Search Results (2,684)

Background: Radiation exposure in the cardiac catheterization laboratory remains a critical occupational hazard for interventional cardiologists and staff, contributing to orthopedic injuries, cataracts, and malignancy. In parallel, procedural complexity continues to increase, demanding both precision and safety. Robotic-assisted percutaneous coronary intervention (R-PCI), alongside advanced shielding systems and imaging integration, has emerged as a transformative strategy to minimize radiation and enhance operator ergonomics. Objective: This state-of-the-art review synthesizes the current clinical evidence and technological advances that support a radiation-reduction paradigm in percutaneous coronary intervention (PCI), with a particular focus on the role of R-PCI platforms, procedural modifications, and emerging shielding technologies. Methods: We reviewed published clinical trials, registries, and experimental studies evaluating robotic PCI platforms, contrast and radiation dose metrics, ergonomic implications, procedural efficiency, and radiation shielding systems. Emphasis was given to the integration of CT-based imaging (coronary computed tomography angiography—CCTA, fractional flow reserve computed tomography—FFR-CT) and low-dose acquisition protocols. Results: R-PCI demonstrated technical success rates of 81–100% and clinical success rates up to 100% in both standard and complex lesions, with significant reductions in operator radiation exposure (up to 95%) and procedural ergonomic burden. Advanced shielding technologies offer radiation dose reductions ranging from 86% to nearly 100%, while integration of (CCTA), (FFR-CT), and Artificial Intelligence (AI) -assisted procedural mapping facilitates further fluoroscopy minimization. Robotic workflows, however, remain limited by lack of device compatibility, absence of haptic feedback, and incomplete integration of physiology and imaging tools. Conclusions: R-PCI, in combination with shielding technologies and imaging integration, marks a shift towards safer, radiation-minimizing interventional strategies. This transition reflects not only a technical evolution but a philosophical redefinition of safety, precision, and sustainability in modern interventional cardiology. Full article

Background: Sexuality in women with muscle-invasive bladder cancer (MIBC) undergoing radical treatment represents a crucial aspect of their overall quality of life, which is increasingly recognized as a key component of patient-centered care and long-term well-being. This review aimed to analyze the available literature to provide a comprehensive overview of the effects of treatments on female sexual function. Methods: We included all qualitative and quantitative studies addressing sexual function in patients treated for MIBC. Excluded were narrative reviews, case reports, conference abstracts, systematic reviews, and meta-analyses. The included studies involved women undergoing either robot-assisted radical cystectomy (RARC) or open RC (ORC), often with nerve-sparing, vaginal-sparing, or pelvic organ-preserving techniques. Data on oncological and functional outcomes were collected. Results: A systematic review of 29 studies including 1755 women was conducted. RC was performed via robotic/laparoscopic approaches in 39% of cases and open techniques in 61%. Urinary diversions included orthotopic neobladders (48%), ileal conduits (42%), ureterocutaneostomies (3%), and Indiana pouches (7%). Radiotherapy, used in 6% of patients, was mainly applied in a curative, trimodal setting. Sexual function was evaluated using various pre- and/or postoperative questionnaires, most commonly the EORTC QLQ-C22, FACT-BL, Bladder Cancer Index (BCI), LENT SOMA, and Female Sexual Function Index (FSFI). Radiotherapy was associated with reduced sexual function, though outcomes were somewhat better than with surgery. Among surgical approaches, no differences in sexual outcomes were observed. Conclusions: Further qualitative research is essential to better understand the experience of FSD after treatment. Incorporating both patient and clinician perspectives will be key to developing tailored interventions. In addition, efforts should be made to standardize the questionnaires used to assess female sexual dysfunction, in order to improve comparability across studies and ensure consistent evaluation. Full article

Background/Objectives: Despite advances in minimally invasive procedures, anastomotic leakages (ALs) after esophageal resections mark the most feared complication. Its early detection can lead to quick interventional treatment with improved survival. Nonetheless, early detection remains challenging, and scores are imprecise and complex. Methods: In our study we analyzed mediastinal drainage fluid to find parameters suggesting AL even before it became clinically evident and correlated them to routine biomarkers. All patients with AL after robotically assisted esophageal resections were included and matched 1:1 with uneventful controls. Additionally, transhiatal distal esophageal resections operated during this period were included. Drainage fluid was collected on postoperative days (PODs) 1–4 with consecutive blood gas analysis. Test quality was determined by the area under the curve (AUC) of the receiver operating characteristic curve (ROC). Results: In total, 40 patients were included, with 17 developing AL. There were no significant differences in gender, age, BMI or oncological treatment. The 30-day morbidity rate was 65.0%. The study was restricted to events in the first 12 days. While lactate value in drainage fluid differed significantly from POD 3 onwards in the two groups, serum CRP remained without significant differences. We developed the LacCRP score (CRP/30 + lactate/2). The AUC on POD 3 was 0.96, with a sensitivity and specificity of 100% and 75%, respectively. An estimator of 1.08 was found in multivariate analysis: one-point increase in the LacCRP score increases AL probability by 8%. Conclusions: This study demonstrates that postoperative lactate determinations in drainage fluid can predict AL after esophageal resection, and its combination with serum CRP results in a reliable LacCRP score. Full article

The field of human–robot collaboration (HRC) still lacks research studies regarding the evaluation of mental workload (MWL) through objective measurement to assess the mental state of operators in assembly tasks. This research study presents a comparative neuroergonomic analysis to evaluate the mental workload and productivity in three laboratory experimental conditions: in the first, the participant assembles a component without the intervention of the robot (standard scenario); in the second scenario, the participant performs the same activity in collaboration with the robot (collaborative scenario); in the third scenario, the participant is fully guided in the task in collaboration with the robot (collaborative guided scenario) through a system of guiding labels according to Poka-Yoke principles. The assessment of participants’ mental workload is shown through combinative analysis of subjective (NASA TLX) and objective (electroencephalogram—EEG). Objective MWL was assessed as the power waves ratio β/α (Beta—stress indicator, Alpha—relaxation indicator). Furthermore, the research used observational measurements to calculate the productivity index in terms of accurately assembled components across the three scenarios. Through ANOVA RM, mental workload significantly decreased in the activities involving the cobot. Also, an increase in productivity was observed shifting from the manual scenario to the cobot-assisted one (18.4%), and to the collaborative guided scenarios supported by Poka-Yoke principles (33.87%). Full article

Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant innovation in Germany, whereas clinical experience in the United States has already yielded promising results. The objective of this study is to present the outcomes of the first 50 patients examined with the ION system at our institutions. Materials and Methods: This is a retrospective, single-center analysis. We included the first 50 consecutive patients who underwent diagnostic evaluation of pulmonary nodules using the ION-RNB system, either in the Department of Thoracic Surgery or the Department of Pulmonology. Results: A total of 50 patients were evaluated, including 24 from the Department of Thoracic Surgery and 26 from the Department of Pulmonology. The pulmonary nodules were found in the peripheral third of the lung in 74% of cases, in the middle third in 18% of cases, and in the central third in 8% of cases. The mean lesion size was 1.64 cm (±0.91 cm). In all, 84% of the nodules were solid, 4% were subsolid, and 12% presented as ground-glass opacities (GGOs). Cone beam computed tomography (CBCT) was used to confirm tool-in-lesion position in 68% of cases compared to C-arm fluoroscopy in 32%. Additionally, radial endobronchial ultrasound (rEBUS) was applied in 30% of procedures. The overall diagnostic yield, independent of imaging modality or histological processing method, was 78%. When CBCT and formalin-fixed paraffin-embedded (FFPE) histological analysis were utilized, the diagnostic yield exceeded 90%. Conclusions: Initial clinical experience with the ION-RNB system in Germany shows encouraging results. The high diagnostic accuracy underlines the system’s potential for evaluating peripheral pulmonary lesions precisely. The use of advanced imaging techniques, particularly CBCT, and the choice of histopathological processing methods are critical variables in optimizing patient-centered diagnostic pathways. Further prospective studies are warranted to assess the long-term clinical utility of robotic-assisted bronchoscopy in diverse clinical settings. Full article

The effective use of nursing assistant robots requires an understanding of key acceptance factors. The study examined the differences in attitudes among 58 nursing students while performing ambulation tasks with and without an Adaptive Robotic Nursing Assistant (ARNA) robot. An ARNA is driven by tactile cues from the patient through a force–torque-measuring handlebar, whose signals are fed into a neuro-adaptive controller to achieve a specific admittance behavior regardless of patient strength, weight, or floor incline. Ambulation tasks used two fall-prevention devices: a gait belt and a full-body harness. The attitude toward the robot included perceived satisfaction, usefulness, and assistance, replacing the perceived ease-of-use construct found in the standard technology acceptance model. The effects of external demographic variables on those constructs were also analyzed. The modified technology acceptance model was validated with the simultaneous estimation of the effects of perceived usefulness and assistance on satisfaction. Our analysis employed an integrated hierarchical linear mixed-effects regression model to analyze the complex relationships between model variables. Our results suggest that nursing students rated the ARNA’s performance higher across all model constructs compared to a human assistant. Furthermore, male subjects rated the perceived usefulness of the robot higher than female subjects. Full article

Pancreatic pseudocysts (PPCs) are frequent complications of acute and chronic pancreatitis, characterized by encapsulated collections of pancreatic fluid. Historically managed by open surgical approaches, treatment paradigms have significantly evolved with advancements in imaging and minimally invasive techniques. This review outlines the historical progression and current standards in PPC management, covering conservative, surgical, laparoscopic, and endoscopic interventions. Conservative management remains a valid first-line option for asymptomatic, stable pseudocysts, particularly in the absence of complications. Surgical techniques, once the mainstay, such as marsupialization and internal drainage procedures (cystogastrostomy, cystojejunostomy, and cystoduodenostomy), now serve as alternatives when less invasive methods fail. Laparoscopic approaches offer reduced morbidity and faster recovery, especially for complex or inaccessible PPCs. However, endoscopic drainage, particularly endoscopic ultrasound-guided transmural drainage using plastic or metal stents—especially lumen-apposing metal stents (LAMSs)—has become the preferred modality due to its efficacy, safety profile, and cost effectiveness. Emerging technologies, including robotic-assisted surgery and hybrid techniques, promise further refinement in PPC management. This review synthesizes current evidence and expert guidelines, providing a comprehensive overview of evolving strategies and future directions in the treatment of PPCs. Full article

Background: The Trunk of Henle and the posterosuperior pancreaticoduodenal vein (Belcher’s Vein) are consistent anatomical landmarks of the portomesenteric venous system. Their recognition is particularly relevant in robot-assisted pancreatoduodenectomy (RAPD), where uncinate process dissection from the portal–mesenteric axis represents the most technically demanding step. Methods: We describe a stepwise robotic surgical approach emphasizing the identification, isolation, and safe division of the Trunk of Henle and Belcher’s Vein. Intraoperative illustrations are provided to demonstrate the use of these veins as reproducible landmarks during dissection of the pancreatic head and uncinate process. Results: Incorporating these veins as key reference points facilitates precise dissection, improves vascular control, and minimizes intraoperative bleeding. Their consistent anatomical presence allows systematization of the uncinate process approach and reliable exposure of the portal–mesenteric axis. Conclusions: The Trunk of Henle and Belcher’s Vein serve as valuable venous landmarks in RAPD. Their routine identification may improve surgical safety, reduce conversion risk, and contribute to a standardized, reproducible methodology for robotic pancreatic head resection. Full article

The evolution of robotic surgery in urologic oncology has led to the emergence of single-port (SP) robotic systems as a potential alternative to the widely adopted multi-port (MP) platforms. This narrative review provides a comprehensive comparison between SP and MP robotic systems, the former of which received FDA approval in 2018 and CE marking in 2024, focusing on their application across radical prostatectomy, partial and radical nephrectomy, and radical cystectomy. Drawing from the most current literature, we examine perioperative outcomes, oncologic efficacy, postoperative recovery, and complication rates. The review highlights the technical challenges unique to SP surgery, including restricted triangulation, limited instrumentation, and a defined learning curve, while also emphasizing innovations such as transvesical prostatectomy and the Supine Anterior Retroperitoneal Access (SARA) approach. Additionally, we explore the potential impact of emerging technologies—such as artificial intelligence, augmented reality, and telesurgery—on the future of SP platforms. Despite early limitations, SP systems have demonstrated comparable safety and effectiveness in selected cases and may offer unique advantages in specific anatomical scenarios. Continued innovation, structured training, and robust long-term outcome data will be essential for the broader adoption and integration of SP robotic surgery in clinical practice. Full article

Urologic oncological surgery increasingly makes use of robotic systems to realize precise and minimally invasive resections, convent to shorter hospital stays and faster recovery times. The dexterity gains enabled through procedures such as robot-assisted (RA) prostatectomy have helped realize significant advancements in recent years. Complementing these effects via the used of hybrid tracers that illuminate surgical targets, i.e., cancerous tissue, has helped advance the surgical decision making via enhanced visualization. A well-known example is Indocyanine green (ICG)-Technetium-99m (^99mTc)-nanocolloid, a hybrid extension of the radiopharmaceutical ^99mTc-nanocolloid. These hybrid tracers provide a direct link between preoperative imaging roadmaps and intraoperative target identification, and improve efficiency, accuracy, and confidence of the urologist in procedures such as sentinel lymph node biopsy (SLNB). Receptor-targeted hybrid tracer analogues, for e.g., prostate specific membrane antigen (PSMA), are also being explored as an extension of the ongoing efforts that use radiotracers such as ^99mTc-PSMA-I&S. Together, these efforts jointly pave the way for novel techniques in intraoperative lesion localization in other urological malignancies. This narrative review discusses the potential use of hybrid tracers in robotic oncological urology, including different imaging techniques and their applications for tumor localization for prostate, bladder, and kidney cancer. Full article

Indoor scene recognition is a computer vision task that identifies various indoor environments, such as offices, libraries, kitchens, and restaurants. This research area is particularly significant for applications in robotics, security, and assistance for individuals with disabilities, as it enables the categorization of spaces and the provision of contextual information. Convolutional Neural Networks (CNNs) are commonly employed in this field. While CNNs perform well in outdoor scene recognition by focusing on global features such as mountains and skies, they often struggle with indoor scenes, where local features like furniture and objects are more critical. In this study, the “MIT 67 Indoor Scene” dataset is used to extract and combine features from both a CNN and a text-based model utilizing object recognition outputs, resulting in a two-channel hybrid model. The experimental results demonstrate that this hybrid approach, which integrates natural language processing and image processing techniques, improves the test accuracy of the image processing model by 8.3%, achieving a notable success rate. Furthermore, this study offers contributions to new application areas in remote sensing, particularly in indoor scene understanding and indoor mapping. Full article

Background: To compare the costs of open retropubic radical prostatectomy (RRP), robotic-assisted radical prostatectomy (RALP), intensity-modulated radiation therapy (IMRT), low-dose brachytherapy (LDBT), stereotactic body radiotherapy (SBRT), cryotherapy (Cryo), and high-intensity focused ultrasound (HIFU) for low/intermediate-risk prostate cancer (PCa), from the healthcare system perspective. Methods: This retrospective, IRB-approved study compared the costs and charges of primary treatment options for localized PCa at Duke University Hospital between January 2018 and December 2019. We identified cases by querying the relevant disease, procedural, and charge codes from Duke Finance. Consecutive cases with NCCN high-risk disease, prior treatment, or missing institutional financial information were excluded. Costs were calculated from the point at which the treatment option was selected until the last treatment session (SBRT and IMRT) or hospital discharge (other modalities). All modalities except RRP were considered technology-intensive. Results: A total of 552 patients with a mean age of 65.0 years met the inclusion criteria. NCCN risk categories included 85 (13%) low, 218 (41%) favorable-intermediate, and 249 (46%) unfavorable-intermediate risk cases. RALP, RRP, Cryo, and HIFU were single-session treatments, whereas IMRT, SBRT, and LDBT were delivered over multiple sessions. IMRT and SBRT were the most expensive modalities, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of sessions (ρ = 0.55, p < 0.001) and being technology-intensive (ρ = 0.58, p < 0.001) were significantly correlated with treatment costs. Conclusions: In this cohort of PCa patients, treatment costs were highest for IMRT and SBRT, followed by RALP, HIFU, LDBT, Cryo, and RRP. The number of treatment sessions was a significant predictor of higher costs. Full article

The growing number of patients in need of rehabilitation, largely due to an aging population and the increasing incidence of strokes, drives the search for more effective therapeutic methods. Stroke remains a leading cause of adult disability, increasing demand for rehabilitation services. Robotic-assisted therapy presents a promising solution by offering precision and repeatability, complementing traditional methods. This study compared traditional rehabilitation led by a physiotherapist with robotic-assisted therapy using the UR10e robot. The research consisted of two stages: in the first, a physiotherapist guided passive upper limb movements, and in the second, the same movements were replicated by the UR10e robot with a specialized adapter for arm positioning. Movements were measured using the Noraxon Ultium Motion system, analyzing flexion, extension, and rotation angles at the shoulder and elbow joints. Full article

Motor impairments significantly affect individuals’ ability to perform activities of daily living, reducing autonomy and quality of life. In response to this, robot-assisted rehabilitation has emerged as an effective and practical solution, enabling controlled limb movements and supporting functional recovery. This study presents the development of an upper-limb exoskeleton designed to assist rehabilitation by integrating neurophysiological signal processing and real-time control strategies. The system incorporates a proportional–derivative (PD) controller to execute cyclic flexion and extension movements based on a sinusoidal reference signal, providing repeatability and precision in motion. The exoskeleton integrates a brain–computer interface (BCI) that utilizes electroencephalographic signals for therapy selection and engagement enabling user-driven interaction. The EEG data extraction was possible by using the UltraCortex Mark IV headset, with electrodes positioned according to the international 10–20 system, targeting alpha-band activity in channels O1, O2, P3, P4, Fp1, and Fp2. These channels correspond to occipital (O1, O2), parietal (P3, P4), and frontal pole (Fp1, Fp2) regions, associated with visual processing, sensorimotor integration, and attention-related activity, respectively. This approach enables a more adaptive and personalized rehabilitation experience by allowing the user to influence therapy mode selection through real-time feedback. Experimental evaluation across five subjects showed an overall mean accuracy of 86.25% in alpha wave detection for EEG-based therapy selection. The PD control strategy achieved smooth trajectory tracking with a mean angular error of approximately 1.70°, confirming both the reliability of intention detection and the mechanical precision of the exoskeleton. Also, our core contributions in this research are compared with similar studies inspired by the rehabilitation needs of stroke patients. In this research, the proposed system demonstrates the potential of integrating robotic systems, control theory, and EEG data processing to improve rehabilitation outcomes for individuals with upper-limb motor deficits, particularly post-stroke patients. By focusing the exoskeleton on a single degree of freedom and employing low-cost manufacturing through 3D printing, the system remains affordable across a wide range of economic contexts. This design choice enables deployment in diverse clinical settings, both public and private. Full article

Transverse myelitis is a rare spinal cord condition that can cause severe motor, sensory, and autonomic dysfunction. This case report describes a 16-year-old male with incomplete paraplegia due to idiopathic transverse myelitis who underwent robotic-assisted gait training (RAGT) using the EKSO exoskeleton, integrated into an intensive rehabilitation programme. After one month, he showed significant improvements in gait speed, dynamic balance, effort tolerance, and trunk mobility. RAGT promoted better weight distribution and reduced compensatory patterns during ambulation. The intervention proved safe and clinically beneficial, highlighting the potential of robotic technologies as effective adjuncts in paediatric spinal cord injury rehabilitation. Full article