Search Results (64)

Introduction: Artificial intelligence (AI) and robot-assisted platforms are increasingly influencing cardiothoracic surgery. AI enhances risk prediction, imaging interpretation, and early complication detection, while robotics improves visualization, dexterity, and minimally invasive access. This systematic review evaluates the current evidence supporting these technologies and their implications for clinical practice. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000–May 2025) following PRISMA 2020 guidelines. After screening and eligibility assessment, 67 studies met predefined inclusion criteria and were incorporated into the qualitative synthesis. Additional high-impact reviews and consensus documents were consulted for contextual interpretation. Results: Machine learning models demonstrated modest but consistent improvements in predictive performance compared with EuroSCORE II and STS scores, particularly in high-risk cohorts. Robot-assisted mitral and coronary procedures showed reduced postoperative pain, blood loss, ICU stay, and recovery time in experienced centers, though early learning phases were associated with longer operative, cross-clamp, and bypass times. AI-enabled intraoperative tools, such as video analysis, workflow recognition, and real-time anatomical segmentation, emerged as promising adjuncts for surgical precision. Structured robotic training programs, especially simulation-based and dual-console pathways, accelerated proficiency acquisition. Conclusions: AI and robotic systems act as augmentative technologies that enhance rather than replace the surgeon’s role. Their safe and effective adoption requires standardized training, transparent AI decision pathways, and clear ethical and medico-legal governance. Full article

Background. Cor triatriatum dexter (CTD) is a rare congenital heart defect where a membrane divides the right atrium into two chambers, resulting from the incomplete regression of the right valve of the sinus venosus. Due to its rarity, only individual case reports and a limited number of case series have been published to date. This study constitutes the most extensive comprehensive review conducted in this area. Eight factors were evaluated: age at diagnosis, sex, clinical presentation, electrocardiographic findings, imaging (ultrasound, CT, or MRI), associated cardiac anomalies, and patient outcomes. Methods. The electronic databases PubMed and Scopus were searched from their inception until 30 October 2025. Only case reports and case series were considered for inclusion. Studies involving foetuses, autopsies, and animals were excluded. The collected data were primarily presented as percentages. Results. One hundred fourteen studies were found encompassing 124 patients. The mean age at diagnosis was 33.3 ± 9.4 years The most common clinical presentations were dyspnoea (44.3%) and cyanosis (29.5%). The most commonly encountered ECG changes were supraventricular tachycardia/atrial flutter/atrial fibrillation (33.3%) and right bundle branch block (22.6%). On chest X-ray, cardiomegaly was noted in 46.5%. CTD was suspected or diagnosed by echocardiography in 95.2% of cases. The diagnosis was confirmed by CT and/or MRI in 34.1% of cases. A concomitant congenital heart defect was found in 67.7%, especially in the form of all kinds of atrial septal defect (38.1%) and of right valvular and right ventricular involvement (20.1%). An outcome was reported in 97/124. Surgical correction was the treatment of choice in 51.6%. Since 1991, a percutaneous approach has been employed in selected cases (5.1%). Conservative management was the treatment of choice in 43.3%. The mortality rate was 8.2%. Discussion. The principal limitation of this systematic review lies in its reliance solely on case reports and small case series, reflecting the absence of large-scale studies on CTD. Nonetheless, it constitutes the most comprehensive analysis available to date. Full article

Background/Objectives: Robotic technology has transformed several surgical specialties, offering enhanced precision, visualization, and dexterity. In plastic and reconstructive surgery, robotic systems are increasingly utilized across a range of procedures, though their applications remain in early development. Methods: A review of the literature was performed to identify studies reporting robot-assisted procedures in plastic and reconstructive surgery. The literature was synthesized thematically to characterize current procedural applications, emerging technologies, and areas of active clinical investigation. Results: Robotic systems have been reported in a broad range of plastic and reconstructive procedures, including flap harvest, microsurgery, breast reconstruction, craniofacial and head and neck reconstruction, esthetic surgery, and gender-affirming surgery. The existing studies primarily consist of case series and case reports with substantial variability in reported indications, techniques, and technological platforms. Comparative clinical outcomes and long-term data are limited. Conclusions: Robot-assisted reconstruction continues to expand across multiple procedural domains. However, current evidence remains largely descriptive, underscoring the need for standardized reporting and prospective studies to better define clinical value, safety, and appropriate indications. Full article

Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, have confirmed the oncological adequacy of segmentectomy for early-stage non-small-cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomical precision and potentially improves segmentectomy outcomes. Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging. Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissection and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care. Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive benefits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance personalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC. Full article

Background: The maintenance of an aseptic barrier between the surgical team and patient aids in the prevention of exposure of the patient to pathogens. Variations in gloving practice may have safety implications due to glove failure. An important relationship exists between optimum glove fit and manual dexterity, tactile sensitivity, and fatigue. The aim of this systematic review was to assess the presence and quality of the available literature that investigates the critical association between glove fit and provider performance in the operating theatre and to ascertain whether there is an established standard to determine appropriate glove size. Methods: A systematic review of the literature was undertaken in accordance with the PRISMA statement using one distinct research question regarding glove fit (INPLASY2025100008). Searches on PubMed, Embase, Cochrane Collaboration of Systematic Reviews and Metanalyses and Google Scholar were performed between 1 May 2022 and 24 January 2023. Studies were assessed for eligibility against pre-defined inclusion and exclusion criteria. Risk of bias was determined using multiple assessment tools. Results: This systematic review included 18 studies, nine of which were high-quality Level I or II trials, and multiple observational analyses. Poor glove fit was consistently associated with reduced manual dexterity, impaired tactile sensitivity, and decreased comfort, while oversized or undersized gloves increased the risk of glove perforation and fatigue. These findings underscore the clinical importance of appropriate glove sizing to optimize surgical performance and safety. Conclusions: There is a scarcity of high-quality studies investigating the relationship of glove fit and performance. Furthermore, there does not appear to be a standard method to determine the optimal glove fit for members of the surgical team, nor are there practical examples of how glove size is determined. Further research in this area is required. Full article

Inspired by the musculoskeletal structure of snakes, this study proposes a cable-driven continuum robotic system, comprising a dual-segment continuum arm and a linear feeding module. The continuum arm provides four joint degrees of freedom through coordinated cable actuation for snake-like bending, while the feeding module enables linear translation along the Z-axis, resulting in a total of five degrees of freedom. A constant-curvature kinematic model is developed, and a real-time inverse kinematics solution based on fifth-order Taylor expansion is proposed. To enhance postural stability, a master–slave teleoperation control framework is implemented that decouples translational motion from orientation control. Leveraging the geometric symmetry of its dual-segment design, the system achieves consistent end-effector orientation by coordinating bending angles and rotation directions between segments. Simulation and experimental results validate the accuracy of the kinematic model and demonstrate the robot’s capability for dexterous, stable movements in confined environments. The proposed continuum robot offers high positioning accuracy, structural adaptability, and strong potential for bioinspired applications in endoscopy and minimally invasive surgical procedures. 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

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

Background/Objectives: The present study aimed to examine the branching pattern images of the Hepatis Portae Vena (HPV), which is one of the vascular structures of the liver, with Computed Tomography (CT), and to uncover the surgical and radiological importance of the variations. Methods: The HPV branching patterns on CT images of healthy liver of 996 individuals (47.8% male, 52.2% female) between the ages of 20 and 59 were evaluated according to previously determined definitions. The division of the main branch of the HPV into ramus (r.), dexter, and r. sinister and the later division of r. dexter into r. anterior and r. posterior branches were called Type I-a, other main branch variations were called Type II-a, Type III-a, and Type IV-a, and the r. dexter variations were called Type V-b, Type VI-b, Type VII-b, and Type VIII-b. Also, all individuals in the present study were examined under four age groups as 20–29, 30–39, 40–49, 50–59, and the data were analyzed in the SPSS 21 software. Results: Type I-a (73.1%) was detected most frequently in all individuals, but Type VI-b (0.1%) and Type VII-b (0.1%) were detected least frequently. Following Type I-a, Type II-a (10.6%), Type III-a (8.2%), and Type V-b (5.5%) were detected, respectively. No statistically significant differences were detected between gender and age groups in terms of the frequency of HPV types (p > 0.05). Conclusions: We believe that accurate knowledge and definition of HPV anatomy will guide liver surgeries and interventional radiology, which are the cornerstones of the treatment of liver diseases. 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: Humans interacting with virtual objects is becoming common due to the popularity of the devices adopting the mixed reality (MR) techniques. Assessing hand functions using these devices for medical purposes provides alternatives in addition to the traditional hand function assessment techniques. Objectives: The objectives were to compare the movement time (MT) of handing a real and a virtual object between post-surgery wrist fracture patients and healthy adults and to determine the correlation between the MT and commonly adopted hand function indicators. Methods: An experiment was performed. A total of 29 participants, including 17 patients and 12 healthy adults, joined. All the participants moved a real or a virtual tube from an origin to a destination. A set of MR device was adopted to generate the virtual object. The MTs were analyzed to compare differences between the patients and the healthy adults. Regression models were developed to predict the MT under experimental conditions. Results: The MT of the surgical hand was significantly longer than that of the nonsurgical hand of the patients and was significantly longer than that of the left hand of the healthy adults. The MT was negatively correlated with the commonly adopted hand function indicators, including grip strength, range of motion, hand dexterity score, and Modified Mayo Wrist Score. Conclusions: The anticipation that the MT of interacting with virtual objects for patients may reveal hand function characteristics for post-surgery patients was supported. The regression models developed could reveal the progression of hand function recovery for these patients. Having patients interact with virtual objects could be a supplemental approach in assessing their hand functions. Full article

Robotic pancreaticoduodenectomy (RPD) has emerged as a viable alternative to open and laparoscopic approaches, offering potential advantages in precision and dexterity. However, its complexity and lack of standardization remain as barriers to widespread adoption. We present a step-by-step surgical approach to RPD, emphasizing key technical strategies to enhance safety, efficiency, and reproducibility. Our technique is structured into defined surgical steps, facilitating learning curve optimization and intraoperative consistency. Key refinements include an optimized trocar placement, the strategic suspension of vascular structures, and specific reconstructive techniques to reduce the operative time and improve surgical ergonomics. These improvements may contribute to a reduction in perioperative morbidity and procedural standardization. Standardizing RPD through defined surgical steps and structured learning pathways may improve its feasibility, safety, and broader adoption. Further studies are needed to validate these strategies in high-volume centers. Full article

For over two decades, robotic-assisted thoracic surgery (RATS) has revolutionized thoracic oncology. With enhanced visualization, dexterity, and precision, RATS has reduced blood loss, shortened hospital stays, and sped up recovery compared to traditional surgery or video-assisted thoracoscopic surgery (VATS). The use of 3D high-definition imaging and articulated instruments allows for complex resections and advanced lymph node assessment. RATS delivers oncological outcomes similar to open surgery and VATS, with high rates of complete (R0) resections and acceptable complication rates. Its minimally invasive nature promotes quicker recovery. Advances in imaging software and augmented reality further enhance surgical accuracy and reduce intraoperative risks. However, RATS has some limitations, including high costs and a lack of tactile feedback, and certain complex procedures, such as extended resections and intrapericardial interventions, remain challenging. With growing experience and technological advances, RATS shows promise in reducing morbidity, improving quality of life, and expanding access to advanced oncologic care. This article reviews the evolution, benefits, and limitations of RATS in NSCLC treatment, highlighting its emerging role in managing complex cases. Full article

Over the past two decades, surgical techniques in colorectal cancer (CRC) have improved patient outcomes through precision and reduced invasiveness. Open colectomy, laparoscopic surgery, robotic-assisted procedures, and advanced rectal cancer treatments such as total mesorectal excision (TME) and transanal TME are discussed in this article. Traditional open colectomy offers reliable resection but takes longer to recover. Laparoscopic surgery transformed CRC care by improving oncological outcomes, postoperative pain, and recovery. Automated surgery improves laparoscopy’s dexterity, precision, and 3D visualisation, making it ideal for rectal cancer pelvic dissections. TME is the gold standard treatment for rectal cancer, minimising local recurrence, while TaTME improves access for low-lying tumours, preserving the sphincter. In metastatic CRC, palliative procedures help manage blockage, perforation, and bleeding. Clinical examples and landmark trials show each technique’s efficacy in personalised care. Advanced surgical techniques and multidisciplinary approaches have improved CRC survival and quality of life. Advances in CRC treatment require creativity and customised surgery. Full article

Background/Objectives: Robotic systems offer enhanced precision, dexterity, and visualization, which are essential in addressing the complex nature of plastic surgery procedures. Despite widespread adoption in other surgical specialties, such as urology and gynecology, their application in plastic surgery remains underexplored. This review examines the use of robotic systems in plastic and reconstructive surgery with a focus on clinical outcomes. Methods: A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. Search terms included (“robotic surgery” OR “surgical robots”) AND (“plastic surgery” OR “reconstructive surgery”). Studies on clinical outcomes and biomimetic innovations published between 1980 and 2024 were included, while non-English, cadaver-based, and animal studies were excluded. Data were systematically extracted using Covidence and analyzed. Results: Twenty-nine studies were identified that evaluated the clinical outcomes of robotics in areas including breast reconstruction, microsurgery, and craniofacial procedures. Robotic systems like the Da Vinci and Symani platforms offer motion scaling, tremor elimination, and enhanced depth perception. In nipple-sparing mastectomies, they reduced skin necrosis rates from 8% to 2%, while in DIEP flap reconstruction, they enabled smaller fascial incisions (2.67 ± 1.13 cm vs. 8.14 ± 1.69 cm) and faster recovery with fewer complications. In microsurgery, they achieved 100% patency for vessels under 0.3 mm and a 25.2% limb volume reduction in lymphedema patients in 3 months. Conclusions: Robotic systems show significant promise, particularly in procedures such as nipple-sparing mastectomies, and have the potential to overcome challenges including surgeon fatigue. However, challenges such as longer operating times, high costs, and limited haptic feedback remain barriers to their adoption. Full article