Search Results (291)

This study presents a comprehensive simulation-based comparative analysis of four parallel robotic mechanisms, each developed to assist patient recovery through adaptive movement control and feedback, particularly for upper and lower limb therapy. Kinematic and dynamic models were developed and implemented in Matlab-Simulink, integrating force control via conventional regulators and real-time interaction with simulated patient-applied forces. The structural differences between spherical, rotational, and universal joints in each kinematic chain variant were evaluated. To systematically determine the most suitable design, a detailed Analytic Hierarchy Process was applied considering performance, precision, stability, and actuator effort. The study emphasizes the advantages of parallel robots in rehabilitation due to their precision, rigidity, and compact design, highlighting the potential of parallel robotic systems in customized and adaptive physical therapy interventions. These insights contribute to the optimal design selection of clinical motor therapy robots. Full article

Background and Clinical Significance: Sleeve gastrectomy is an effective and widely performed bariatric procedure that provides long-term, sustained weight loss, but it carries risks of early and late complications. Among these, gastric fistula is a rare occurrence associated with an increased mortality rate and must be carefully considered to ensure timely diagnosis and appropriate management. Case Presentation: We will present the complex case of a patient who was referred to the general surgery department due to severe abdominal pain, exertional dyspnea, nausea, fever and fatigue, symptoms that appeared one month after a robotic gastric sleeve. The investigations led to the diagnostic of high gastric fistula secondary to a gastric sleeve procedure. The patient underwent exploratory laparotomy with jejunostomy, peritoneal lavage, drainage, and endoscopic placement of an endoluminal vacuum assisted closure (E-VAC) system. Close clinical, laboratory, imaging, and endoscopic monitoring demonstrated progressive improvement, with complete resolution of the fistula achieved after seven weeks of E-VAC therapy. Conclusions: The particularity of this case lies in the occurrence of a delayed mechanical gastric suture dehiscence, with late diagnosis, managed using E-VAC. Even though rare, gastric fistulas represent a potentially life-threatening complication of sleeve gastrectomy. Early diagnosis and a multidisciplinary approach, which includes infection control, surgical intervention and minimally invasive techniques like E-VAC, are essential for effective management and favorable outcomes. Full article

With the global ageing population and the increasing prevalence of mobility impairments, the demand for effective and comfortable rehabilitation and assistive solutions has grown rapidly. Soft exoskeletons have emerged as a key direction in the development of wearable rehabilitation devices. This review examines how these systems are designed and controlled, as well as how they differ from the rigid exoskeletons that preceded them. Made from flexible fabrics and lightweight components, soft exoskeletons use pneumatic or cable mechanisms to support movement while keeping close contact with the body. Their compliant structure helps to reduce joint stress and makes them more comfortable for long periods of use. The discussion in this paper covers recent work on lower-limb designs, focusing on actuation, power transmission, and human–robot coordination. It also considers the main technical barriers that remain, such as power supply limits, the wear and fatigue of soft materials, and the challenge of achieving accurate tracking performance, low latency, and resilience to external disturbances. Studies reviewed here show that these systems help users regain functionality and improve rehabilitation, while also easing caregivers’ workload. The paper ends by outlining several priorities for future development: lighter mechanical layouts, better energy systems, and adaptive control methods that make soft exoskeletons more practical for everyday use as well as clinical therapy. Full article

Robotic devices have become increasingly important in upper-limb rehabilitation, as they assist therapists, improve treatment efficiency, and enable personalised therapy. However, the lack of standardised protocols and integrative tools limits their widespread adoption and effectiveness. To address these challenges, a robotic framework was developed for upper-limb rehabilitation in patients with acquired brain injury (ABI). The framework is designed to be adaptable to various ROS-compatible collaborative robots with admittance control and potentially adaptable to other types of control, and also integrates kinematic and electrophysiological (EMG) metrics to monitor patient performance and progress. It combines data acquisition through EMG and robot motion sensors, gamification elements to enhance engagement, and configurable robot control modes within a unified software platform. A pilot evaluation with eight healthy subjects performing upper limb movements on an ROS-compatible robot from the UR family demonstrated the feasibility of the framework’s components, including robot control, EMG acquisition and synchronization, gamified interaction, and synchronised data collection. User performance through all levels remained below the controller limits of force and velocity thresholds even in the most resistive damping. These results support the potential of the proposed framework as a flexible, extensible, and integrative tool for upper-limb rehabilitation, providing a foundation for future clinical studies and multi-platform implementations. Full article

Background: Locally advanced prostate cancer (PCa) is commonly treated with multimodal therapy; however, long-term outcomes of surgery alone are poorly defined. We investigated the potential and limitations of robot-assisted radical prostatectomy (RARP) as primary treatment without perioperative systemic therapy in patients with locally advanced PCa. Methods: We retrospectively analyzed 258 patients who underwent RARP with extended pelvic lymph node dissection between 2012 and 2022 with locally advanced PCa, defined as present if at least one of the following was met: clinical stage cT3b–T4; primary Gleason pattern 5; >4 biopsy cores with Grade Group 4 or 5; or more than one NCCN high-risk characteristic. Patients who received neoadjuvant or adjuvant therapy were excluded. Endpoints included biochemical recurrence-free survival, metastasis-free survival, cancer-specific survival, and predictors of persistent PSA. Results: Median follow-up was 60.6 months. Pathological stage ≥ pT3a occurred in 63.6% and nodal involvement (pN1) in 27.1%. Five-year BRFS, MFS, and CSS were 36.6%, 88.9%, and 98.3%, respectively. Persistent PSA occurred in 21.3%. Preoperative predictors included PSA > 40 ng/mL, clinical stage ≥ cT3a, and >4 biopsy cores with a Gleason score of 8–10; patients with ≥2 features had significantly poorer BRFS and MFS. Postoperative predictors of recurrence were pathological stage, lymphovascular invasion, and nodal involvement. Conclusions: RARP alone provided durable long-term cancer control in selected men with locally advanced PCa, whereas patients with multiple adverse features were unlikely to be cured with surgery alone. Careful risk stratification may identify candidates for surgical monotherapy and help avoid overtreatment, while others may benefit from multimodal therapy. Full article

Stroke is a leading cause of long-term disability worldwide, with survivors often facing significant challenges in regaining upper-limb functionality. In response, robotic rehabilitation systems have emerged as promising tools to enhance post-stroke recovery by delivering precise, adaptable, and patient-specific therapy. This paper presents a review of robotic interfaces developed specifically for upper-limb rehabilitation. It analyses existing exoskeleton- and end-effector-based systems, with respect to three core design pillars: assistance types, control philosophies, and actuation methods. The review highlights that most solutions favor electrically actuated exoskeletons, which use impedance- or electromyography-driven control, with active assistance being the predominant rehabilitation mode. Resistance-providing systems remain underutilized. Furthermore, no hybrid approaches featuring the combination of robotic manipulators with actuated interfaces were found. This paper also identifies a recent trend towards lightweight, modular, and portable solutions and discusses the challenges in bridging research prototypes with clinical adoption. By focusing exclusively on upper-limb applications, this work provides a targeted reference for researchers and engineers developing next-generation rehabilitation technologies. Full article

Background: Robotic liver surgery is emerging as a key advancement in minimally invasive techniques, though it still faces several challenges. Meanwhile, colorectal cancer (CRC) continues to be a leading cause of cancer deaths, with liver metastases affecting 25–30% of patients. These metastases significantly burden healthcare systems by raising costs and resource demands. Methods: A narrative literature review was performed, resulting in the inclusion of 14 studies in our analysis. Fourteen studies met the inclusion criteria and were analyzed with attention to patient characteristics, surgical details, perioperative outcomes, and reporting limitations. For consistency, simultaneous robotic-assisted resection (RAR) refers to cases in which the colorectal primary and liver metastasectomy were performed during the same operative session. Results: The 14 studies included a total of 771 patients (520 males and 251 females), aged between 31 and 88, undergoing simultaneous robotic-assisted resection (RAR). Most were affected by rectal cancer (76%) and unilobar liver metastases (82%). All surgeries using the DaVinci system are represented by 62% wedge resection and 38% anatomical (21.39% major and 16.61% minor). Patients’ BMI ranged from 19.5 to 40.4 kg/m², the average blood loss was 181.5 mL (30–780), the median hospital stay was 7 days (range 2–28), and the mean operative time ranged from 30 to 682 min. Data on POLF (postoperative liver failure) are reported in two studies: Rocca et al., 1/90 patients; Marino et al., 1/40 patients. Biliary leak is reported in one case by Marino et al., while Winckelmans et al. reported a 2.6% incidence of biliary leak in the laparoscopic group and 3.4% in the robotic group. Conclusions: As research advances and new therapies emerge for colorectal liver metastasis (CRLM), surgery remains the mainstay of treatment. However, evidence is limited by small sample sizes, heterogeneous study designs, inconsistent reporting of perioperative chemotherapy, timing of surgery, metastasis localization, and complications. Robotic liver surgery has become a well-established technique and possibly represents the future for managing colorectal liver metastases. Further prospective and comparative studies with standardized outcome reporting are needed to define optimal patient selection and long-term effectiveness. Full article

This study aimed to investigate the use of social robots as an interactive learning approach for treating children diagnosed with autism spectrum disorder (ASD). A review was conducted using the meta-analysis technique to compile pertinent research. An analysis was performed on the results of the online search process, which gathered information on pertinent research published until 31 January 2025, from three publication databases: IEEE Xplore, SCOPUS, and Google Scholar. One hundred and seven papers out of the 591 publications that were retrieved satisfied the previously established inclusion and exclusion criteria. Despite the differences in methodology and heterogeneity, the data were synthesized narratively. This review focuses on the various types of social robots used to treat ASD, as well as their communication mechanisms, development areas, target behaviors, challenges, and future directions. Both practitioners and seasoned researchers looking for a fresh approach to their next project will find this review a useful resource that offers broad summaries of state-of-the-art research in this field. Full article

For more than 20 years, after the introduction of the first robotic system, research on prostate cancer (PCa) surgery has mainly focused on evaluating outcomes of Robotic-Assisted Radical Prostatectomy (RARP). In the last few years, however, a new generation of innovative techniques, surgical approaches, and expanded indications have emerged. The Single Port (SP) robotic system was the first real hardware innovation in robotic surgery, and has already demonstrated advantages in terms of shorter length of stay, better cosmetic results and reduced postoperative pain. Artificial Intelligence (AI)-powered algorithms are being proposed as reliable tools for surgical assistance, aiding in standardization and mass implementation of robotic training. New surgical indications are emerging on the basis of patient and tumor characteristics. The extensive adoption of PCa screening and the precision of diagnostic tools have increased the rate of PCa diagnoses in a localized stage. Partial prostatectomy, despite needing further validation, has emerged as a safe and minimally invasive treatment option for confined tumors, able to minimize the side effects of prostate surgery. For locally advanced PCa, radioguided surgery has not only enhanced the oncological effectiveness of lymphadenectomy by enabling the precise identification and extraction of pathological lymph nodes, but has also contributed to minimizing the side effects associated with unnecessarily extensive dissections. Finally, in light of the increased efficacy of modern systemic therapies and the longer life expectancy, RP is currently being evaluated for primary tumor management in the metastatic phase. Despite the novelty of the aforementioned treatment options, they are already set to shape the future evolution of PCa management and international guidelines. Full article

Background: We investigated the predictive role of prostatic morphology on preoperative multiparametric magnetic resonance imaging for post-prostatectomy urinary incontinence. Methods: Patients who underwent robot-assisted radical prostatectomy between February 2018 and October 2021 and who were not previously incontinent, did not undergo radiotherapy, hormone therapy, or transurethral resection of the prostate, and who had a follow-up longer than 12 months were selected. For each patient, a radiology physician evaluated the preoperative magnetic resonance imaging, measuring prostatic and membranous urethral length, classifying prostatic apex according to the Lee Type, and estimating the presence of the median lobe and its intravesical protrusion. Multivariate logistic regression models evaluated the influence of anatomic features measured in magnetic resonance imaging on urinary continence recovery, defined as daily pad usage less than or equal to one, considering age, body mass index, prostate volume, International Prostatic Symptoms Score, the usage of a nerve sparing technique, and the International Society of Urological Pathology classification. Results: A total of 95 patients who underwent robot-assisted radical prostatectomy were enrolled. Median age, median body mass index, and median PSA density were respectively 66 years (62, 70), 26.12 kg/m² (23.88, 28.09), and 0.16 ng/mL/cc (0.10, 0.26). Patients with urinary continence ranged from 32 (33.7%) at baseline to 93 (97.8%) after one year from surgery. At preoperative magnetic resonance, Lee Type was almost equally distributed, but Type C was less represented (18 patients, 18.9%) and Type D was more frequent (31 patients, 32.2%). Median prostatic urethral length, median membranous urethral length, and median intravesical prostatic protrusion were respectively 36 mm (31, 42), 15 mm (13, 16), and 0 mm (0, 0). Multivariate logistic regression models showed no statistical significance, except for Lee Type C and A comparison at vesical catheter removal after surgery (OR 0.17; 95% CI 0.04–0.71; p-value 0.01). Conclusions: The results of this study showed that patients who had Lee Type C might have higher probability of early urinary continence recovery, but no further statistically significant correlations were found. Full article

A 75-year-old Jehovah’s Witness with recent ST-elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI) with stenting of the proximal LAD. She was later diagnosed with gallbladder cancer and required urgent surgery but firmly refused allogeneic blood transfusion. This posed a major challenge, as the surgery was expected to cause significant bleeding, and the patient had undergone coronary stenting within the previous three months, which is when the risk of stent thrombosis is highest if dual antiplatelet therapy (DAPT) is interrupted. After conducting a careful multidisciplinary discussion and obtaining informed consent, both aspirin and clopidogrel were discontinued five days preoperatively. Through comprehensive blood conservation strategies—including acute normovolemic hemodilution (ANH), intraoperative cell salvage, and robotic-assisted minimally invasive surgery—the patient successfully underwent extended cholecystectomy without transfusion. This case highlights the possibility of safe, completely transfusion-free major surgery in patients with recent PCI and high thrombotic risk when individualized perioperative planning is applied. Full article

Stroke remains one of the leading causes of disability worldwide, often resulting in persistent impairments in gait and balance. Traditional rehabilitation methods—though beneficial—are limited by factors such as therapist dependency, low patient adherence, and restricted access. In recent years, sensor-supported technologies, including virtual reality (VR), robotic-assisted gait training (RAGT), and wearable feedback systems, have emerged as promising adjuncts to conventional therapy. This systematic review evaluates the effectiveness of wearable and immersive technologies for gait and balance rehabilitation in adult stroke survivors. Following PRISMA guidelines, a systematic search of the PubMed and ScienceDirect databases retrieved 697 articles. After screening, eight studies published between 2015 and 2025 were included, encompassing 186 participants. The interventions included VR-based gait training, electromechanical devices (e.g., HAL, RAGT), auditory rhythmic cueing, and smart insoles, compared against conventional rehabilitation or baseline function. Most studies reported significant improvements in motor function, dynamic balance, or gait speed, particularly when interventions were intensive, task-specific, and personalized. Patient engagement, adherence, and feasibility were generally high. However, heterogeneity in study design, small sample sizes, and limited long-term data reduced the strength of the evidence. Technologies were typically implemented as complementary tools rather than standalone treatments. In conclusion, wearable and immersive systems represent promising adjuncts to conventional stroke rehabilitation, with potential to enhance motor outcomes and patient engagement. However, the heterogeneity in protocols, small sample sizes, and methodological limitations underscore the need for more robust, large-scale trials to validate their clinical effectiveness and guide implementation. Full article

To address the limitations of traditional mirror therapy in stroke rehabilitation, such as rigid movement mapping and insufficient personalization, this study proposes a robot-assisted mirror rehabilitation framework integrating multimodal biofeedback. By synchronously capturing kinematic features of the unaffected upper limb and surface electromyography (sEMG) signals from the affected limb, a dual-modal feature fusion network based on a cross-attention mechanism is developed. This network dynamically generates a time-varying mirror ratio coefficient $\lambda$, which is incorporated into the exoskeleton’s admittance control loop. Combining a trajectory generation algorithm based on dynamic movement primitives (DMPs) with a compliant control strategy incorporating dynamic constraints, the system achieves personalized rehabilitation trajectory planning and safe interaction. Experimental results demonstrate that, compared to traditional mirror therapy, the proposed system exhibits superior performance in bilateral trajectory covariance metrics, the mirror symmetry index, and muscle activation levels. 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