Sliding mode control with self-adaptive parameters of a 5-DOF hybrid robot.

Due to the advantages of high stiffness, high precision, high load capacity and large workspace, hybrid robots are applicable to drilling and milling of complicated components with large sizes, for instance car panels. However, the difficulty in establishing an exact dynamic model and external disturbances affect the high accuracy control directly, which will decrease the machining accuracy and thereby affect the machining quality and efficiency of the system. Sliding mode control is an effective approach for high-order nonlinear dynamic systems since that it is very insensitive to disturbances and parameter variations. However, chattering may exist in traditional sliding mode control with fixed parameters, which results from a constant approaching speed. Besides, the approaching speed will affect the chattering strength directly. To solve these problems, a modified sliding mode controller with self-adaptive parameters is proposed to enhance the trajectory-tracking performance of a 5-degree-of-freedom hybrid robot. Firstly, the kinematic model of the robot is established. Then adopting the principle of virtual work, a rigid dynamic model of the robot is built. Based on the built dynamic model, a modified sliding mode control method is developed, of which the approaching speed is dependent on the system state. Finally, the sliding mode controller with self-adaptive parameters is created for a hybrid robot. The proposed sliding mode controller can achieve a rapid approaching speed and suppress chattering simultaneously. Simulation results demonstrate that the proposed modified sliding mode controller can achieve a comparatively accurate and smooth trajectory, which owns good robustness to external disturbances.

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.

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.

Effects of modifying hinotori™ surgical robot system on perioperative outcome of robot-assisted radical prostatectomy.

OBJECTIVES: One of the main advantages of the hinotori™ surgical robot system (HSRS) is that it can be easily adjusted. This study aimed to clarify the effects of modifying the HSRS on the perioperative outcomes of robotic-assisted radical prostatectomy (RARP). METHODS: Overall, 158 cases of RARP using the HSRS were classified into three groups based on the modification to the system: group A (no modification, 70 cases), group B (addition of the ability to switch between two types of scopes and to adjust the arm base tilt back and forth, left and right, 42 cases), and group C (reduction of arm floating sensation, mitigation of emergency stop during arm collision, and addition of clutch function via hand switch in addition to foot pedal, 46 cases). The perioperative outcomes of each group were compared. RESULTS: The median of operation time, cockpit time, and cockpit time excluding the time required for lymph node dissection of group C were 223, 146, and 135 min, respectively, where are significantly shorter than those of group A (308, 228, and 208 min, p < 0.0001, respectively) and group B (319, 241, and 214 min, p < 0.0001, respectively). There was no significant difference in the rate of positive margin rates and the pad-free rate before the first follow-up visit among these three groups. The complication rates in groups A, B, and C were 11.4%, 9.4%, and 8.4% (Clavien-Dindo grades I-II), and 4.3%, 2.4%, and 0% (grade III), respectively. CONCLUSIONS: The modifications to the HSRS have enabled smoother surgical procedures for RARP.

Development of a bionic hexapod robot with adaptive gait and clearance for enhanced agricultural field scouting.

High agility, maneuverability, and payload capacity, combined with small footprints, make legged robots well-suited for precision agriculture applications. In this study, we introduce a novel bionic hexapod robot designed for agricultural applications to address the limitations of traditional wheeled and aerial robots. The robot features a terrain-adaptive gait and adjustable clearance to ensure stability and robustness over various terrains and obstacles. Equipped with a high-precision Inertial Measurement Unit (IMU), the robot is able to monitor its attitude in real time to maintain balance. To enhance obstacle detection and self-navigation capabilities, we have designed an advanced version of the robot equipped with an optional advanced sensing system. This advanced version includes LiDAR, stereo cameras, and distance sensors to enable obstacle detection and self-navigation capabilities. We have tested the standard version of the robot under different ground conditions, including hard concrete floors, rugged grass, slopes, and uneven field with obstacles. The robot maintains good stability with pitch angle fluctuations ranging from -11.5° to 8.6° in all conditions and can walk on slopes with gradients up to 17°. These trials demonstrated the robot's adaptability to complex field environments and validated its ability to maintain stability and efficiency. In addition, the terrain-adaptive algorithm is more energy efficient than traditional obstacle avoidance algorithms, reducing energy consumption by 14.4% for each obstacle crossed. Combined with its flexible and lightweight design, our robot shows significant potential in improving agricultural practices by increasing efficiency, lowering labor costs, and enhancing sustainability. In our future work, we will further develop the robot's energy efficiency, durability in various environmental conditions, and compatibility with different crops and farming methods.

Improvement of Self-Driven Nanowire-Based Ultraviolet Photodetectors by Metal-Organic Frameworks for Controlling Humanoid Robots.

Self-driven photodetectors (PDs) hold significant potential for the development of new information devices, which boast the advantages of ultralow power consumption and straightforward fabrication. In this study, we have proposed and demonstrated a self-driven ultraviolet PD utilizing gallium nitride/metal-organic framework (GaN/MOF) heterojunction nanowires successfully. By introducing Gd-ETTC MOFs on the surface of GaN nanowires, the photocurrent and responsivity of the device can be improved by approximately 75% under 310 nm illumination. Furthermore, they can also be effectively enhanced under visible light illumination. Owing to the appropriate energy level alignment, Gd-ETTC MOFs can serve as both a light harvester and a hole conductor, facilitating the efficient absorption, separation, and transmission of photogenerated carriers. It has been observed that due to reduced interface resistance, MOFs can enhance the charge transport through the acceleration of charge transfer. Furthermore, the PD equipped with MOFs is capable of continuous operation for 30,000 s, a feat attributable to the exceptional stability of both GaN nanowires and Gd-ETTC MOFs. By implementation of the humanoid robot systems, the control commands from the self-driven PD can drive the humanoid robot to execute different actions. The PD-equipped autonomous feedback system of a humanoid robot enables a seamless integration of light perception with intelligent robotic actions. Therefore, the design and demonstration of GaN/MOF nanowires hold significant reference value for further enhancing the performance of PDs and broadening their applications in ultralow-power artificial intelligence systems, humanoid intelligent robots, etc.

Enhancing postural stability in musculoskeletal quadrupedal locomotion through tension feedback for CPG-based controller.

A central pattern generator (CPG)-based controller enhances the adaptability of quadrupedal locomotion, for example, by controlling the trunk posture. The conventional CPG-based controllers with attitude control often utilized the posture angle as feedback information. However, if the robot's body is as soft as a musculoskeletal structure, it can measure the over-tilting of the trunk based on proprioceptive information of the muscles. In general, proprioceptive information such as muscle tension changes more rapidly than posture angle information. Therefore, a feedback loop based on proprioceptive information has great potential to respond to sudden disturbances that occur during locomotion over uneven terrain. In this research, we proposed a CPG-based controller utilizing the tension of soft pneumatic artificial muscles (PAMs). Musculoskeletal quadruped robots driven by PAMs are so soft, which prevents over-extension of the leg and over-tilting of the trunk to some extent. In addition, tension, one of the proprioceptive information of PAMs, exhibits high sensitivity to changes in trunk posture because the soft body's motion easily changes due to over-titing of the trunk. To validate the efficacy of the proposed controller, we conducted numerical simulations with a simple quadruped model and experiments with a musculoskeletal quadruped robot. As a result, the tension feedback was effective for posture stabilization when the robot's locomotion was subjected to disturbances. Moreover, the tension feedback was effective in improving the running velocity over uneven terrain. These results will enhance the locomotion capability of musculoskeletal quadruped robots, advancing their practical application. .

Establishing the Foundations of Emotional Intelligence in Care Companion Robots to Mitigate Agitation Among High-Risk Patients With Dementia: Protocol for an Empathetic Patient-Robot Interaction Study.

BACKGROUND: An estimated 6.7 million persons are living with dementia in the United States, a number expected to double by 2060. Persons experiencing moderate to severe dementia are 4 to 5 times more likely to fall than those without dementia, due to agitation and unsteady gait. Socially assistive robots fail to address the changing emotional states associated with agitation, and it is unclear how emotional states change, how they impact agitation and gait over time, and how social robots can best respond by showing empathy. OBJECTIVE: This study aims to design and validate a foundational model of emotional intelligence for empathetic patient-robot interaction that mitigates agitation among those at the highest risk: persons experiencing moderate to severe dementia. METHODS: A design science approach will be adopted to (1) collect and store granular, personal, and chronological data using Personicle (an open-source software platform developed to automatically collect data from phones and other devices), incorporating real-time visual, audio, and physiological sensing technologies in a simulation laboratory and at board and care facilities; (2) develop statistical models to understand and forecast the emotional state, agitation level, and gait pattern of persons experiencing moderate to severe dementia in real time using machine learning and artificial intelligence and Personicle; (3) design and test an empathy-focused conversation model, focused on storytelling; and (4) test and evaluate this model for a care companion robot (CCR) in the community. RESULTS: The study was funded in October 2023. For aim 1, architecture development for Personicle data collection began with a search for existing open-source data in January 2024. A community advisory board was formed and met in December 2023 to provide feedback on the use of CCRs and provide personal stories. Full institutional review board approval was received in March 2024 to place cameras and CCRs at the sites. In March 2024, atomic marker development was begun. For aim 2, after a review of open-source data on patients with dementia, the development of an emotional classifier was begun. Data labeling was started in April 2024 and completed in June 2024 with ongoing validation. Moreover, the team established a baseline multimodal model trained and validated on healthy-person data sets, using transformer architecture in a semisupervised manner, and later retrained on the labeled data set of patients experiencing moderate to severe dementia. In April 2024, empathy alignment of large language models was initiated using prompt engineering and reinforcement learning. CONCLUSIONS: This innovative caregiving approach is designed to recognize the signs of agitation and, upon recognition, intervene with empathetic verbal communication. This proposal has the potential to have a significant impact on an emerging field of computational dementia science by reducing unnecessary agitation and falls of persons experiencing moderate to severe dementia, while reducing caregiver burden. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55761.

Hyperspectral imaging for pest symptom detection in bell pepper.

BACKGROUND: The automation of pest monitoring is highly important for enhancing integrated pest management in practice. In this context, advanced technologies are becoming increasingly explored. Hyperspectral imaging (HSI) is a technique that has been used frequently in recent years in the context of natural science, and the successful detection of several fungal diseases and some pests has been reported. Various automated measures and image analysis methods offer great potential for enhancing monitoring in practice. RESULTS: In this study, the use of hyperspectral imaging over a wide spectrum from 400 to 2500 nm is investigated for noninvasive identification and the distinction of healthy plants and plants infested with Myzus persicae (Sulzer) and Frankliniella occidentalis (Pergande) on bell peppers. Pest infestations were carried out in netted areas, and images of single plants and dissected leaves were used to train the decision algorithm. Additionally, a specially modified spraying robot was converted into an autonomous platform used to carry the hyperspectral imaging system to take images under greenhouse conditions. The algorithm was developed via the XGBoost framework with gradient-boosted trees. Signals from specific wavelengths were found to be associated with the damage patterns of different insects. Under confined conditions, M. persicae and F. occidentalis infestations were distinguished from each other and from the uninfested control for single leaves. Differentiation was still possible when small whole plants were used. However, application under greenhouse conditions did not result in a good fit compared to the results of manual monitoring. CONCLUSION: Hyperspectral images can be used to distinguish sucking pests on bell peppers on the basis of single leaves and intact potted bell pepper plants under controlled conditions. Wavelength reduction methods offer options for multispectral camera usage in high-grown vegetable greenhouses. The application of automated platforms similar to the one tested in this study could be possible, but for successful pest detection under greenhouse conditions, algorithms should be further developed fully considering real-world conditions.

Effects of Single-Joint Type Hybrid Assistive Limb in Knee Rehabilitation on Reduction of Pre-motor Time and Increased Rate of Fast Muscle Activation for Anterior Cruciate Regiment (ACL) Reconstruction.

BACKGROUND/OBJECTIVES: Changes in muscle characteristics after post-anterior cruciate regiment (ACL) reconstruction are common. Knee robotic-assisted therapy using hybrid assistive limb (HAL) single-joint training for recovery from ACL injury has the potential to optimize muscle activity; however, its neurophysiological effects remain unclear. Thus, this study aimed to explore the electrophysiological parameters. METHODS: This prospective, nonrandomized, controlled trial was conducted between December 2021 and January 2024. The patients were divided into two groups: the HAL group and the control group, each including five patients who underwent arthroscopic ACL reconstruction. Knee HAL single-joint training was conducted once weekly for three sessions. Three electrophysiological measures were examined related to knee neuromuscular responses pre-motor time, peak amplitude time, and neuromuscular rate of electromyography rise (RER) using surface electromyography (EMG). The pre-motor time and peak amplitude time were assessed in both groups at each session pre- and post-intervention. Both groups were evaluated for RER at postoperative weeks 17 and 21. RESULTS: Regarding the interaction of pre-motor time within each group, the interaction of pre-motor time within each group, the effect size of vastus medialis (VM) was larger in the HAL group. The peak amplitude time of EMG, the overall estimated marginal means, and the HAL group exhibited a significant difference in the VM (p=0.019), while vastus lateralis (VL) showed no significant difference but a larger effect size (d=0.61). The RER revealed a significant difference in semitendinosus-RER30ms in the HAL group (p=0.044). CONCLUSIONS: The knee HAL training for post-ACL reconstruction patients may influence neurophysiological outcomes.

Microstimulation-based path tracking control of pigeon robots through parameter adaptive strategy.

Research on animal robots utilizing neural electrical stimulation is a significant focus within the field of neuro-control, though precise behavior control remains challenging. This study proposes a parameter-adaptive strategy to achieve accurate path tracking. First, the mapping relationship between neural electrical stimulation parameters and corresponding behavioral responses is comprehensively quantified. Next, adjustment rules related to the parameter-adaptive control strategy are established to dynamically generate different stimulation patterns. A parameter-adaptive path tracking control strategy (PAPTCS), based on fuzzy control principles, is designed for the precise path tracking tasks of pigeon robots in open environments. The results indicate that altering stimulation parameter levels significantly affects turning angles, with higher UPN and PTN inducing changes in the pigeons' motion state. In experimental scenarios, the average control efficiency of this system was 82.165%. This study provides a reference method for the precise control of pigeon robot behavior, contributing to research on accurate target path tracking.

Breaking into the black box of customer perception towards robot service: Empirical evidence from service sector.

The advent of artificial intelligence and machine learning has enabled robots to serve in consumer market for a better customer experience. Nevertheless, acceptance of robotic technology among consumers is still lacking. Therefore, this study has developed an integrated model with robot appearance, expectation confirmation model, diffusion of innovation and theory of planned behavior and empirically investigates customer intention to use service robot. The research model is empirically tested with 349 responses retrieved from customers visiting retail stores. Statistical results have revealed that customer innovativeness, compatibility, behavioral control, expectation confirmation, service robot appearance and subjective norms explained R 2 80.1 % variance in customer attitude to use service robot. Practically, this research has suggested that policy makers should pay attention in innovativeness, compatibility, perceived behavioral control, expectation confirmation, robot appearance and subjective norms to boost robot service acceptance among customers. This study is original as it develops an integrated model with the combination robot appearance, theory of planned behavior, expectation confirmation and diffusion of innovation theory. In addition to that customer self-identity is conceptualized as moderating factor and hence distinguishing current research with past studies.

Effect of enhanced recovery after surgery on postoperative outcomes in children undergoing robot-assisted laparoscopic pyeloplasty.

OBJECTIVE: To assess the effects of the enhanced recovery after surgery (ERAS) perioperative protocol on the outcomes of robot-assisted laparoscopic pyeloplasty (RALP) in pediatric patients. METHODS: A total of 57 children who underwent RALP at our center between November 2021 and December 2023 were included in the study. They were randomly assigned to either the ERAS (intervention) group or the non-ERAS (control) group. The analysis focused on comparing the length of hospital stay, recovery of gastrointestinal function, incidence of complications within 90 days post-surgery, postoperative extubation time (urinary tube and double-J tube), postoperative auxiliary examinations, and readmission rates within 30 days. Additionally, the patients were divided into two age groups: <4 years old and ≥4 years old, to assess pain severity. RESULTS: There were no significant differences in preoperative general information, preoperative auxiliary examination findings, or intraoperative conditions between the ERAS and non-ERAS groups. The ERAS group had a significantly shorter postoperative hospital stay compared to the non-ERAS group. Furthermore, the time to the first postoperative bowel movement was shorter, and the incidence of postoperative complications was significantly lower in the ERAS group. Among children <4 years old, there was no significant difference in pain severity between the two groups. However, in children ≥4 years old, the ERAS group experienced significantly lower pain levels at 6 and 24 h post-surgery compared to the non-ERAS group. DISCUSSION: The findings of this prospective randomized controlled trial should determine if ERAS is superior to traditional perioperative management in children undergoing RALP, particularly regarding postoperative hospital stay, intestinal function recovery, pain response, and complication rates. We anticipate that our data will offer valuable clinical insights and guidance for the implementation of ERAS in pediatric robotic surgery for urinary diseases. CONCLUSION: The ERAS protocol can reduce the length of hospital stay, aid in the recovery of gastrointestinal function, and lower postoperative complication rates. It also has the potential to lessen postoperative pain to varying degrees in certain pediatric patients. ERAS is a safe and effective protocol for pediatric patients undergoing RALP.

Robot-assisted minimally invasive esophagectomy for esophageal cancer in the left lateral decubitus position.

BACKGROUND: The use of robot-assisted minimally invasive esophagectomy (RAMIE) in the prone position for esophageal cancer has been currently increasing worldwide. In future, as surgical-assisted robots become more widespread, it is estimated that only two methods of transthoracic approach will remain: RAMIE and open thoracotomy for thoracic esophageal cancer. RAMIE in the left lateral decubitus position (RAMIE-LLDP) has the same field of view as open thoracotomy, is safe in emergency situations, and provides education on open thoracotomy. METHODS: Between September 2020 and April 2024, RAMIE-LLDP was performed in 64 consecutive patients with esophageal cancer. RAMIE-LLDP was performed with the operating table rotated and tilted 45° to the ventral side under artificial pneumothorax. The hand-control setting of the surgical-assist robot system was reversed left to right when the Patient Cart was rolled from the same direction as the RAMIE in the prone position. RESULTS: The mean total surgery and console times during the thoracic procedure were 254-min overall and 225 min in the last 24 cases and 195-min overall and 178- min in the last 24 cases, respectively. The mean amount of blood loss was 203.4 g overall and 28.3 g in the last 24 cases. Postoperative recurrent laryngeal nerve palsy with Clavien-Dindo classification (CD) was ≥ 2 in six patients (9.4%). Postoperative pneumonia with CD ≥ 2 was observed in 11 patients (17.2%). Conversion to open thoracotomy was observed in three patients (4.7%). In all three patients, an immediate conversion to thoracotomy without patients' position change was actually possible and no serious complications were noted. No mortality occurred within 30 days postoperatively. CONCLUSION: RAMIE-LLDP which facilitates emergency thoracotomy has perioperative results comparable to those of conventional thoracoscopic esophagectomy and is educational for open surgery. RAMIE-LLDP is the safest and most optimal surgery for esophageal cancer.

Current status, evolution, and future perspectives in robotic platform systems for prostate cancer treatment: a narrative review.

BACKGROUND AND OBJECTIVE: Robotic surgery has contributed greatly to the shift from traditional surgery to minimally invasive surgery. Urology is the major field of application of robotic surgery. Several urological procedures, especially radical prostatectomy, benefit from the use of robotic surgery. METHODS: Non-systematic research of the literature was performed using "Robot-assisted radical prostatectomy" and "Robotic platforms" as keywords to understand the actual situation and the future perspectives of this technology in prostate cancer treatment. KEY CONTENT AND FINDINGS: The robotic platform landscape is constantly evolving. DaVinci has always been the mainstay in this field, particularly after the advent of the new single port platforms. New platforms are emerging, providing an alternative option to the well-known DaVinci system. Since in literature, few studies compare the use of different robotic platforms, their application in urological procedures is not yet widely used, for both oncological and non-oncological procedures. Furthermore, artificial intelligence begins to play a role in this landscape and could be useful for future developments. So further studies are warranted to give a full comprehension of the whole scenario. CONCLUSIONS: This review aims to analyze the current state of the use of robotic platforms in urology, particularly in radical prostatectomy, and to understand the evolution.

Intravenous indocyanine green to evaluate distal ureteral vascularity during robot-assisted radical cystectomy with intracorporeal urinary diversion.

PURPOSE: The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES). METHODS: The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates. RESULTS: We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2-5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3 cm, p = 0.007). CONCLUSION: In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis.

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.

Human in the collaborative loop: a strategy for integrating human activity recognition and non-invasive brain-machine interfaces to control collaborative robots.

Human activity recognition (HAR) and brain-machine interface (BMI) are two emerging technologies that can enhance human-robot collaboration (HRC) in domains such as industry or healthcare. HAR uses sensors or cameras to capture and analyze the movements and actions of humans, while BMI uses human brain signals to decode action intentions. Both technologies face challenges impacting accuracy, reliability, and usability. In this article, we review the state-of-the-art techniques and methods for HAR and BMI and highlight their strengths and limitations. We then propose a hybrid framework that fuses HAR and BMI data, which can integrate the complementary information from the brain and body motion signals and improve the performance of human state decoding. We also discuss our hybrid method's potential benefits and implications for HRC.

Tumor involvement of the trigone and urethra at the time of robot-assisted radical cystectomy is associated with adverse oncological outcomes.

INTRODUCTION: The trigone/urethra (T/U) has a distinct embryologic origin and a different histologic morphology compared to the rest of the urinary bladder. We sought to determine the association between tumors involved in the T/U and the presence of variant histology, pathologic, and oncologic outcomes in patients who underwent robot-assisted radical cystectomy (RARC). METHODS: Tumor location was classified into 2 groups: tumors in the bladder walls only, or tumors in the T/U area, with or without involvement of other bladder walls. Univariable and multivariable Cox regression models were used to determine the association between T/U with recurrence-specific (RSS), cancer-specific (CSS), and overall survival (OS). RESULTS: 608 patients who underwent RARC were identified, T/U involvement occurred in 191 (31%). Patients in the T/U group were more likely to have pT3/pT4 (57% vs. 42%, P < 0.01), positive surgical margins (21% vs. 9%, P < 0.01), and received salvage chemotherapy more frequently (16% vs. 8%, P < 0.01). Squamous variant histology was more frequent in the T/U group (25% vs. 17%, P = 0.02). On multivariable analysis, T/U location was independently associated with RSS (HR1.63, 95% CI 1.23-2.16, P < 0.01) and CSS (HR1.50, 95% CI 1.04-2.16, P = 0.02) but not OS. CONCLUSION: Residual T/U tumor involvement was associated with a higher risk of an advanced tumor stage, positive margin, cancer recurrence, and cancer-specific death.

[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.