How do Japanese patients really feel about losing potency after radical prostatectomy? (MAJI study).

OBJECTIVES: To investigate actual patients' feelings about losing erectile function because of treatment for prostate cancer. METHODS: The study participants were 20 patients who were going to receive robot-assisted laparoscopic radical prostatectomy without nerve sparing. Before surgery, we interviewed them using an original questionnaire. The questionnaire included inquiries concerning their feelings about losing sexual function, whether they were sad or not, wanted to preserve sexual function, wanted to receive treatment if there were one that would restore sexual function and how much they would be willing to pay to recover their sexual function. RESULTS: The median age of the participant was 67 years (range 60-73 years). Fourteen patients (70%) were sad about losing their sexual function and 17 (85%) wanted to preserve it if they could. Thirteen patients (65%) wanted to receive treatment that would restore their lost sexual function, and they thought that they would be willing to pay a median of 500 000 yen (range 0-1 000 000 yen) to recover it. CONCLUSIONS: Most of the patients felt sad about losing their potency just before radical prostatectomy without nerve sparing. Although almost all patients wanted to preserve their sexual function if they could, they did not want to spend a great deal of money for it.

[Germany's first robot-assisted kidney transplantation from a deceased donor: a good option in obese recipients-with the right team]. / Deutschlands erste roboterassistierte postmortale Nierentransplantation: eine gute Option bei Adipositas permagna ­ wenn das Team stimmt.

Robot-assisted kidney transplantations have been performed in Europe since 2015. In Germany, the technique is slowly spreading - most recently, 3 urological centers performed this type of procedure. We present the first case of a post-mortem, robot-assisted kidney transplantation in Germany in a 60-year-old patient. In addition to the surgical technique and the clinical course, the opportunities of this surgical technique and its challenges are discussed in particular. In summary, the experience at our center is consistent with the findings from the literature that robot-assisted post-mortem kidney transplantation is a safe method for supplementing the principles of open transplantation surgery with the advantages of minimally invasive methods.

The effect of puboperiurethral suspension stitch placement on climacturia after robot-assisted laparoscopic radical prostatectomy.

BACKGROUND: Climacturia is defined as urine leakage associated with orgasm and can negatively affect patients' quality of life. The high prevalence of climacturia after radical prostatectomy (RP) has led to continued efforts to reduce climacturia rates. It has been shown that puboperiurethral suspension stitch placement during RP assists in the recovery of urinary continence. AIM: To evaluate the impact of puboperiurethral suspension stitch placement during RP on post-RP climacturia. METHODS: We conducted a retrospective study of patients who underwent nerve-sparing robot-assisted laparoscopic RP (RALP) at our institution between 2016 and 2023. The patients were categorized into 2 groups: Group 1 (n = 32) that underwent nerve-sparing RALP with puboperiurethral suspension stitch placement and Group 2 (n = 62) that underwent nerve-sparing RALP alone. Patients who were not able to achieve penetration at the last follow-up visit were excluded from the study. The clinical history, parameters of prostate cancer, details of medical and surgical treatments, and follow-up data were evaluated. OUTCOMES: Differences in sexual and urinary function, climacturia rates, and complications between nerve-sparing RP with and without puboperiurethral suspension stitch placement. RESULTS: There were no significant differences between the groups in terms of surgical complications. The mean follow-up time was 14.62 ± 3.55 months in Group 1 and 14.43 ± 4.44 months in Group 2 (P = .42). Postoperative erectile functions were similar between the groups. At the last follow-up visit, climacturia was present in 4 patients (12.5%) in Group 1 and 24 patients (38.7%) in Group 2 (P = .016). The long-term stress urinary incontinence rates were similar between the groups. CLINICAL IMPLICATIONS: This study provides comparative results on postoperative climacturia rates between nerve-sparing RALP groups with and without puboperiurethral suspension stitch placement. These results show that puboperiurethral suspension stitch can help to prevent postoperative climacturia after RP. STRENGTH AND LIMITATIONS: This is the first study in the literature that evaluates the effect of puboperiurethral suspension stitch on climacturia. The limitations include the single-center, retrospective design with potential selection bias, possible inaccuracies in the recorded medical data, and challenges in controlling confounding variables. CONCLUSION: Our study demonstrated that puboperiurethral suspension stitch was a feasible option for the prevention of climacturia after RALP without an increased risk of complications.

Trend of robot-assisted surgery system in gastrointestinal and liver surgery: A bibliometric analysis.

BACKGROUND: Robot-assisted gastrointestinal and liver surgery has been an important development direction in the field of surgery in recent years and it is also one of the fastest developing and most concerning fields in surgical operations. AIM: To illustrate the major areas of research and forward-looking directions over the past twenty-six years. METHODS: Using the Web of Science Core Collection database, a comprehensive review of scholarly articles pertaining to robot-assisted gastrointestinal and liver surgery was researched out between 2000 and 2023. We used Citespace (Version 6.2.4) and Bibliometrix package (Version 4.3.0) to visualize the analysis of all publications including country, institutional affiliations, authors, and keywords. RESULTS: In total, 346 articles were retrieved. Surgical Endoscopy had with the largest number of publications and was cited in this field. The United States was a core research country in this field. Yonsei University was the most productive institution. The current focus of this field is on rectal surgery, long-term prognosis, perioperative management, previous surgical experience, and the learning curve. CONCLUSION: The scientific interest in robot-assisted gastrointestinal and liver surgery has experienced a significant rise since 1997. This study provides new perspectives and ideas for future research in this field.

Quantitative in-vitro assessment of a novel robot-assisted system for cochlear implant electrode insertion.

PURPOSE: As an increasing number of cochlear implant candidates exhibit residual inner ear function, hearing preservation strategies during implant insertion are gaining importance. Manual implantation is known to induce traumatic force and pressure peaks. In this study, we use a validated in-vitro model to comprehensively evaluate a novel surgical tool that addresses these challenges through motorized movement of a forceps. METHODS: Using lateral wall electrodes, we examined two subgroups of insertions: 30 insertions were performed manually by experienced surgeons, and another 30 insertions were conducted with a robot-assisted system under the same surgeons' supervision. We utilized a realistic, validated model of the temporal bone. This model accurately reproduces intracochlear frictional conditions and allows for the synchronous recording of forces on intracochlear structures, intracochlear pressure, and the position and deformation of the electrode array within the scala tympani. RESULTS: We identified a significant reduction in force variation during robot-assisted insertions compared to the conventional procedure, with average values of 12 mN/s and 32 mN/s, respectively. Robotic assistance was also associated with a significant reduction of strong pressure peaks and a 17 dB reduction in intracochlear pressure levels. Furthermore, our study highlights that the release of the insertion tool represents a critical phase requiring surgical training. CONCLUSION: Robotic assistance demonstrated more consistent insertion speeds compared to manual techniques. Its use can significantly reduce factors associated with intracochlear trauma, highlighting its potential for improved hearing preservation. Finally, the system does not mitigate the impact of subsequent surgical steps like electrode cable routing and cochlear access sealing, pointing to areas in need of further research.

An Integrated Electroencephalography and Eye-Tracking Analysis Using eXtreme Gradient Boosting for Mental Workload Evaluation in Surgery.

OBJECTIVE: We aimed to develop advanced machine learning models using electroencephalogram (EEG) and eye-tracking data to predict the mental workload associated with engaging in various surgical tasks. BACKGROUND: Traditional methods of evaluating mental workload often involve self-report scales, which are subject to individual biases. Due to the multidimensional nature of mental workload, there is a pressing need to identify factors that contribute to mental workload across different surgical tasks. METHOD: EEG and eye-tracking data from 26 participants performing Matchboard and Ring Walk tasks from the da Vinci simulator and the pattern cut and suturing tasks from the Fundamentals of Laparoscopic Surgery (FLS) program were used to develop an eXtreme Gradient Boosting (XGBoost) model for mental workload evaluation. RESULTS: The developed XGBoost models demonstrated strong predictive performance with R2 values of 0.82, 0.81, 0.82, and 0.83 for the Matchboard, Ring Walk, pattern cut, and suturing tasks, respectively. Key features for predicting mental workload included task average pupil diameter, complexity level, average functional connectivity strength at the temporal lobe, and the total trajectory length of the nondominant eye's pupil. Integrating features from both EEG and eye-tracking data significantly enhanced the performance of mental workload evaluation models, as evidenced by repeated-measures t-tests yielding p-values less than 0.05. However, this enhancement was not observed in the Pattern Cut task (repeated-measures t-tests; p > 0.05). CONCLUSION: The findings underscore the potential for machine learning and multidimensional feature integration to predict mental workload and thereby improve task design and surgical training. APPLICATION: The advanced mental workload prediction models could serve as instrumental tools to enhance our understanding of surgeons' cognitive demands and significantly improve the effectiveness of surgical training programs.

Primary robot-assisted laparoscopic partial nephrectomy for hemorrhage secondary to angiomyolipoma: a retrospective study from a large tertiary hospital in China.

With the continuous development of robot-assisted technology, Robot-assisted Laparoscopic Partial Nephrectomy (RALPN) has gradually become an optional method for the treatment of Hemorrhage secondary to angiomyolipoma (HSA). However, there are rare clinical reports of the primary RALPN for HSA. Therefore, this research aims to evaluate the efficacy and safety of primary RALPN for HSA. Fourteen patients(six males and eight females), aged 14-56 years, underwent primary RALPN for HSA and were retrospectively analyzed from 2015 to 2023. The initial blood routine examination revealed decreased hemoglobin in all patients, and Contrast-enhanced computed tomography (CT) indicated retroperitoneal hematoma. After correcting shock and electrolyte imbalance through fluid therapy and medical treatment, all primary RALPN procedures were performed with transabdominal access on the side of the Hemorrhage. After tumor resection and hematoma removal with a monopolar Curved Scissor, the absorbable barbed suture was performed for inner and outer running stitches, respectively. Patient demographic information, perioperative characteristics, and functional outcomes were collected and analyzed. The initial tumor size of fourteen patients ranged from 57 to 145 mm, and the RENAL ranged from 7 to 11. All of the HSA was controlled, and primary RALPN was successful. The operating time it was ranged from 105 to 265 min. Postoperatively, one patient exhibited chylous drainage (Clavien-Dindo II), and another patient developed pleural effusion (Clavien-Dindo III). No postoperative transfusion and Digital Subtraction Angiography (DSA) highly selective embolization of the bleeding vessel was needed. No patients developed urinoma or urinary fistula. Within the follow-up period, the overall complications were manageable. Primary RALPN is a safe and effective procedure for HSA, which may be considered an alternative to selective renal artery embolization.

Clinical features, surgical treatment strategy, and feasibility of minimally invasive surgery for synchronous and metachronous multiple colorectal cancers: A 14-year single-center experience.

BACKGROUND: Patients with a history of colorectal cancer (CRC) are at increased risk of developing secondary synchronous/metachronous CRCs. The role of minimally invasive surgery (MIS) for multiple CRCs remains unclear. This study aimed to evaluate the short-term outcomes of MIS in patients with multiple CRCs and elucidate their clinical characteristics. METHODS: This retrospective study reviewed CRC patients who underwent MIS between 2010 and 2023. Multiple CRC cases were categorized into synchronous and metachronous cohorts. Demographics, pathological findings, and perioperative outcomes were analyzed. Propensity score matching (PSM) analysis was performed as appropriate. RESULTS: A total of 1,272 patients met the inclusion criteria, with 99 (7.8%) having multiple CRCs (75 synchronous and 24 metachronous). Multiple CRC patients had a higher prevalence of strong family history (8.1% vs. 1.0%, P < 0.001) and right-sided colon cancer (55.6% vs. 34.4%, P < 0.001) compared to solitary CRC patients. MSI-high/MMR-deficient status, including Lynch syndrome, was frequently observed among patients with multiple CRCs. Synchronous CRCs requiring double-anastomosis were associated with longer operation times (P = 0.03) and increased blood loss (P = 0.03) compared to those with a single-anastomosis. In the metachronous cohort, repeat operation patterns were categorized based on tumor location and sacrificed arteries. Preservation of the left-colic artery avoided extended colectomy in some patients. Patients with multiple CRC involving rectal cancer had a higher anastomotic leakage (AL) rate (17.6% vs. 5.7%, P < 0.01); however, this difference in AL rate disappeared after PSM (8.8% vs. 8.8%, P = 1.0). In patients with multiple CRCs, AL has not been observed ever since the indocyanine green fluorescence imaging was implemented. CONCLUSIONS: MIS is feasible for multiple CRCs, with perioperative outcomes comparable to those for solitary CRCs. Preservation of critical arteries may benefit patients at high risk of secondary CRCs, particularly those with a strong family history of CRC, right-sided tumors, or MSI-high/MMR-deficient profiles, including Lynch syndrome.

Has robot-assisted pyeloplasty reached outcome parity with laparoscopic pyeloplasty in children <15 kg? A Paediatric YAU international multi-center study.

INTRODUCTION: Ureteropelvic Junction Obstruction (UPJO), is a major cause of pathological hydronephrosis in children. Minimally invasive surgery (MIS), including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), has gained popularity due to its known advantages. LP faces technical difficulties and a steep learning curve. RALP has overcome these limitations, making it safer and more effective for children. The study aims to assess the safety and effectiveness of LP and RALP in infants weighing ≤15 kg. MATERIALS AND METHODS: This is a retrospective analysis (2010-2022). The study included pediatric patients who had a confirmed diagnosis of UPJO and weighed ≤15 kg. The patients were divided into two groups: LP and RALP. The study evaluated preoperative, intraoperative, perioperative, and follow-up data, including complications. Success was defined as no worsening of hydronephrosis on postoperative ultrasound in the first year of follow-up. RESULTS: The total patients were 94: 42 in the LP group, and 52 in the RALP group. The median age at the intervention was 17.5 months (LAP group) versus 29 months (RALP group) (p = 0.01). The median weight at the time of intervention was 9.5 Kg (LP group), and 11.6 Kg (RALP group) (p = 0.44). The median operative time was significantly longer in the LP group: 245 min versus 125.5 min in the RALP group (p = 0.001). The median length of hospitalization was comparable: 4.3 days (LP group) and 3.5 days (RALP group) (p = 0.42). No intraoperative complications were reported in either group. There were no statistically significant differences regarding postoperative complications. During follow-up, all patients remained asymptomatic, with no episodes of urinary tract infection or abdominal pain, and none of them had a recurrence of UPJ obstruction. Consequently, the two techniques are equally effective and safe in the short term. DISCUSSION: Both procedures offer excellent outcomes with comparable postoperative complications. LOS was similar for both groups, with no intraoperative complications or conversions, and a non-significant increase in postoperative complications. A notable finding was the significant difference in operation times between the procedures, emphasizing the importance of reduced surgical time in pediatric patients for minimizing anesthetic and intubation durations. CONCLUSION: For the absence of intra- and postoperative complications and recurrences, RALP is as effective as LP in pyeloplasty in children weighing 15 kg or less. This finding reinforces the idea that RALP can be safely executed, benefiting from its advanced technology and the learning curve, for patients of any age regarding pyeloplasty for UPJO.

Impact of robotic-assisted surgery on length of hospital stay in Paris public hospitals: a retrospective analysis.

The number of available hospital beds is decreasing in many countries. Reducing the length of hospital stay (LOS) and increasing bed turnover could improve patient flow. We evaluated whether robot-assisted surgery (RAS) had a beneficial impact on the LOS in a French hospital trust with a long-established robotic program (Assistance Publique-Hôpitaux de Paris, AP-HP). We extracted data from "Programme de Médicalisation des Systèmes d'Information" to determine the median LOS for adults in our trust after RAS versus laparoscopy and open surgery in 2021-2022 for eight target procedures, and compared data nationally and at similar academic centres (same database). We also calculated the number of hospitalisation days 'saved' using RAS. Overall, 9326 target procedures were performed at AP-HP: 3864 (41.4%) RAS, 2978 (31.9%) laparoscopies, and 2484 (26.6%) open surgeries. The median LOS for RAS was lower than laparoscopy and open surgery for all procedures, apart from hysterectomy and colectomy (equivalent to laparoscopy). Results for urological procedures at AP-HP reflected national values. The equivalent of 5390 hospitalisation days was saved in 2021-2022 using RAS instead of open surgery or laparoscopy at AP-HP; of these, 86% represented hospitalisation days saved using RAS in urological procedures. Using RAS instead of open surgery or laparoscopy (particularly in urological procedures) reduced the median LOS and may save thousands of hospitalisation days every year. This should help to increase patient turnover and facilitate patient flow.

Accuracy of robotic computer-assisted implant surgery for immediate implant placement: A retrospective case series study.

OBJECTIVES: This study investigated the accuracy of robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement. METHODS: Twenty cases with 20 implant sites were selected based on predefined inclusion criteria. The preparation of the implant bed and implant placement followed the standardized dental implant robotic surgery protocol. Postoperative cone-beam computed tomography scans were conducted to assess possible discrepancies between actual and planned implant positions. RESULTS: The r-CAIS technology for immediate implant placement exhibited a mean global coronal deviation of 0.71 ± 0.27 mm (95% CI: 0.58-0.83 mm), a mean global apical deviation of 0.69 ± 0.26 mm (95% CI: 0.56-0.81 mm), and an angular deviation of 1.27 ± 0.47° (95% CI: 1.05-1.49°). A substantial number of deviations were observed buccally at both coronal (90%) and apical (95%) levels, with a consistent tendency for buccal deviation. CONCLUSIONS: The r-CAIS technology proved a promising approach for immediate implantation in the anterior region, with satisfactory clinical outcomes. However, an optimized surgical protocol for r-CAIS technology is required for particular implant sites like extraction sockets or bone defects.

Minimally invasive robot-assisted direct pars repair: illustrative cases.

BACKGROUND: Robot-assisted techniques are increasingly integrated into the field of spine surgery, with the potential benefits of increased accuracy and reduced radiation exposure. The objective of this study was to describe the technique of minimally invasive robot-assisted direct pars repair with 2 case illustrations. OBSERVATIONS: An 18-year-old male and a 42-year-old male, both with bilateral L5 spondylolysis, underwent successful minimally invasive L5 direct pars repairs with robotic assistance after conservative measures failed, and their cases are presented herein. LESSONS: A robot-assisted direct pars repair is a safe and effective technique for treating bilateral lumbar spondylolysis. The integration of robot-assisted techniques in spine surgery has the potential to improve outcomes, decrease surgical time, and reduce the amount of radiation exposure to operating room staff. https://thejns.org/doi/10.3171/CASE2415.

A transcrestal sinus floor elevation strategy based on a haptic robot system: An in vitro study.

OBJECTIVES: To reveal the force profiles recorded by haptic autonomous robotic force feedback during the transcrestal sinus floor elevation (TSFE) process, providing a reference for the surgery strategy during TSFE. MATERIALS AND METHODS: A total of 42 maxillary sinus models with different angles of the sinus floor (30°, 40°, 50°, 60°, 70°, 80°, and 90°, compared to vertical plane) were 3D printed. Implant site preparation was performed using a robotic system, and the total force (Ft) and axial force along the drill (Fz) during the surgery were recorded by the haptic robotic arm. The actual initial breakthrough point (drill contacting sinus floor) and complete breakthrough point (drill penetrating the sinus floor) were defined visually (the actual IBP and the actual CBP). The theoretical initial breakthrough point (the theoretical IBP) and the theoretical complete breakthrough point (the theoretical CBP) defined by the robot-guided system and the CBCT were determined by real-time force feedback and imaging distance measurement, respectively. The distance from the bottom of the resin model to the actual IBP and the actual CBP was defined as Di and Dt, respectively. RESULTS: The difference in Fz began to increase significantly at 70°, while the difference in Ft became significant at 60°. When the angle was greater than 70°, there was no significant difference in the discrepancy between the actual and theoretical perforation points. Compared to judging the breakthrough point by CBCT, real-time force feedback TSFE under robotic surgery achieved more accurate initial breakthrough point detection. CONCLUSIONS: The smaller the angle, the larger the breakthrough force for the drill. The real-time force feedback of haptic robotic system during TSFE could provide reliable reference for dentists. More clinical studies are needed to further validate the application of robotic surgery assisted TSFE.

Influence of dental implant clinical experience on the accuracy of robot-assisted immediate implant placement: an in vitro study.

OBJECTIVES: To assess the accuracy and effectiveness among operators with different levels of experience in a robot-assisted immediate implant surgery. MATERIALS AND METHODS: The study included four participants who had received dental training at the same institution but have varying levels of clinical experience in implant dentistry, denoted as undergraduate student (UG), dental resident (DR), specialist with no robot experience (IS) and specialist with robot experience (RS). Following comprehensive theoretical training in robot-assisted implant operation, each operator participated in five robotic-assisted implant procedures at 21 sites, resulting in the implant surgery of a total of 20 implants. Subsequently, the accuracy of the implants was assessed by analyzing the preoperative planning and the postoperative CBCT scans, and the time required for each procedure was also recorded. RESULTS: Angular deviation in UG, DR, IS and RS group was 0.82 ± 0.27°, 0.55 ± 0.27°, 0.83 ± 0.27°, and 0.56 ± 0.36°, respectively. The total deviation of the implant platform point was 0.28 ± 0.10 mm, 0.26 ± 0.16 mm, 0.34 ± 0.08 mm and 0.31 ± 0.06 mm, respectively. The total deviation of the apical point was 0.30 ± 0.08 mm, 0.25 ± 0.18 mm, 0.31 ± 0.09 mm, and 0.31 ± 0.05 mm, respectively. The time spent was 10.37 ± 0.57 min, 10.56 ± 1.77 min, 9.93 ± 0.78 min, and 11.76 ± 0.78 min for each operator. As the number of operations increased, the operation time decreased, but there was no significant difference in implant accuracy between the different groups. CONCLUSIONS: Within the scope of this study, robot-assisted implant surgery demonstrated high accuracy, with no significant differences in performance between operators with varying levels of clinical experience or implant robot-user experience. Furthermore, the learning curve for robotic implant surgery is steep and consistent. CLINICAL RELEVANCE: Robot-assisted implant surgery demonstrates consistent high accuracy across operators of varying clinical and robotic experience levels, highlighting its potential to standardize procedures and enhance predictability in clinical outcomes.

The rise of the machines: are robots the future of renal artery aneurysm repair? A systematic review.

Renal artery aneurysms (RAAs) are a rare vascular condition. Robot-assisted surgery offers a minimally invasive approach for RAA repair, potentially improving surgical outcomes. This review investigates the current evidence on the effectiveness and limitations of this technique. A systematic search following PRISMA guidelines identified relevant studies across five electronic databases. Studies investigating the use of robot-assisted surgery for RAA repair were included. The review identified 11 studies encompassing a total of 23 patients. Procedures included aneurysmectomy, end-to-end anastomosis, prosthetic graft repair, and even coil embolization. All surgeries were successful, with only minor complications reported in four cases. Robot-assisted RAA repair shows promise as a minimally invasive approach with encouraging preliminary outcomes. However, the limited data come from small studies. Future advancements in robotic technology hold the potential to optimize this approach for improved patient care.

Comparing open and robot-assisted partial nephrectomy - a single institution report.

BACKGROUND: Open partial nephrectomy (OPN) has previously been considered the gold standard procedure for treatment of T1 localized renal tumors. After introduction of robot assisted partial nephrectomy (RAPN) as an alternative method to OPN, OPN was gradually abandoned at our department. The aim of the study was to retrospectively compare the results of patients treated with either OPN or RAPN for suspected renal carcinoma. METHODS: Patients who underwent either open or robotic assisted partial nephrectomy between January 1st 2010 and December 31st 2020 were retrospectively included in the study. Each tumor subjected to surgery was scored preoperatively by the RENAL nephrometry score. Complications within 30 days were assessed according to the Clavien-Dindo classification system. RESULTS: A total of 197 patients who underwent partial nephrectomy were identified; 75 were subjected to OPN and 122 were treated with RAPN. There were no significant differences between the groups with respect to age (OPN: 63 years ± 11, RAPN: 62 years ± 10), gender (OPN: 71/29%, RAPN: 67/33%), body mass index (OPN: 28 ± 5, RAPN: 28 ± 5), ASA score (OPN: 2.4 ± 0.6, RAPN: 2.2 ± 0.5), or nephrometry score (OPN: 6.6 ± 1.7, RAPN: 6.9 ± 1.7, p = 0.2). The operative time was significantly shorter in the OPN group (81 min) compared to the RAPN group (144.5 min, p < 0.001). Mean perioperative blood loss was 227 ± 162 ml in the OPN group compared to 189 ± 152 ml in the RAPN group (p = 0.1). Mean length of stay was shorter in the RAPN group (3 days) compared to the OPN group (6, days, p < 0.001). Positive surgical margin rate was significantly higher in the OPN group (21.6%) compared to the RAPN group (4.2%, p < 0.001). There were no differences in the number of Clavien-Dindo graded complications between the groups (p = 0.6). CONCLUSIONS: The introduction of RAPN at our department resulted in shorter length of stay and fewer positive surgical margins, without increasing complications.

Collaborative Implementation of Robotic Surgery Into an Academic Pediatric Surgery Practice.

INTRODUCTION: Robotic surgery continues to drive evolution in minimally invasive surgery. Due to the confined operative fields encountered, pediatric surgeons may uniquely benefit from the precise control offered by robotic technologies compared to open and laparoscopic techniques. We describe a unique collaborative implementation of robotic surgery into an academic pediatric surgery practice through adult robotic surgeon partnership. We compare robotic cholecystectomy (RC) and laparoscopic cholecystectomy (LC) outcomes, hypothesizing that RC will be equivalent to LC in key quality outcomes. METHODS: We evaluate 14 mo of systems development and training, and 24 mo of collaborative operative experience evoking a purposeful tiered case progression, establishing core robotic competencies, prior to advancing operative complexity. Univariate analyses compared LC versus RC. RESULTS: 36 robotic operations were performed in children aged 8-18 y, in a tiered progression from 24 cholecystectomies to 2 ileocecectomies, 2 paraesophageal hernia repairs, 1 anterior rectopexy, 1 spleen-preserving distal pancreatectomy, 1 Heller myotomy, 1 choledochal cyst resection with roux-en-y hepaticojejunostomy, 1 median arcuate ligament release, and 1 thoracic esophageal duplication cyst resection. For LC and RC, there were no significant differences in procedure duration, discharge opioids, hospital readmission, or rates of surgical site infection or bile duct injury. CONCLUSIONS: Robotic surgery has potential to significantly enhance pediatric surgery. RC appears equivalent to LC but presents multiple additional theoretical benefits in pediatric patients. Our pilot program experience supports the feasibility and safety of pediatric robotic surgery. We emphasize the importance of a stepwise progression in operative difficulty and collaboration with adult robotic surgery experts.

Comparison of Percutaneous Core Needle Biopsy Results in Patients Who Previously Underwent Open and Robot-Assisted Kidney Transplantation.

Objective: The objective of this study was to investigate the safety and efficacy of percutaneous graft biopsy, specifically in patients who have undergone robotic kidney transplantation, a topic that has received limited attention in the existing literature. While percutaneous graft biopsy is well established in patients who have undergone open transplantation, its application in robotic transplantation remains relatively unexplored. Material and Methods: A retrospective analysis was conducted on patient records spanning from 2013 to 2024, focusing on those who underwent graft biopsy due to acute graft dysfunction. The cohort was bifurcated into two distinct groups: individuals who underwent open kidney transplantation and those who underwent robotic kidney transplantation. Results: The study encompassed a total of 89 patients, with 64 having undergone open kidney transplantation and 25 having undergone robot-assisted kidney transplantation. The mean age of the patients was 40.61 (±12.26) years, with 60 (67.4%) being male and 29 (32.6%) being female. Comparative analysis revealed no significant disparities in age, gender distribution, body mass index, donor type (cadaveric versus living), or rates of graft loss between the two groups. Furthermore, examination of the total complication rates did not uncover any noteworthy differences between the cohorts. Conclusions: Ultrasound-assisted percutaneous needle biopsy is a reliable method in patients who have undergone robot-assisted kidney transplantation in cases of both indication-based and protocol biopsies. This study underscores the reliability of ultrasound-assisted percutaneous needle biopsy as a viable method for patients who have undergone robot-assisted kidney transplantation. By shedding light on the safety and efficacy of percutaneous graft biopsy in the context of robotic transplantation, this research contributes to the expanding body of knowledge in the field, providing valuable insights for clinical practice and future research endeavors.

Comparing robotic and open partial nephrectomy under the prism of surgical precision: a meta-analysis of the average blood loss rate as a novel variable.

Exploration of surgical precision in robotic procedures is extensive, yet lacks a unified framework for comparability. This study examines tissue handling precision by comparing the per-minute blood loss rate between robotic and open partial nephrectomy. A literature search from August 2022 to June 2024 identified 43 relevant studies providing data on estimated blood loss and procedure duration. The expected values and standard errors of these variables were used to compute the per-minute blood loss rate (Q). Meta-analytical methods estimated pooled and subgroup-level mean differences, favoring robotic surgery (MDQ = - 1.043 ml/min, CI95% = [- 1.338; - 0.747]). Subgroup analyses by publication year, patient matching, referral center count, and ROBINS-I status consistently supported this advantage. Sensitivity analyses confirmed the above benefit in studies with increased accuracy in reported results (MDQ = - 0.957 ml/min, CI95% = [- 1.269; - 0.646]), low risk of bias involving matched comparisons (MDQ = - 0.563 ml/min, CI95% = [- 0.716; - 0.410]), large sample sizes and increased statistical power (MDQ = - 0.780 ml/min, CI95% = [- 1.134; - 0.425]), and multicenter analyses with patient matching (MDQ = - 0.481 ml/min, CI95% = [- 0.698; - 0.263]). The subsequent analysis of correlation between the original variables suggested a slight reduction in the robotic advantage when the latter were proportionally related. Multilevel meta-regression at both temporal and qualitative scales consistently indicated a comparative benefit of the robotic approach. Potentially, lower per-minute blood loss compared to open surgery suggests that robotic partial nephrectomy demonstrates enhanced precision in tissue handling.

HybGrip: a synergistic hybrid gripper for enhanced robotic surgical instrument grasping.

PURPOSE: A fundamental task of a robotic scrub nurse is handling surgical instruments. Thus, a gripper capable of consistently grasping a wide variety of tools is essential. We introduce a novel gripper that combines granular jamming and pinching technologies to achieve a synergistic improvement in surgical instrument grasping. METHODS: A reliable hybrid gripper is constructed by integrating a pinching mechanism and a standard granular jamming gripper, achieving enhanced granular interlocking. For our experiments, our prototype is affixed to the end-effector of a collaborative robot. A novel grasping strategy is proposed and utilized to evaluate the robustness and performance of our prototype on 18 different surgical tools with diverse geometries. RESULTS: It is demonstrated that the integration of the pinching mechanism significantly enhances grasping performance compared with standard granular jamming grippers, with a success rate above 98%. It is shown that with the combined use of our gripper with an underlying grid, i.e., a complementary device placed beneath the instruments, robustness and performance are further enhanced. CONCLUSION: Our prototype's performance in surgical instrument grasping stands on par with, if not surpasses, that of comparable contemporary studies, ensuring its competitiveness. Our gripper proves to be robust, cost-effective, and simple, requiring no instrument-specific grasping strategies. Future research will focus on addressing the sterilizability of our prototype and assessing the viability of the introduced grid for intra-operative use.