Search Results (1,498)

Background: Lobectomy has long been the gold standard for early-stage NSCLC, but recent trials challenge its universality. The Japanese JCOG0802 trial demonstrated superior overall survival with segmentectomy versus lobectomy, whereas the North American CALGB140503 trial showed non-inferiority of sublobar resection, including wedge and segmentectomy, compared with lobectomy. Methods: This commentary critically evaluates evidence from JCOG0802 and CALGB140503 in the context of wider thoracic surgical practice. We examine trial disparities, the role of real-world data, heterogeneity in surgical approach and lymph node staging, the impact of robotics on segmentectomy adoption, and the application of segmental resection in pulmonary metastasectomy. Results: The divergent trial findings reflect differences in populations, nodal staging, and surgical definitions. Worldwide, variability in sublobar practice and inconsistent nodal assessment present challenges to oncological reliability. Robotics has facilitated a rapid increase in anatomical segmentectomy but risks shifting surgical intent from necessity to feasibility. In metastasectomy, segmentectomy may improve local control but remains unproven in randomised studies. Emerging strategies such as IVLP and molecular profiling offer potential to refine patient selection and outcomes. Conclusion: Sublobar resection represents a paradigm shift in the surgical management of small NSCLC. Ensuring oncological validity in real-world practice requires rigorous nodal staging, equitable access to technology, and prospective evaluation of segmentectomy in both primary and metastatic disease. Future advances will depend on aligning surgical precision with biologically informed patient selection. Full article

Objectives: To evaluate perioperative outcomes, renal function preservation, and short-term oncologic results of off-clamp, sutureless, or selectively sutured robotic-assisted partial nephrectomy (RAPN) in patients with renal tumors treated at multiple high-volume centers. Methods: This multicenter retrospective study included 250 patients who underwent off-clamp, sutureless/selectively sutured RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors > 7 cm, or prior renal surgery were excluded. All procedures were performed without renal artery clamping, using hemostatic agents and selective suturing when necessary. Perioperative, functional, and oncologic outcomes were compared with 313 patients who underwent standard RAPN with parenchymal suturing. Results: The median operative time was 110 min (IQR 100–140), and the median estimated blood loss was 180 mL (IQR 100–250). The overall complication rate was 8.4%, predominantly Clavien–Dindo grade I–II, with no conversions to open surgery. The median decline in estimated glomerular filtration rate (eGFR) at three months was 5.5% (IQR 3.5–8.9; p = 0.56), and no cases of acute kidney injury were recorded. The positive surgical margin rate was 3.7%, and no tumor recurrences were observed during the 12-month follow-up period. Conclusions: Off-clamp, sutureless or selectively sutured robotic-assisted partial nephrectomy (RAPN) was not associated with increased perioperative risk, renal functional decline, or compromised short-term oncologic control compared with conventional sutured RAPN. These findings indicate that the technique is feasible and safe in appropriately selected patients, although prospective studies with longer follow-up are needed to confirm long-term outcomes and refine patient selection criteria. Full article

Background: Nephrectomy in patients with polycystic kidney disease (PKD) is typically arduous due to the considerable size of the kidneys. The laparoscopic method has arisen as a minimally invasive substitute for open surgery. Nonetheless, conventional laparoscopic methods may be inadequate for tackling the distinct anatomical complexities of a large polycystic kidney. This study presents a unique method, “the hilum first technique”, specifically designed for nephrectomy in patients with PKD, emphasizing its safety and efficacy in addressing this intricate condition. Methods: A retrospective analysis of patients with PKD who underwent minimally invasive nephrectomy using “the hilum first technique” at our hospital between 2020 and 2025. Data on operative time, blood loss, conversion rates, hospital stay, and outcomes were analyzed to evaluate this technique’s safety and efficacy. Results: Minimally invasive nephrectomy using the “hilum first technique” was successfully performed in 16 cases; the mean age of patients was 56.3 years. Two of which were robot-assisted, in which one of them, a bilateral nephrectomy was done, with no conversions to open surgery, even for huge kidneys. The mean operative time was 159.6 min, with an estimated blood loss of 50 mL. Postoperatively, the median duration of hospital stay was 4 days (range: 3–10 days), and 75% of patients experienced no complications. Three patients (18.7%) were readmitted within 30 days due to surgical site infection, subcutaneous hematoma, and pneumonia. Seven patients (43.7%) underwent kidney transplantation within a median duration of 132 days post-nephrectomy. Conclusions: This retrospective study, although limited by a small sample size, demonstrated significant promise as a novel strategy for tackling the challenges of huge polycystic kidneys. The findings suggest its feasibility and safety, although further validation is required. Full article

Radical prostatectomy remains a cornerstone treatment for localized prostate cancer. While oncological control is essential, functional outcomes such as urinary continence and erectile function play a critical role in patient satisfaction and quality of life. Despite the growing emphasis on surgical quality, no standardized intraoperative scoring system has been universally adopted. This narrative review summarizes current approaches to evaluating the technical quality of radical prostatectomy and associated functional outcomes. It focuses on objective intraoperative assessment tools and functional evaluation scales used in clinical research and surgical education. A non-systematic literature search was conducted using the PubMed and Scopus databases to identify relevant intraoperative assessment tools (e.g., GEARS, PACE, and OSATS), functional scales (e.g., IIEF, EPIC, and pad test), and outcome reporting systems. Articles were reviewed for scale structure, clinical applicability, validation status, and limitations. Several tools have been developed to evaluate surgical skills in minimally invasive surgery, yet few are specific to radical prostatectomy. Most rely on subjective surgeon assessment or delayed functional outcomes, limiting their utility for intraoperative feedback. Video-based assessment is promising but underutilized. A gap remains for a prostatectomy-specific, reproducible, and real-time assessment scale. There is a pressing need for validated tools that bridge the gap between surgical technique and functional outcomes. Current methods lack specificity and reproducibility. Development of an objective, intraoperative scoring system may support surgeon feedback, quality improvement, and improved patient counseling. Full article

Background/Objectives: Bulkamid^® (Axonics, Irvine, CA, USA) is a non-particulate polyacrylamide hydrogel used in the treatment of urinary incontinence. While its effectiveness is well-documented in female stress urinary incontinence (SUI), there is limited data on its role in male stress urinary incontinence, particularly post-prostatectomy incontinence (PPI). This study evaluates the efficacy of Bulkamid as a primary or adjunctive treatment for male PPI. Methods: A retrospective chart review was conducted on male patients who developed PPI and underwent Bulkamid injections between 2016 and 2021. Data collected included pre- and post-procedure pad usage, the volume of Bulkamid injected, prior and subsequent incontinence treatments, and patient-reported satisfaction. Bulkamid was injected transurethrally in four quadrants near the vesicourethral anastomosis using a rigid cystoscope. Results: Twenty-one men with a history of radical prostatectomy (six open and fifteen robotic), including four who received adjuvant radiotherapy, were included. Fifteen underwent Bulkamid injection as a primary treatment, with five (33%) requiring repeat injections due to initial improvement. Eight (54%) subsequently underwent an AdVance XP^® sling placement, while two (13%) required no further treatment. Six patients received Bulkamid as an adjunct to prior incontinence surgery, with 80% of post-sling patients reporting improved continence. Bulkamid was less effective in men with detrusor overactivity or prior radiation. Conclusions: Bulkamid demonstrated a higher success rate as an adjunct to the AdVance XP sling, with 80% of men experiencing improved continence. As a primary treatment for PPI, success was modest, with only 33% achieving improvement, often requiring repeat injections or conversion to a sling. Bulkamid presents a low-risk option for select male PPI patients, particularly those with prior sling placement, but durability and long-term effectiveness remain concerns. Full article

Lymphedema is a chronic, progressive, and debilitating disease of the lymphatic system with no current cure. Physiologic procedures, which address the underlying pathophysiology of lymphatic dysfunction, have gained traction in both treatment and prevention of lymphedema. This narrative review examines current physiologic lymphedema surgical techniques and emerging developments in this rapidly evolving field. While the two most common physiologic surgeries remain lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT), newer physiologic surgery techniques such as vascularized lymph vessel transfer (VLVT) and lymph node to vein anastomosis (LNVA) have been described in an effort to reduce donor site morbidity, with early promising clinical outcomes. The use of bioengineering with stem cells, pro-lymphangiogenic growth factors, and biomaterials such as Biobridge can be applied in conjunction with surgery to help promote lymphangiogenesis. Technological advances in robotic surgical systems and 3D exoscopes are helping to make supermicrosurgery more technically feasible and ergonomic, and increasing accessibility to lymphedema surgery. As our surgical armamentarium expands, treatment algorithms must be updated to determine how various surgical techniques can be combined and sequenced, how the indications for physiologic surgery can be expanded, and how surgical treatment can be tailored to the patient and disease process. Full article

Vascular surgery has evolved from durable yet invasive open reconstructions to less traumatic endovascular techniques. While endovascular repair reduces perioperative morbidity, it introduces durability challenges and the need for lifelong surveillance. Laparoscopic surgery bridged some gaps but was hindered by steep learning curves and technical limitations. Robotic-assisted surgery represents a “third revolution”, combining the durability of open repair with the recovery and ergonomic benefits of minimally invasive approaches through enhanced 3D visualization, wristed instrumentation, and tremor filtration. This review synthesizes current evidence on robotic applications in vascular surgery, including aortic, visceral, venous, and endovascular interventions. Feasibility of robotic vascular surgery has been demonstrated in over 1500 patients across aortic, visceral, venous, and decompression procedures. Reported outcomes include pooled conversion rates of ~5%, 30-day mortality of 1–3%, and long-term patency rates exceeding 90% in aortoiliac occlusive disease. Similarly favorable outcomes have been observed in AAA repair, visceral artery aneurysm repair, IVC reconstructions, renal vein transpositions, and minimally invasive decompression procedures such as median arcuate ligament and thoracic outlet syndromes. Endovascular robotics enhances catheter navigation precision and reduces operator radiation exposure by 85–95%, with multiple series demonstrating consistent benefit compared to manual techniques. Despite these advantages, adoption is limited by high costs, lack of dedicated vascular instruments, absent haptic feedback on most platforms, and the need for standardized training. Most available evidence is observational and from high-volume centers, highlighting the need for multicenter randomized trials. Future directions include AI-enabled planning and augmented-reality navigation, which are the most feasible near-term technologies since they rely largely on software integration with existing systems. Other advances such as microsurgical robotics, soft-robotic platforms, and telesurgery remain longer-term developments requiring new hardware and regulatory pathways. Overcoming barriers through collaborative innovation, structured training, and robust evidence generation is essential for robotics to become a new standard in vascular care. Full article

Background: Robot-assisted surgery (RAS) is a major innovation in the treatment of lung cancer, offering advantages in surgical precision and reducing postoperative complications. However, its impact on 90-day mortality remains controversial due to methodological biases in comparative studies. This study uses machine learning methods to improve propensity score estimation and reduce selection bias. Methods: We used the French national hospital database (PMSI) to identify patients who underwent lung resection for cancer between 2019 and 2023. Four models were applied for propensity score estimation: logistic regression, Random Forest, Gradient Boosting Machine (GBM), and XGBoost. Group balancing was achieved through propensity score weighting and matching, followed by logistic regression analysis to estimate the effect of RAS on 90-day mortality. Results: Among the 30,988 patients included, 5717 (18.5%) underwent robot-assisted surgery, while 25,271 (81.5%) underwent thoracotomy. RAS patients had a lower prevalence of comorbidities and earlier-stage tumors. XGBoost was the most effective model for propensity score estimation, with an AUC ROC of 0.9984 and a Brier Score of 0.0119. The adjusted analysis showed a significant reduction in 90-day mortality in the RAS group (OR = 0.39, 95% CI: 0.34–0.45) with weighting and (OR = 0.58, 95% CI: 0.48–0.70) with matching. Conclusions: The application of machine learning to adjust for selection bias allowed for better control of confounding factors in the analysis of the effect of RAS on 90-day mortality. Our results suggest a potential benefit of robotic surgery compared to thoracotomy, although further studies are needed to confirm these findings. Full article

An incision point acts as the pivot point when a minimally invasive surgery procedure is applied. The assistive robot arms employed for such operation must have the capability to perform a remote center of motion (RCM) at this pivot point. Other than designing RCM mechanisms, a common practice is to use a readily available spatial serial robot arm and control it to impose this RCM constraint. When this assistive robot is required to be backdriven by the surgeon, the relation between the interaction forces/moments and the motion with RCM constraint becomes challenging. This paper carefully formulates a hybrid position/force control scheme for this relationship when any readily available robot arm that is coupled with a force/torque sensor is used for an RCM task. The verification of the formulation is carried out on a readily available robot arm by implementing the additional constraints that are derived from a surgical robot application. Full article

Minimally invasive surgery (MIS) has become increasingly favored by both patients and surgeons owing to its advantages such as shortened recovery times and reduced surgical trauma. To enhance intraoperative feedback from surgical instruments while minimizing harmful radiation exposure, a wide range of electromagnetic tracking systems (EMTS) has been developed at micro scales for medical applications. This review provides a comprehensive summary of advances in the field over the past five years, with an emphasis on the working principles of EMTS, system architecture, current research progress, and clinical applications. In comparison to other review papers, this article focuses specifically on EMTS for medical micro-devices, such as robotic catheters, endoscopes, and capsule robots. Moreover, Representative research studies and commercial systems are presented along with their clinical implementations, placing greater emphasis on the translation of EMTS into medical applications. Finally, this review outlines and discusses future research directions, highlighting major challenges and potential opportunities for advancing the integration of EMTS into routine clinical workflows. Full article

Bone drilling is a widely encountered process in orthopedic surgeries and keyhole neuro surgeries. We are developing a sensor-integrated smart end-effector for drilling for robotic surgical applications. In manual surgeries, surgeons assess tool wear based on experience and force perception. In this work, we propose a machine-learning (ML)-based tool condition monitoring system based on multi-sensor data to preempt excessive tool wear during drilling in robotic surgery. Real-time data is acquired from the six-component force sensor of a collaborative arm along with the data from the temperature and multi-axis vibration sensor mounted on the bone specimen being drilled upon. Raw data from the sensors may have noises and outliers. Signal processing in the time- and frequency-domain are used for denoising as well as to obtain additional features to be derived from the raw sensory data. This paper addresses the challenging problem of identification of the most suitable ML algorithm and the most suitable features to be used as inputs to the algorithm. While dozens of features and innumerable machine learning and deep learning models are available, this paper addresses the problem of selecting the most relevant features, the most relevant AI models, and the optimal hyperparameters to be used in the AI model to provide accurate prediction on the tool condition. A unique framework is proposed for classifying tool wear that combines machine learning-based modeling with multi-sensor data. From the raw sensory data that contains only a handful of features, a number of additional features are derived using frequency-domain techniques and statistical measures. Using feature engineering, we arrived at a total of 60 features from time-domain, frequency-domain, and interaction-based metrics. Such additional features help in improving its predictive capabilities but make the training and prediction complicated and time-consuming. Using a sequence of techniques such as variance thresholding, correlation filtering, ANOVA F-test, and SHAP analysis, the number of features was reduced from 60 to the 4 features that will be most effective in real-time tool condition prediction. In contrast to previous studies that only examine a small number of machine learning models, our approach systematically evaluates a wide range of machine learning and deep learning architectures. The performances of 47 classical ML models and 6 deep learning (DL) architectures were analyzed using the set of the four features identified as most suitable. The Extra Trees Classifier (an ML model) and the one-dimensional Convolutional Neural Network (1D CNN) exhibited the best prediction accuracy among the models studied. Using real-time data, these models monitored the drilling tool condition in real-time to classify the tool wear into three categories of slight, moderate, and severe. Full article

Minimally invasive surgery is known to lessen postoperative stress and complications compared with open procedures, yet its molecular effects on immunity and cancer-related mechanisms remain unclear. This study examined immune and inflammatory responses after robot-assisted (RS) versus open (OS) colorectal cancer surgery. Sixty-one patients (RS = 30; OS = 31) were enrolled. Blood samples were collected before surgery and at 8, 24, and 72 h post-incision. Cytokines, growth factors, and prostanoids were measured using multiplex immunoassays and mass spectrometry to assess systemic immune and inflammatory changes. Surgery type markedly influenced perioperative immune profiles. RS induced stronger activation of Th1-associated cytokines, including IFNγ and IP-10, suggesting enhanced cellular immune responsiveness. In contrast, Th2 cytokines and other immunosuppressive mediators—such as IL-4, IL-10, and G-CSF—showed smaller or transient increases after RS, whereas OS triggered broader and more sustained elevations. Angiogenic factors (VEGF-A, PDGF-BB, FGF2) rose significantly after OS but remained comparatively lower and returned to baseline faster after RS, indicating a weaker proangiogenic response. Similarly, postoperative surges in prostaglandins linked to inflammation and tumor progression (PGE₂, PGF₂α) were blunted and resolved earlier following RS. Overall, the robotic approach was associated with reduced inflammatory and immunosuppressive activity, faster recovery of immune balance, and diminished biochemical signals favoring angiogenesis and potential tumor regrowth, suggesting a potential protective effect against pathogens and cancer-promoting mechanisms after colorectal tumor resection. Full article

Background/Objectives: Endometriosis is a chronic inflammatory systemic disease that commonly affects bowel structures, including the appendix, where it may mimic or coexist with chronic appendicitis. Visual inspection alone often fails to detect appendiceal involvement, leading to underdiagnosis and suboptimal management. This study investigates the prevalence and histopathologic spectrum of appendiceal abnormalities in patients undergoing minimally invasive laparoscopic surgery for endometriosis and evaluates the safety and postoperative outcomes of selective appendectomy. Methods: We conducted a retrospective cohort study of 236 patients who underwent a selective appendectomy concurrent with laparoscopic surgery for endometriosis with and without robotic assistance from January 2024 to April 2025. Preoperative evaluation included clinical assessment, imaging, and risk stratification using the Nezhat Endometriosis Risk Advisor tool, with some patients referred after positive ReceptivaDx testing. Intraoperatively, the appendix was examined for endometriosis, adhesions, or obliteration, and abnormal findings warranted removal using a vascular stapler. Postoperative outcomes and histopathologic results were assessed over six months, with appendiceal involvement analyzed in relation to endometriosis stage. Results: Of 236 patients who underwent selective laparoscopic appendectomy during surgical treatment for endometriosis, abnormal appendiceal pathology was identified in 216 (91.53%) patients. Histopathology revealed appendiceal endometriosis in 34 patients (14.41%), adhesions in 140 (59.32%), fibrous obliteration in 82 (34.75%), inflammation in 20 (8.47%), and neuroendocrine tumors in 3 (1.27%), one of which was malignant. Endometriotic lesions of the appendix showed a significant association with advanced-stage (III–IV) disease (p = 0.05), while other pathologies were not stage-dependent. No intraoperative complications occurred, and postoperative outcomes were favorable, with only one readmission unrelated to the appendectomy. Conclusions: Selective appendectomy during laparoscopic surgery for endometriosis revealed a high prevalence (91.5%) of appendiceal pathology. Even without visible implants, the appendix may contribute to symptoms, underscoring the importance of thorough intraoperative evaluation. Selective appendectomy based on surgical findings may aid symptom relief, prevent missed diagnoses, and enhance comprehensive management of endometriosis, but these potential benefits must be weighed against the small risks of concurrent appendectomy. Full article

Accurate segmentation of surgical instruments in endoscopic videos is crucial for robot-assisted surgery and intraoperative analysis. This paper presents a Segment-then-Classify framework that decouples mask generation from semantic classification to enhance spatial completeness and temporal stability. First, a Mask2Former-based segmentation backbone generates class-agnostic instance masks and region features. Then, a bounding box-guided instance-level spatiotemporal modeling module fuses geometric priors and temporal consistency through a lightweight transformer encoder. This design improves interpretability and robustness under occlusion and motion blur. Experiments on the EndoVis 2017 and 2018 datasets demonstrate that our framework achieves mIoU improvements of 3.06%, 2.99%, and 1.67% and mcIoU gains of 2.36%, 2.85%, and 6.06%, respectively, over previously state-of-the-art methods, while maintaining computational efficiency. Full article

Background/Objectives: Postoperative pneumonia and other infectious complications after robotic-assisted minimally invasive esophagectomy still contribute to morbidity and mortality. Selective oral decontamination of the esophagus prior to surgery might reduce the rate of infectious complications. However, its impact on the esophageal microbiota is unknown. Therefore, this study aimed to analyze whether selective oral decontamination of the esophagus prior to surgery reduces postoperative pneumonia rates and alters the esophageal microbiome. Methods: We conducted a proof-of-principle study including 22 patients who underwent robotic-assisted minimally invasive esophagectomy. Thirteen patients were treated with 50 mg amphotericin B, 8 mg tobramycin, and 10 mg colistin orally 7 days prior to surgery, intraoperatively, and 5 days postoperatively. The remaining nine patients received standard-of-care treatment (no oral decontamination). The esophageal microbiome was assessed using 16S rRNA gene amplicon libraries which were annotated using the Ribosomal Data Project. The incidence of postoperative (at discharge from hospital or 30 days, whichever was later) infectious complications was assessed. Results: Selective oral decontamination was associated with reduced overall rates of infectious complications (7.7% vs. 55.5%, p = 0.008) and postoperative pneumonia (0% vs. 33.3%, p = 0.007). Alterations in the esophageal microbiome depending on selective oral decontamination were detectable. The microbiomes of patients with infectious complications showed higher abundances of Neisseria and lower abundances of Streptococcus than samples without infectious complications. Conclusions: Selective oral decontamination reduced the rate of postoperative complications, postoperative pneumonia in particular, after robot-assisted esophagectomy. Alterations in the microbiome were also evident following decontamination. Further studies with larger sample sizes are necessary to confirm these data. Full article