uses three robotic arms and two assistant ports. To resect the pulmonary vessels or bronchi with endoscopic staplers, the port for the robotic arm was removed and the endoscopic staplers were placed through a 12-mm Xcel bladeless port. This change reduced operation time, blood loss, and robotic arm interference. No patient developed intraoperative complications during RATS lobectomy. Conclusion: The present total port approach, with three robotic arms, appears to be feasible for introducing surgical staplers during RATS with the da Vinci Si robotic system. [ABSTRACT FROM AUTHOR]

A pheochromocytoma is a rare tumor of neuroendocrine origin that secretes hormones like epinephrine, norepinephrine, and occasionally dopamine. The most notable symptom of the release of catecholamines is exceedingly high blood pressure. A 45-year-old male presented with a symptomatic pheochromocytoma of large size. He reported experiencing fatigue, orthopnea, dizziness, headache, and chest tightness with deep inspiration for several months. At the time of presentation, he was found to be in hypertensive emergency and was started on alpha-blockade for several days followed by a beta-blockade for a total of 28 days of anti-hypertensive treatment. During his admission, CT imaging showed his tumor to measure at least 14 cm in length, larger than most. After stabilization of the patient, an attempt was made to resect the tumor robotically, but the procedure was converted to an open left adrenalectomy owing to the size of the tumor and the number of tributaries. The patient tolerated the procedure well and, afterward, his blood pressure normalized. He recovered postoperatively with minimal hypotensive episodes and was started on physical therapy. This report reviews the details and management of this case., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bethishou et al.)

Introduction: The curriculum for a da Vinci surgeon in gynecology requires special training before a surgeon performs their first independent case, but standardized, objective assessments of a trainee's workflow or skills learned during clinical cases are lacking. This pilot study presents a methodology to evaluate intraoperative surgeon behavior in hysterectomy cases through standardized surgical step segmentation paired with objective performance indicators (OPIs) calculated directly from robotic data streams. This method can provide individual case analysis in a truly objective capacity., Materials and Methods: Surgical data from six robot-assisted total laparoscopic hysterectomies (rTLH) performed by two experienced surgeons was collected prospectively using an Intuitive Data Recorder. Each rTLH video was annotated and segmented into specific, functional surgical steps based on the recorded video. Once annotated, OPIs were compared through workflow analysis and across surgeons during two critical surgical steps: colpotomy and vaginal cuff closure., Results: Through visualization of the individual steps over time, we observe workflow consistencies and variabilities across individual surgeons of a similar experience level at the same hospital, creating unique surgeon behavior signatures across each surgical case. OPI differences across surgeons were observed for both the colpotomy and vaginal cuff closure steps, specifically reflecting camera movement, energy usage and clutching behaviors. Comparing colpotomy and vaginal cuff closure time needed for the step and the events of energy use were significantly different ( p  < 0.001). For the comparison between the two surgeons only the event count for camera movement during colpotomy showed significant differences ( p  = 0.03)., Conclusion: This pilot study presents a novel methodology to analyze and compare individual rTLH procedures with truly objective measurements. Through collection of robotic data streams and standardized segmentation, OPI measurements for specific rTLH surgery steps can be reliably calculated and compared to those of other surgeons. This provides opportunity for critical standardization to the gynecology field, which can be integrated into individualized training plans in the future. However, more studies are needed to establish context surrounding these metrics in gynecology., Competing Interests: MS, LP, XL, and ME were employed by Intuitive Surgical Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Neis, Brucker, Bauer, Shields, Purvis, Liu, Ershad, Walter, Dijkstra, Reisenauer and Kraemer.)

Pancreaticoduodenectomy, so‐called "Whipple operation," is a time‐consuming and technically demanding complex operation. Traditionally, this procedure has been performed most usually by open approach, which results in a large and painful wound. With the introduction of laparoscopic and robotic surgery, minimally invasive surgery (MIS) has emerged as a worldwide trend to improve wound cosmesis and to minimize wound pain. Although MIS for pancreaticoduodenectomy has also been attempted at some centers, the role of MIS, either robotic or laparoscopic approach, has not been well‐established for complex pancreaticoduodenectomy. Given that laparoscopic pancreaticoduodenectomy has been limited by its technical complexity and the high level of advanced laparoscopic skills required for pancreatic reconstruction, a robotic surgical system is introduced to overcome several limitations related to the laparoscopic approach. Providing high‐quality three‐dimensional (3‐D) vision, high optical magnification, articulation of robotic instruments, greater precision with suture targeting, and elimination of surgeon tremor, robotic surgical systems innovatively perform more delicate and complex procedures involving extensive dissection and suturing techniques such as pancreaticoduodenectomy. Although associated with longer operative time, robotic pancreaticoduodenectomy (RPD) has been claimed to have the benefits of less delayed gastric emptying, less blood loss, shorter length of postoperative stay, and lower wound infection rate, as compared with the traditional open pancreaticoduodenectomy (OPD). Moreover, RPD seems to be not only technically feasible but also justified without compromising the survival outcomes for pancreatic head and ampullary adenocarcinomas. Therefore, RPD could be recommended not only to surgeons but also to patients in terms of surgical feasibility, surgical outcomes, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Background The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. Case presentation Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. Conclusion This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.

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The robotic surgery has been proposed as another adjunct for pediatric minimal surgery for choledochal cyst. However, the Roux-en-Y jejunal limb in most reports on robot-assist choledochal cyst resection is usually created extracorporeally in children. The pediatric surgery team of West China Hospital of Sichuan University had completed 10 cases of total robot-assisted choledochal cyst resection. The aim of this current study was to present our initial experience in total robot-assisted surgery and discuss the technical points. Between January 2015 and February 2020, patients with choledochal cysts treated with total robot-assisted procedures were retrospectively analyzed. The data collected included demographic information of all patients, type and size of cyst, operative details and postoperative outcomes. A total of 10 episodes of patients were enrolled in the study. The median age of the patient was 69.50 months with a mean weight of 20.50 kg. The most common symptoms were abdominal pain, vomiting, and jaundice (60%, 30%, and 30%, respectively). The types of cyst included 2 Ia, 7 Ic and 1 IV. The mean operation time was 218.70 min and there were no red blood cell transfusion and conversion in the 10 patients. The mean time to taking water was 3.37 days and mean time to starting liquid diet was 3.77 days. And the average length of postoperative hospital stay was 7.92 days. All 10 patients were eventually discharged and made uneventful recoveries after the operation. Total robot-assisted choledochal cyst excision comprising Roux-en-Y limb formation, excision of the cyst and hepaticojejunostomy appears to be safe and feasible in pediatrics. Our initial experience shows that it is recommended to perform total robot-assisted choledochal cyst excision for patients over 4 years while a Roux-en-Y jejunojejunal anastomosis is recommended to be performed extracorporeally by prolapsing the jejunum out of abdominal cavity for patients under 4 years old. Treatment Study. Retrospective Study. [ABSTRACT FROM AUTHOR]

Robotic surgery, currently monopolized by the Intuitive “da Vinci Surgical System” (dVSS) has now established its strong foothold in the USA and a few other countries in Europe and Asia. However, because of its high cost and lack of evidence to support its superiority over the traditional laparoscopic technique, its utility especially in less affluent countries remains controversial. In this article, we studied the adoption and development of robotic programs in Thailand, a middle income country, that had its head start relatively early with the acquisition of the first generation da Vinci system by the private international hospital. The systems have since been installed in 5 other institutions, 4 of which are academic centers. We analyzed and discussed the causes of success of the urological program and failure of others. In the end, we concluded that instead of resisting the trend, it should be selectively and rationally embraced. We then suggested steps to help with the program development that are best suited to the Thailand financial and health care conditions.

Abstract Background Few studies have been done on robot-assisted sacral surgery. This study aims to evaluate the outcomes of seven patients with benign sacral or presacral tumors treated with a robotic surgical system at a single center. Methods All patients with benign sacral or presacral tumors who underwent transperitoneal resection (between June 2015 and June 2016) using the da Vinci Si HD robotic surgical system (Intuitive Surgical Inc.) were included in this retrospective study. Results Seven patients with a mean age of 43.8 years (range: 22- 62 years) were included in this study. The operation time ranged from 60 to 335 min. Five out of these seven patients with presacral tumor underwent complete tumor resection by the da Vinci robotic surgical system, with a median blood loss of 52 ml. The other patients underwent excision of the presacral tumor by the da Vinci robotic surgical system, followed by a posterior approach, with a median blood loss of 675 ml. The histological diagnosis was schwannoma of the sacral nerve in five cases (71.5%). The other two cases were chordoma and solitary fibroma of the sacrum, respectively. No perioperative or postoperative complications were encountered. The average hospitalization stay was 5.7 days. No recurrences were found at follow-up 24 to 31 months later. Conclusion Robot-assisted minimally invasive sacral surgery can provide precise dissection of the tissue under a perfect view. It is a technically feasible procedure that is associated with minimal blood loss, fewer injuries and short hospitalization. It is particularly suitable for presacral benign tumors.

Emerging techniques in minimally invasive rectal resection include robotic total mesorectal excision (R-TME). The Da Vinci Surgical System offers precise dissection in narrow and deep confined spaces and is gaining increasing acceptance during recent times. The aim of this study is to analyse our initial experience of R-TME with Da Vinci Xi platform in terms of perioperative and oncological outcomes in the context of data from recently published randomised ROLARR trial amongst minimally invasive novice surgeons. Patients who underwent R-TME or tumour specific mesorectal excision for rectal cancer between May 2016 and November 2019 were identified from a prospectively maintained single institution colorectal database. Demographic, clinical-pathological and short-term oncological outcomes were analysed. Of the 178 patients, 117 (65.7%) and 31 (17.4%) patients had lower and mid third rectal cancer. Most of the tumours were locally advanced, cT3–T4: 138 (77.5%). One hundred/178 (56.2%) underwent sphincter preserving TME. Eighty-seven (48.8%) were grade II adenocarcinoma. Nonmucinous adenocarcinoma was the predominant histology, 138 (78.4%). One hundred one cases (56.7%) were pT3. The mean number of lymph node yield was 13 ± 5. Distal resection margin and circumferential resection margin were positive in 2 (1.12%), 12 cases (6.74%) respectively. Eleven cases (6.7%) had to be converted to open TME. Mean blood loss and duration of surgery was 170 ± 60 ml and 286 ± 45 min respectively. Five percent cases had an anastomotic leak. Grade IIIa–IIIb Clavien Dindo (CD) morbidity score was reported to be in 12 (6.75%) and 10 (5.61%) cases. Median length of hospitalisation was 7 days (range 4–14 days). Perioperative and pathologic outcomes following robotic rectal resection is associated with good short-term oncological outcomes and is safe, effective, and reproducible by a minimally invasive novice surgeon. [ABSTRACT FROM AUTHOR]

Introduction: Patients before 50 years of age with HPV-positive oropharyngeal cancer are characterized by significantly better survival than HPV-negative patients. The consequences of oncological treatment directly affect physiological function of the organs of the upper respiratory tract and, in consequence, the quality of life of these individuals. Therefore, the choice of therapy is of great importance. Minimally invasive surgery offers radical oncological treatment, while preserving the quality of life. The principal surgical methods are transoral access using TLM, electrosurgery and TORS. Radiochemotherapy as primary treatment is equally effective in the first and second stages of clinical advancement of cancer. However, occurrence of late complications such as swallowing, breathing, taste and smell disorders led to a recent re-emergence of minimally invasive surgery, particularly transoral robotic surgery, which has been widely used in head and neck surgery in the United States of America, Asia and Western European countries for more than 20 years. After many years, Poland joined the community of countries where the head and neck interventions are performed using the da Vinci Surgical System. Objective: The purpose of the work is to present our own experience with the TORS at the Department of the Head and Neck Surgery and Laryngological Oncology of the Poznan University of Medical Sciences and to analyze the latest literature reports on the use of TORS in the treatment of oropharyngeal squamous cell carcinoma. [ABSTRACT FROM AUTHOR]