Search Results (125)

Introduction: Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision, ergonomics, and individualized surgical planning. In the context of personalized medicine, robotic technology may enable tailoring of surgical strategies to patient-specific anatomy, spleen size, and comorbid hematologic conditions. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science, and EMBASE databases to locate studies on robotic splenectomies in children. This review was prospectively registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods when appropriate. 95% prediction intervals were calculated, and the certainty of evidence for each outcome was assessed using the GRADE approach. Results: This review included 272 pediatric patients from 16 studies conducted between 2003 and 2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (−0.93 days; 95% CI: −1.61 to −0.24; p = 0.01) was found, though this became marginally significant after HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (−63.88 mL; 95% CI: −120.38 to −7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions: Robotic-assisted splenectomy in pediatric patients has been reported as technically feasible and performed safely in selected cases. However, the small number of studies, their retrospective design, substantial methodological heterogeneity, and the resulting very low certainty of the evidence according to GRADE preclude any firm conclusions about its comparative safety or efficacy versus laparoscopy. Well-designed prospective studies are needed to clarify its clinical benefits. Full article

Background: Distal pancreatectomy (DP) is a potentially curative procedure for tumors of the pancreatic body and tail. Minimally invasive DP (MIDP), including laparoscopic and robotic techniques, is increasingly being adopted. This study aimed to evaluate the perioperative outcomes of robotic DP (RDP) in comparison with laparoscopic and open approaches using a network meta-analysis and meta-regression. Methods: We systematically searched MEDLINE, EMBASE, Web of Science, and Scopus for studies comparing at least two surgical approaches. Both Bayesian and frequentist network meta-analyses were performed. Results: Sixty-seven studies involving 18,113 patients met the inclusion criteria. Surface under the cumulative ranking (SUCRA) analysis showed that RDP ranked first in 84.6% of measured parameters. Laparoscopic DP (LDP) demonstrated intermediate performance, whereas open DP (ODP) consistently ranked lowest. Operative time was significantly longer for RDP compared with ODP (MD = +25.93 min, 95% CI 7.68–44.18), while LDP and ODP were comparable. RDP significantly reduced 30-day mortality (OR = 0.37, 95% CI 0.16–0.84) and conversion rates compared with LDP (OR = 0.30, 95% CrI 0.22–0.40). Both minimally invasive approaches (RDP and LDP), compared with open surgery, were associated with reduced blood loss (−304 mL and −273 mL), fewer transfusions (OR 0.25 and 0.30), smaller transfused volumes (−1.98 and −1.86 units), shorter ICU stays (−4.0 and −2.3 days), fewer reinterventions (OR 0.45 and 0.56), and shorter hospital stays (−8.8 and −6.9 days), respectively. Conclusions: Although associated with longer operative time, RDP appears safe and may confer significant advantages over both laparoscopic and open surgery, including reduced 30-day mortality, lower conversion rates, and improved perioperative outcomes, particularly when performed in high-volume, well-equipped centers. Full article

Introduction: In minimally invasive, off-clamp partial nephrectomy (ocMIPN), the reconstructive strategy profoundly influences functional outcomes. Traditional nephrometry scores aid preoperative planning but do not directly inform the choice of closure technique. This dual-institutional study aimed primarily to identify preoperative CT-derived parameters predictive of renorrhaphy versus a sutureless approach, and secondarily to compare perioperative and functional outcomes between these techniques. Methods: We retrospectively analyzed 201 consecutive ocMIPN cases performed using a standardized off-clamp technique by two experienced surgical teams across robotic platforms and conventional laparoscopy. Preoperative CT scans were centrally reviewed to quantify morphometric features, including contact surface area (CSA), tumor radius, and Gerota’s fascia thickness. Univariable and multivariable logistic regression models—one restricted to radiologic variables and one expanded with RENAL score terms—were generated to identify independent predictors. Perioperative outcomes, renal functional metrics, and Trifecta rates were compared between cohorts. Results: Among the 201 patients, 101 (50.2%) underwent sutureless reconstruction and 100 (49.8%) renorrhaphy. Cohorts were comparable at baseline except for tumor size (3.1 vs. 3.6 cm; p = 0.04). In multivariable analysis, CSA > 15 cm² (OR 3.93; 95% CI 1.26–12.26; p = 0.02) and tumor radius (OR 1.14 per mm; 95% CI 1.01–1.29; p = 0.04) consistently predicted renorrhaphy, while Gerota’s fascia < 10 mm emerged as significant only in the expanded specification (OR 0.08; 95% CI 0.01–0.70; p = 0.02). Integration with RENAL improved predictive performance (ΔAUC 0.06; NRI 0.14; IDI 0.07), and the final model demonstrated strong discrimination (AUC 0.81) with satisfactory calibration. Perioperative outcomes, postoperative renal function, and Trifecta achievement were similar between groups (all p ≥ 0.21). Conclusions: A concise set of CT-derived morphologic markers—CSA, tumor radius, and perinephric fascia thickness—anticipated reconstructive strategy in ocMIPN and augmented the discriminatory power of RENAL nephrometry. When anatomy was favorable, sutureless repair was not associated with statistically significant differences in perioperative safety or renal function, although the study was not powered for formal equivalence testing. These findings support the integration of radiologic markers into preoperative planning frameworks for nephron-sparing surgery. Full article

Background and Objectives: This study compares laparoscopic and robotic surgical techniques for rectal cancer, focusing on oncologic outcomes, mesocolic excision quality, lymph node yield, and postoperative sexual and urinary function, while also exploring patient satisfaction and recovery trajectories through clinical outcomes and validated questionnaires. Materials and Methods: A retrospective analysis was conducted on 100 patients who underwent rectal cancer surgery between 2017 and 2021 at our tertiary center—53 underwent laparoscopic and 47 robotic surgery. Demographic data, tumor characteristics, and surgical details (procedure type, lymph node yield, morbidity, and mortality) were collected, and postoperative outcomes, including local recurrence, metastasis, need for reoperation, urinary incontinence, and sexual dysfunction, were compared. Functional outcomes were evaluated using the LARS questionnaire, Wexner score, IPSS, IIEF, and FSFI. Results: No significant differences were found in age, BMI, tumor size, or ASA scores between groups. Robotic surgery was associated with shorter hospital stays (p < 0.001), no conversions to open surgery (vs. 28.3% in laparoscopy), and zero cases of positive circumferential margins (vs. 35.8% in laparoscopy; p < 0.001). Lymphatic and perineural invasion rates were similar. Tumor recurrence occurred in four robotic and six laparoscopic cases, and factors significantly associated with recurrence included pathological stage, hospital stay, and adjuvant treatment. Robotic surgery showed improved urinary and sexual function, with lower Wexner, IPSS, and FSFI scores. Conclusions: Robotic surgery is a safe, effective, and patient-friendly alternative to laparoscopy, offering better preservation of continence and sexual function, reduced conversion rates, and shorter hospitalization, and should be considered the preferred approach in appropriately selected rectal cancer patients. Full article

Objective: This retrospective cohort study compares surgical outcomes among patients with endometrial carcinoma (EC) after the implementation of a robotic-assisted (RA) surgical program at a tertiary care center. Methods: A total of 122 EC patients who underwent surgery between March 2022 and February 2025 were included. Patients were divided into two cohorts based on the implementation of RA surgery: Group 1 (March 2022–August 2023) and Group 2 (September 2023–February 2025). Data collected included demographics, surgical approach, operative time, hospital stay, completion of staging procedures, and 30-day postoperative complications. Results: RA laparoscopy was used predominantly in Group 2, replacing conventional laparoscopy (CL). Laparotomy was significantly less frequent in group 2 (11.9% vs. 36.4%; p < 0.001). Among patients with FIGO stage I, all patients underwent minimally invasive surgery (MIS) in Cohort 2 (100% vs. 71.9%; p < 0.001). Median hospital stay was significantly shorter in Group 2 (3 days vs. 4 days; p < 0.001). A 30-day mortality occurred in one patient (n = 1) within the total study cohort (0.82%) and was attributed to pulmonary embolism on postoperative day 14 after RA laparoscopy. Rates of Grade ≥3 postoperative complications were similar (7.3% vs. 7.5%), as were wound complications (5.5% vs. 3%). The use of sentinel lymph node (SLN) mapping increased significantly in Group 2 (91% vs. 54.5%; p < 0.001). Completion staging procedures were significantly reduced in group 2 (9.1% vs. 0%; p = 0.017). Conclusions: The integration of RA laparoscopy significantly reduced laparotomy rates and hospital stays while increasing SLN mapping. These results support the continued adoption of RA laparoscopy to enhance MIS and improve patient outcomes. Full article

Background: Long-term survival in penile cancer is dependent on the presence and extent of lymph node metastases. Historically, inguinal lymph node dissection (ILND) has been performed via an open approach (O-ILND). More recently, minimally invasive surgical alternatives (MIS-ILND) such as video-endoscopic and robot-assisted ILND have emerged. This review aims to compare the (1) perioperative outcomes, (2) complication rates, and (3) oncological efficacy between O-ILND and MIS-ILND. Methods: We conducted a PRISMA-compliant meta-analysis including studies comparing O-ILND versus MIS-ILND for penile cancer. Outcomes were pooled in random-effects meta-analyses. Results: Sixteen articles comprising 1054 patients were analysed. There was an observed trend towards longer operative time for the MIS-ILND approach (mean difference 28 min; 95% CI −2 to 58 min, p = 0.06), particularly with the robotic-assisted technique. Total LN yield (mean 12.3, mean difference 0.3, 95% CI −0.3 to 0.9, p = 0.13), and positive LN (RR 0.98, 95% CI 0.88–1.10, p = 0.75) were similar between groups. MIS-ILND significantly reduced complication rates for both minor (RR: 0.65, 95% CI 0.45–0.94, p = 0.02) and major complications (RR: 0.25, 95% CI 0.12–0.53, p = 0.002). Particularly, there was also lower wound infection rate with MIS-ILND (RR: 0.43, 95% CI 0.22–0.82, p = 0.02), corresponding to a shorter hospital stay of average 4 days (MD −4, 95% CI −6–−2, p = 0.05). Rates of skin/flap necrosis, lymphedema, lymphocele, and drainage time did not differ significantly. Local groin recurrence and overall survival did not differ between approaches. Conclusions: MIS-ILND is associated with fewer perioperative complications and shorter hospitalisation without compromising oncologic outcomes. These findings support its broader adoption, particularly in high-volume centres with appropriate surgical expertise. Full article

Background: Robotic liver resection (RLR) has seen remarkable advancements in recent years, overcoming many limitations of laparoscopic liver resection (LLR). RLR has evolved to include increasingly complex procedures, offering enhanced precision, reduced blood loss, and lower complication rates. Materials and Methods: A total of 150 consecutive RLRs, performed at the Department of General Surgery II and HPB Unit of Santa Chiara Hospital (Trento, Italy), between January 2013 and June 2024 were retrospectively reviewed. Collected data included demographics, disease etiology, operative parameters, oncologic margins, and perioperative outcomes. Results: Indications were malignant disease in 83% of cases while benign disease accounted for 17%. Minor resections accounted for 91%. Cirrhosis was present in 49% of patients (Child–Pugh A 91%; B 9%; mean MELD 9). According to the Iwate difficulty score, resections were low difficulty in 38% of cases, intermediate in 50%, advanced in 7%, expert in 5%. Conversion rate was 12%, mainly for bleeding or adhesions. Mean blood loss was 159 mL (66% <100 mL); Pringle maneuver was used in 3%; drains omitted in 45%; ICG fluorescence used in 81%. Mean operative time was 250 min (console time 184 min). Mean lesion size was 34 mm; R0 margin rate was 82%. Overall mortality was 1.3%; morbidity 24% (Clavien–Dindo ≥ III in 10%). Mean hospital stay was 7 days (median 5; range 2–46). Conclusions: RLR is a safe and effective alternative to laparoscopy, providing comparable or superior perioperative outcomes. Medium-volume centers can achieve high-quality results with RLR. Continued technological advancements will further expand its applications to increasingly complex liver procedures. Full article

Background: Gastric cancer is increasingly being diagnosed at early stages, enabling the application of curative oncological and surgical approaches. With the growing adoption of minimally invasive techniques, robotic surgery is gaining increasing prominence in the operating rooms. As described by Stoyanova et al., the robotic completely intracorporeal jejunal pouch reconstruction after gastrectomy offers potential benefits, including technical feasibility without significant intraoperative challenges or prolonged operative times, as well as long-term advantages such as a reduced incidence of midline incision hernias. Objectives: This retrospective, single-center study is the first to compare the clinical and oncological outcomes after laparoscopic versus robotic completely intracorporeal jejunal pouch reconstruction following gastrectomy. Methods: A total of 27 patients who underwent gastrectomy between 2018 and 2025 were included in the study, and were divided into two groups: 12 patients in the robotic and 15 patients in the laparoscopic group. The study evaluated mean operative time, intraoperative and postoperative complications, length of hospital and ICU stay, and certain oncological outcomes. Results: A main purpose of the robotic method is the avoidance of an unfavourable midline incision due to the completely intracorporeal pouch reconstruction without substantial technical or clinical disadvantages. Conclusions: Further research involving larger patient cohorts and extended follow-up periods is necessary to draw more definitive conclusions about the relative advantages of this surgical technique. Full article

Objective: The primary objective of this study was to evaluate the evolution of surgical approaches in the management of endometrial cancer in Polish tertiary referral hospitals, comparing the use of minimally invasive surgery (MIS) and laparotomy in 2023 versus 2013. Methods: This retrospective observational study analyzed data from tertiary referral centers in Poland. All surgeries performed for apparently early-stage endometrial cancer in 2013 and 2023 were included. Results: A total of 1062 patients were analyzed, with 417 undergoing operations in 2013 and 640 in 2023. In 2013, 92.6% (386/417) of patients underwent laparotomy. By 2023, 80.1% (513/640) of patients were treated using minimally invasive approaches, including laparoscopy (56.2%, 362/640), robotic-assisted laparoscopy (21.7%, 139/640), and vaginal surgery (1.9%, 12/640). No conversions to laparotomy were recorded in 2013. In 2023, 22 conversions occurred—21 in the laparoscopy group (5.8%, 21/362) and one in the vaginal surgery group (8.3%, 1/12). No conversions were reported in the robotic-assisted group. Intraoperative complications were observed in 2.2% (8/362) of laparoscopic cases, and postoperative complications in 4.4% (16/362). In the robotic-assisted group, one intraoperative complication (0.7%) was reported, with no postoperative complications. Conclusions: Over the past decade, there has been a significant shift in the surgical management of endometrial cancer in Poland, with a growing preference for minimally invasive surgery (MIS). The rate of conversion from MIS to laparotomy remains below 6%. Robotic-assisted laparoscopic surgery may offer additional benefits, particularly for obese patients. Full article

Background and Objectives: Hysterectomy is a common non-obstetric procedure. Minimally invasive techniques, such as laparoscopy and robot-assisted surgery, have replaced open surgery for benign gynecologic conditions. Robotic surgery offers reduced blood loss and shorter hospital stays but is limited by high costs. Articulating laparoscopic instruments aim to replicate robotic dexterity cost-effectively. However, comparative data on these two approaches in hysterectomy are limited. Materials and Methods: This multicenter study analyzed the outcomes of hysterectomies for benign gynecological diseases using articulating laparoscopic instruments (prospectively recruited) and robot-assisted surgery (retrospectively reviewed). The surgeries were performed by minimally invasive gynecological surgeons in South Korea, Japan, and Taiwan. The baseline characteristics, operative details, and outcomes, including operative time, blood loss, complications, and hospital stay, were compared. Statistical significance was set at p < 0.05. Results: A total of 151 patients were analyzed, including 67 in the articulating laparoscopy group and 84 in the robot-assisted group. The operating times were comparable (114.9 vs. 119.9 min, p = 0.22). The articulating group primarily underwent dual-port surgery (79.1%), whereas the robot-assisted group required four or more ports in 71.4% of the cases (p < 0.001). Postoperative complications occurred in both groups, without a significant difference (9.0% vs. 3.6%, p = 0.17). No severe complications or significant differences in the 30-day readmission rates were observed. Conclusions: Articulating laparoscopic instruments provide outcomes comparable to robot-assisted surgery in hysterectomy while reducing the number of ports required. Further studies are needed to explore the learning curve and long-term impact on surgical outcomes. Full article

Colorectal surgery has undergone significant advances over the past few decades, driven by the evolution of minimally invasive techniques, particularly laparoscopy and robotics. While laparoscopy is widely recognized for its short-term benefits and oncological safety, the increasing adoption of robot-assisted surgery (RAS) has generated considerable debate regarding its clinical benefits, economic implications, and overall impact on patient outcomes. This narrative review synthesizes the existing evidence, highlighting the clinical and economic aspects of RAS in colorectal surgery, while exploring areas for future research. The findings suggest that RAS offers potential technical advantages, including increased precision, three-dimensional visualization, and improved ergonomics, particularly in anatomically complex scenarios such as low rectal resections. Still, its superiority over laparoscopy remains inconclusive and current evidence is mixed. For colon cancer, meta-analyses and analyses of large cohorts suggest lower conversion rates and faster recovery with RAS, although data are mostly retrospective and lack long-term oncological endpoints. In rectal cancer, emerging evidence from randomized controlled trials demonstrates improved short-term outcomes. Additionally, the recently published three-year results of the REAL trial are the first to demonstrate enhanced oncological outcomes following RAS. However, findings remain inconsistent due to methodological heterogeneity, the absence of patient stratification, and limited data on long-term survival and cost-effectiveness. The available evidence indicates that RAS may offer advantages in selected patient populations, particularly for anatomically complex procedures. Yet, its overall utility remains uncertain. Future studies should emphasize high-quality randomized trials, stratified subgroup analyses, and standardized economic evaluations to better define the role of RAS in colorectal surgery. Full article

(1) Minimally invasive techniques are standard in colorectal surgery, though complete mesocolic excision (CME) with central lymphadenectomy remains technically demanding. Robotic systems may address these challenges. While the DaVinci system is well established, the modular Dexter system allows rapid switching between laparoscopy and robotics. (2) This prospective single-surgeon study compared right hemicolectomy with CME and intracorporeal anastomosis using Dexter, DaVinci, and conventional laparoscopy in 75 patients (25 per group) at a German high-volume center. Outcomes assessed included operative time, complications, lymph node yield, and CME quality. (3) Mean operative time was longest with DaVinci (190.5 min) versus Dexter (164.8 min) and laparoscopy (152.6 min). Intracorporeal anastomosis was more frequent in robotic groups. No significant differences were found in lymph node yield, CME quality, postoperative complications, length of stay, or survival. (4) The ability to convert briefly to laparoscopy during Dexter procedures helped manage challenging steps, especially during the learning curve. The results suggest that Dexter is a safe, feasible alternative to established robotic and laparoscopic techniques, with the added benefits of flexibility and integration into existing workflows. Full article

Background and Objectives: The isthmocele is a pouch-shaped defect in the anterior uterine wall, site of a previous cesarean section, due to a scar defect or dehiscence. The prevalence could be underestimated, but the rate of cesarean section is still high in the world. The preferable technique to correct this anomaly is not clearly indicated in the literature. Our objective is to evaluate the literature on the surgical treatment of isthmocele in pre-Cesarean women treated with minimally invasive technique. Our hypothesis is that robotic treatment is more effective than other procedures in women desirous of having children. Materials and Methods: The words “isthmocele”, “laparoscopy”, “robot” and “cesarean scar pregnancy” were searched on the main online scientific search sources (PubMed, Google Scholar, Scopus, WES, and Embase, etc.). We included articles in English and French, chosen for the relevance to the topic. We have decided to include also surgical corrections of isthmocele linked to pregnancies at the site of the defect, with particular attention to video training explanation. Results: We analyzed the literature about the minimally invasive surgery for the repair of an isthmocele, evaluating 20 articles. Comparing several surgical techniques, robotic-assisted laparoscopy could be an effective method to correct the defect, without high risk of intraoperative complications. Conclusions: As indicated in the literature, robotic tailored excision and repair of isthmocele (and of concomitant cesarean scar pregnancy) could be advantageous and safe, and it is necessary to promote video-training about this technique. Full article

Background and Clinical Significance: Robotic surgery reduces the need for extensive surgical approaches and lowers perioperative complications. In particular, it offers enhanced dexterity, three-dimensional visualization, and improved precision in confined anatomical spaces. Pelvic masses pose significant challenges due to their close relationship with critical neurovascular structures, making traditional open or laparoscopic approaches more invasive and potentially riskier. Robot-assisted resection, combined with intraoperative neurophysiological monitoring, may therefore offer a safe and effective solution for the management of complex pelvic lesions. Case Presentation: An 18-year-old woman was incidentally diagnosed with an 11 cm asymptomatic pelvic mass located anterior to the sacrum. Initial differential diagnoses included neurofibroma, teratoma, and myelolipoma. Histopathological examination confirmed a ganglioneuroma. Following multidisciplinary discussion, the patient underwent a robot-assisted en bloc resection using the Da Vinci Xi multiport system. Preoperative planning was aided by 3D modeling and intraoperative navigation. Conclusions: Surgery lasted 322 min. Preoperative and postoperative eGFR values were 145.2 mL/min and 144.0 mL/min, respectively. The lesion measured 11 cm × 9 cm × 8 cm. The main intraoperative complication was a controlled breach of the iliac vein due to its close adherence to the mass. No major postoperative complications occurred (Clavien-Dindo Grade I). The drain was removed on postoperative day 3, and the bladder catheter on day 2. The patient was discharged on postoperative day 5 without further complications. Presacral ganglioneuromas are rare neoplasms in a surgically complex area. A multidisciplinary approach using robotic-assisted laparoscopy with nerve monitoring enables safe, minimally invasive resection. This strategy may help avoid open surgery and reduce the risk of neurological and vascular injury. Full article

Background: The surgical management of endometrial cancer in severely obese patients (BMI ≥ 40) presents unique challenges. This study evaluates the outcomes of various surgical approaches in terms of safety and efficacy in lymph node retrieval. Methods: A systematic review and network meta-analysis focused on intra-operative complications, post-operative complications, severe complications, and complete surgical staging rates. The analysis included 1163 patients, following a pre-specified methodology based on the PRISMA-NMA guidelines. The study was registered on PROSPERO with protocol number CRD 395959. Results: Intra-operative complications: No significant difference was found between minimally invasive surgery (MIS, 233 patients) and laparotomy (LPT) (OR 0.68 [95% CI 0.21–2.26], p = 0.18). However, robotic surgery showed a significantly lower risk (OR 0.28 [0.10–0.74]). Post-operative complications: The MIS group (457 patients) had a lower risk compared to LPT (OR 0.41 [0.26–0.64]). Network analysis: Robotic surgery had a 70.7% probability of reducing intra-operative complications compared to laparoscopy (LPS) and a 99.2% probability compared to LPT. Laparoscopy was the safest option for post-operative complications, with a 74.3% probability. Robotic surgery had an 82.4% probability of achieving complete surgical staging compared to LPT. Conclusions: Robotic surgery shows superior outcomes for complete lymph nodal staging in obese endometrial cancer patients, while LPS is favorable for post-operative complications. Further studies are needed to optimize strategies. Full article