The aim of the study is to evaluate the effectiveness of Individualised Counselling Session (ICS) on Robotic Assisted Surgery to reduce stress and anxiety among parents of children undergoing Robotic Assisted Surgery. The objective was to assess the level of pre-operative stress and anxiety among the parents of children undergoing Robotic Assisted Surgery in selected surgical wards in experimental and control groups. A Quasi experimental study design and 50 samples were taken. The samples were selected by purposive sampling techniques, who fulfilled the sample criteria. The demographic variable and structured questionnaire were used for data collection. The descriptive and inferential statistics were used for data analysis with the help of SPSS software version 27. Out of 50 samples (25 each in experimental and control group) the experimental group RAS type pyeloplasty counts for 10(41.7%), Ureteric Reimplantation 4(16.7%), Bladder reconstruction surgery 5(20.8%), Mitrofanoff surgery 6(20.8%). Length of the stay for patient before surgery were 4-8 days in 12 patients (50%), 8-10 days in 11 patient (45.8%), 10-12 days in 2 patient (4.2%). Level of education of father who were included in the study were secondary education counts for 2(4.2%), Senior secondary education 7(29.2%), Graduation 16(66.7%) whereas level of education of mother who were included in the study were primary education counts for 3(12.5%), secondary education 4(12.5%), senior secondary 11(45.8%), graduation 7(29.2%) under the control group male were included in the study were 22(88%) and female were 3(12%).The RAS type pyeloplasty counts for 12(48%), Ureteric Reimplantation 4(16%), Bladder reconstruction surgery 3(12%), Mitrofanoff surgery 6(24%). Length of the stay for patient before surgery were 4-8 days in 10 patients (40%), 8-10 days in 13 patient (52%), 10-12 days in 2 patient (8%). Level of education of father who were included in the study were primary education counts for 2(8%), Senior secondary education 9(36%), Graduation 14(56%) whereas level of education of mother who were included in the study were primary education counts for 2(8%), secondary education 6(24%), senior secondary 10(40%), graduation 7(28%). Effectiveness of Individualised counselling Session (ICS) among parents were assessed with the help of structured tool APAIS and B-MEPS for anxiety and stress respectively in experimental and control group. In the experimental group in pre-test their Median was 1 and 26 in stress and anxiety respectively and after giving the Individualised Counselling Session (ICS) their post Test Score was Median 0.78 and 26 in stress and anxiety respectively. After apply the Wilcoxon Signed rank Test the p-value was significant i.e. < 0.001 for both stress and anxiety. The Z-value was -4.374 and -4.391in stress and anxiety respectively. In the control group in pre-test median was 1 and 25 in stress and anxiety respectively, and the post- test score was 0.78 and 26 in stress and anxiety respectively. After applying the Wilcoxon signed rank test the p-value was < 0.001 for stress and 0.412 for anxiety. It shows significantly increase in anxiety but not stress. The Z-value was -4.05 and -0.821 in stress and anxiety respectively. Therefore, it is concluded that there is effectiveness in experimental group after giving the counselling their stress and anxiety got reduced whereas in control group their stress got reduced but anxiety was persistent pre-operatively.
Robotic pancreatic surgery has advanced considerably in recent years; however, morbidity and mortality remain significant. Improving outcomes requires standardised procedures with optimised perioperative settings. Proper positioning of robotic trocars plays a key role in enabling safe and effective surgical performance. This study evaluates the impact of anthropometric differences on trocar placement in robotic pancreatic surgery and assesses the feasibility of a universal trocar placement strategy. A retrospective analysis of 103 consecutive contrast-enhanced arterial-phase computed tomography scans was performed. Key distances between the target anatomy and surface landmarks, including the umbilicus and xiphoid process, were measured. The origin of the gastroduodenal artery was selected as the target anatomy for pancreaticoduodenectomy, while the origin of the celiac trunk served as the target anatomy for distal pancreatectomy. The analysis demonstrated that the widely adopted universal periumbilical trocar placement was unsuitable for a substantial proportion of patients. The target anatomy lay outside the recommended range (10–20 cm) in 24% of robotic pancreaticoduodenectomy cases and in 9% of robotic distal pancreatectomy cases. Accordingly, we propose a simple method to optimise patient-tailored yet standardised trocar placement in robotic pancreatic procedures. Conventional vs. Novel Techniques: Robotic pancreatic surgery has emerged as an alternative to open and laparoscopic approaches. A universal approach to trocar placement is widely adopted; however, considerable inter-individual anatomical variability challenges its effectiveness. Modifications and Innovations: This study evaluates an individualised trocar placement strategy tailored to patient-specific anatomical variation. Target anatomy corresponds to the origin of the gastroduodenal artery for pancreaticoduodenectomy and the origin of the celiac trunk for distal pancreatectomy. Preoperative contrast-enhanced computed tomography scans were used for assessment. The tailored approach incorporates measurements between the umbilicus, xiphoid process, and the target anatomy, thereby optimising robotic trocar positioning for each patient. Implications and Recommendations: A standardised trocar placement approach may not be optimal for all robotic pancreatic procedures because of anthropometric differences. An individualised strategy may improve surgical efficiency, minimise instrument collisions, and potentially enhance perioperative outcomes.
We are currently uncertain of the benefits and harms of standard pelvic lymph node dissection (PLND) compared to extended PLND in the treatment of urothelial carcinoma of the bladder. To assess the effects of extended versus standard PLND in people undergoing cystectomy to treat muscle-invasive (cT2 and cT4a) and treatment-refractory, non-muscle-invasive (cT1 with or without carcinoma in situ) urothelial carcinoma of the bladder. We conducted a comprehensive literature search using multiple databases (CENTRAL, PubMed, Embase, Web of Science, and LILACS), trial registries, and conference proceedings published up to 24 September 2025, with no restrictions on language or publication status. We included randomized controlled trials (RCTs) in which participants underwent radical cystectomy for muscle-invasive or therapy-refractory non-muscle-invasive urothelial carcinoma of the bladder with either an extended PLND with an upper extent reaching as far as the inferior mesenteric artery, or a standard PLND up to the bifurcation of the internal and external iliac artery, with otherwise the same anatomical boundaries. Critical outcomes were time to death from any cause (assessed at five years), time to death from bladder cancer (assessed at five years), and Clavien-Dindo classification of surgical complications grade III-V (assessed up to 90 days' postoperatively). Important outcomes were time to recurrence (assessed at five years), Clavien-Dindo I-II complications (assessed up to 90 days' postoperatively), and disease-specific quality of life. We used the Cochrane RoB 2 tool to assess the risk of bias in the included studies. We conducted statistical analyses according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. We combined the results for each outcome using a meta-analysis with a random-effects model. We employed GRADE to evaluate the certainty of the evidence. We included two RCTs with 993 randomized participants (extended PLND 490, standard PLND 503). Both studies were published in full text. The median age of both groups was similar, ranging from 67 to 69 years for the extended group and 68 years for the standard group. All participants had locally completely resectable, invasive urothelial bladder cancer. Overall, the certainty of evidence for most outcomes was moderate to low, primarily downgraded due to imprecision. Time to death from any cause Extended PLND may result in little to no difference in time to death from any cause as compared to standard PLND (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.75 to 1.30; 2 studies, 993 participants; low-certainty evidence). Based on the control event risk of 43.0% at five-year follow-up, this corresponds to 3 fewer deaths from any cause (95% CI 86 fewer to 88 more) per 1000 participants. Time to death from bladder cancer Extended PLND likely extends the time to death from bladder cancer as compared to standard PLND (HR 0.65, 95% CI 0.44 to 0.97; 1 study, 401 participants; moderate-certainty evidence). Based on the control event risk of 35.0% at five-year follow-up, this corresponds to 106 fewer deaths from bladder cancer (95% CI 177 fewer to 8 fewer) per 1000 participants. Clavien-Dindo grade ≥ 3 complications (up to 90 days) Extended PLND likely increases Clavien-Dindo grade ≥ 3 complications as compared to standard PLND (risk ratio [RR] 1.22, 95% CI 1.06 to 1.41; 2 studies; 993 participants; moderate-certainty evidence). Based on the control event risk of 39.0% at 90-day follow-up, this corresponds to 86 more complications (95% CI 23 more to 160 more) per 1000 participants. Time to recurrence Extended PLND may result in little to no difference in time to recurrence as compared to standard PLND (HR 0.96, 95% CI 0.71 to 1.31; 2 studies, 993 participants; low-certainty evidence). Based on the control event risk of 40.0% at five-year follow-up, this corresponds to 12 fewer recurrences (95% CI 96 fewer to 88 more) per 1000 participants. Clavien-Dindo grade ≤ 2 complications (up to 90 days) Extended PLND likely results in similar Clavien-Dindo grade ≤ 2 complications as compared to standard PLND (RR 0.85, 95% CI 0.73 to 1.00; 2 studies, 993 participants; moderate-certainty evidence). Based on the control event risk of 40.2% at 90-day follow-up, this corresponds to 60 fewer complications (95% CI 108 fewer to 0 fewer) per 1000 participants. Disease-specific quality of life No studies reported this outcome. This updated systematic review synthesizes the evidence from the two available RCTs in this field. We found that extended PLND likely improves bladder cancer-specific survival; however, it may result in little to no difference in overall survival or recurrence-free survival. Extended PLND likely increases severe complications (Clavien-Dindo grade ≥ 3), while likely showing similar rates of minor complications (grade ≤ 2) at 90-day follow-up compared to standard PLND. These findings underscore the trade-offs of potential oncologic benefits of extended PLND versus the increased risk of serious complications in patients undergoing radical cystectomy. None REGISTRATION: Protocol (2018) available via https://www.crd.york.ac.uk/PROSPERO/view/CRD42018116290 Original review (2019) DOI: 10.1002/14651858.CD013336.
Because fixed costs such as capital investment, lease-related expenses, and depreciation vary substantially according to institutional case volume, timing of platform introduction, and local accounting policy, direct cross-platform comparison based on total cost may be difficult to interpret in routine practice. This study aimed to descriptively compare marginal profit rates of conventional laparoscopy (Lap), the da Vinci single-port (SP) system, and the da Vinci multi-port platforms in colorectal cancer surgery using institutionally standardized running costs. We retrospectively reviewed patients with resectable primary colorectal cancer who underwent minimally invasive surgery at our institution between October 2024 and December 2025. The primary economic outcome was marginal profit rate (MPR), defined as the proportion of reimbursement revenue remaining after subtraction of institutionally standardized running costs. These running costs included materials, personnel, and time-based operating room allocations. Fixed costs, including capital investment, lease-related cost, and depreciation, were excluded to focus on procedural cost efficiency during routine clinical operation. Because this study was designed as a descriptive cost-accounting analysis, no formal hypothesis testing was performed; however, 95% confidence intervals (CIs) were calculated for descriptive transparency. In an additional subgroup analysis, multi-port robotic cases were separated into da Vinci Xi and da Vinci 5. Of the 607 colorectal resections initially assessed during the study period, 575 cases were included in the final analysis. In the original platform-level comparison, laparoscopic surgery showed the highest marginal profit rates across evaluated procedures. Among robotic approaches, the SP group showed numerically higher marginal profit rates than the pooled multi-port group in colectomy and rectal resection. In the additional subgroup analysis, the cohort consisted of 118 laparoscopic cases, 131 SP cases, 258 Xi cases, and 68 da Vinci 5 cases. In colectomy, mean MPRs were 53.3% (95% CI, 52.4–54.3) for laparoscopy, 33.4% (95% CI, 32.1–34.7) for SP, 28.1% (95% CI, 27.2–29.0) for Xi, and 19.1% (95% CI, 16.3–21.9) for da Vinci 5. In rectal resection, the corresponding values were 61.5% (95% CI, 59.7–63.2), 43.3% (95% CI, 41.2–45.4), 40.8% (95% CI, 39.8–41.7), and 35.6% (95% CI, 33.0–38.3), respectively. In this single-center descriptive cost-accounting study using institutionally standardized running costs excluding depreciation, the da Vinci SP platform showed numerically higher marginal profit rates than the pooled multi-port cohort. Additional separation of the multi-port group suggested heterogeneity between Xi and da Vinci 5 in this early institutional experience. These findings do not establish economic superiority of any specific platform, but rather suggest that workflow behavior and resource utilization patterns may influence procedural profitability under real-world robotic colorectal surgery conditions. Further studies incorporating case-mix adjustment and device-level consumable analysis are warranted. The online version contains supplementary material available at 10.1007/s11701-026-03414-5.
Single-port (SP) robotic-assisted surgery is the latest development in minimally invasive colorectal surgery and may offer advantages such as improved cosmesis, reduced pain, and shorter hospital stay. However, evidence remains fragmented, and inconsistent outcome reporting limits comparison across studies and meaningful meta-analysis. This scoping review evaluated outcome reporting in SP robotic colorectal surgery to identify gaps and inform standardisation. A scoping review was conducted in accordance with PRISMA-ScR guidelines. Ovid MEDLINE, Embase, and the Cochrane Library were searched from inception to January 2026. Studies reporting clinical outcomes of SP transabdominal robotic colorectal surgery or comparing SP with multi-port (MP) approaches were included. Data extraction assessed reporting completeness across patient demographics, operative details, intraoperative outcomes, postoperative recovery, and long-term follow-up. Nineteen studies met inclusion criteria, comprising 992 patients, of whom 610 underwent SP robotic resection. Eight studies were comparative and eleven non-comparative. Most were single-centre retrospective series from high-volume centres in the United States and South Korea. Outcome reporting was highly heterogeneous. Operating time, complications, and conversion rates were most consistently reported. In contrast, postoperative and patient-centred outcomes were inconsistently captured, including pain scores (4/19 studies), return to theatre (2/19), and follow-up interval (5/19). All studies reported complications, but only 9/19 used standardised grading systems. No study assessed health economic outcomes or cost-effectiveness. Outcome reporting in SP robotic colorectal surgery remains inconsistent and focused mainly on technical feasibility. Standardised core outcome sets are needed to support robust comparison, pooled analysis, and evidence-based adoption.
To assess the feasibility and benefits of transoral robotic surgery in the public healthcare system and to conduct a cost analysis of its implementation. This prospective, nonrandomized, observational cohort study was conducted over 24 months and included patients with T1-T2 oropharyngeal and supraglottic laryngeal tumors. Thirty patients were included. The mean surgery duration was 204 min, and the mean hospital stay was 2.1 days. Postoperative complications included one case of bleeding and one case of aspiration. The estimated 5-year survival rate was 77%. Cost analysis revealed a higher initial cost for robotic surgery compared with conventional approaches; however, reduced postoperative complications mitigated the overall expenses. Transoral robotic surgery is a feasible and safe option within the public healthcare system. It enables highly complex procedures with faster postoperative recovery, lower morbidity, and survival outcomes comparable to conventional approaches.
Robotic-assisted total knee arthroplasty has been adopted to enhance surgical precision, yet contemporary national evidence on clinical and economic outcomes remains limited. To compare in-hospital complications, length of stay, and hospital charges between robotic-assisted and conventional total knee arthroplasty using recent nationwide data. We conducted a retrospective cohort study using the Nationwide Inpatient Sample from 2016-2022. Adult elective primary knee arthroplasty admissions were identified; cases with revision procedures or documented coronavirus disease were excluded. Robotic-assisted and conventional procedures were compared after 1:1 propensity score matching on demographics, hospital factors, and comorbidities and year of admission (two cohorts of 173,565 patients each). Outcomes included length of stay, total hospital charges, and major in-hospital complications. Two-sided tests were used with a significance threshold of 0.05. The proportion of robotic-assisted procedures increased from 0.7% in 2016 to 14.9% in 2022. After matching, robotic-assisted surgery was associated with a shorter mean length of stay (1.9 vs 2.7 days; p < 0.001) and lower rates of several complications. When expressed as relative risks (RR) (risk in conventional TKA divided by risk in robotic-assisted TKA), transfusion (RR 3.7), pneumonia (RR 3.0), pulmonary embolism (RR 2.6), prolonged ventilation (RR 2.1), and deep vein thrombosis (RR 1.8) were all higher in the conventional group (all p < 0.01). Acute kidney injury was marginally more frequent with robotic assistance (relative risk 0.9; p = 0.03). Mean hospital charges were higher for robotic-assisted procedures (US$70,758 vs US$62,618; p < 0.001). In a large, contemporary national cohort, robotic-assisted total knee arthroplasty was associated with fewer in-hospital complications and shorter hospital stays than conventional surgery, while incurring higher hospital charges. These findings support a potential safety advantage for robotic assistance during the index admission and motivate further study of longer-term clinical and economic outcomes. Levels of Evidence: LEVEL III.
Robotic surgery represents a major paradigm shift in surgical care, delivering significant improvements in precision, ergonomics, and postoperative patient outcomes. However, the rapid global proliferation of these systems necessitates a critical evaluation of their environmental sustainability. The healthcare sector, particularly within hospital operating theatres, is already a highly resource-intensive environment contributing substantially to national greenhouse gas emissions. The integration of robotic platforms may further exacerbate this ecological footprint through energy-intensive console and robotic arm operations, high consumption of single-use instruments, complex waste streams, and significant upstream manufacturing emissions. Recent life-cycle assessments indicate that robotic systems draw approximately 3.5 kW during operation, generating roughly 4 kg of CO₂ per hour. This is markedly higher than the 0.6 kW and 1 kg of CO₂ per hour associated with conventional laparoscopic equipment. This commentary piece aims to highlight these environmental realities for surgeons and key stakeholders. We do not advocate for the abandonment of robotic surgery, as its clinical benefits remain high. Rather, we issue a call for responsible environmental stewardship and innovation toward ecologically sustainable robotic platforms and components that maintain clinical excellence while mitigating planetary harm.
Robotic surgery has redefined hepatopancreatobiliary (HPB) practice, delivering enhanced precision and promising improved patient outcomes. Yet these benefits come with hidden costs, which are crucial in shaping adoption, equitable access, and hospital workforce capacity. This narrative review examines these hidden costs across three domains: financial, training, and environmental. From a financial perspective, we assess procedural cost structures, capital investment, market dynamics, reimbursement, and opportunity costs. In terms of training, we explore learning curves, their consequences, and the structural training limitations hindering skill diffusion. On the environmental front, we evaluate the ecological impact of robotic surgery and the importance of comprehensive life-cycle analyses. In addition, the review highlights areas that warrant further research and explores strategies to address the identified hidden costs. Collectively, the findings underscore the need to evaluate robotic HPB surgery not only for clinical outcomes, but also for its broader system-level implications to ensure equitable, sustainable, and economically prudent adoption.
Robot-assisted spine surgery (RASS) enhances procedural accuracy and reproducibility by ensuring full adherence to preoperative surgical plans. However, its widespread adoption remains limited by the need for a substantial upfront investment. In this study, the economic impact of spinal procedures performed under the guidance of the Mazor™ robotic system was compared with that of conventional techniques from an advanced Spanish hospital perspective. A 10-year budget impact analysis was conducted. The target population included all spinal surgeries potentially suitable for robot assistance, estimated from published data and expert input. Two scenarios were compared: a baseline scenario without Mazor™ and a progressive Mazor™ adoption scenario. Unit costs (€, 2025), obtained from Spanish sources, were applied to components of health care resource consumption. Model inputs and assumptions were validated by a panel of Spanish experts. A deterministic one-way sensitivity analysis (OWSA) was performed to assess the robustness of the results. The number of RASS-eligible patients increased from 213 to 330 annually over 10 years (2,673 total). The mean cost per patient was €10,093 for conventional surgery and €9,082 for RASS, generating average savings of €1,011 per patient. Savings were driven mainly by reductions in the length of hospital stay (€1,523), revision surgeries (€793), and complications (€261), outweighing the Mazor™ acquisition cost. Over the 10-year horizon, cumulative savings reached €2.54 million, achieving full capital investment recovery within 3.83 years. OWSA confirmed the robustness of these findings. From an advanced Spanish hospital perspective, the initial investment in RASS is recouped within four years, supporting its financial sustainability and long-term economic advantage over conventional spinal surgery.
Complex ventral hernias are a surgical challenge associated with high morbidity and healthcare costs. Component separation techniques have improved throughout the years with better outcomes, although the optimal approach remains debated. Robotic surgery has shown promising outcomes as an alternative to open repair, although data in large multicenter studies is still limited. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Adult patients undergoing component separation for ventral hernia repair were identified using CPT and ICD codes. Outcomes included 30-day surgical, wound, medical, and overall complications, as well as length of stay and readmission. Multivariable logistic regression and propensity score matching were applied to adjust for baseline differences. A total of 6,207 patients were included, from those 4,443 (71.6%) underwent open technique and 1,764 (28.4%) robotic. After propensity matching (n = 5,259), robotic repair was independently associated with significantly lower overall complication rates (4.8% vs. 19.6%, aOR 0.193, 95% CI 0.140-0.265, p < 0.001), including wound (2.2% vs. 10.2%, aOR 0.164, p < 0.001), surgical (2.9% vs. 10.0%, aOR 0.271, p < 0.001), and medical complications (2.0% vs. 7.0%, aOR 0.229, p < 0.001). Robotic surgery was also associated with shorter length of stay (1.34 vs. 3.86 days, p < 0.001) and lower readmission rates (4.4% vs. 9.1%, p < 0.001). Robotic component separation for ventral hernia repair is associated with lower postoperative complication rates, shorter length of stay, and fewer readmissions compared to the open approach. These benefits remained significant after multivariate analysis and propensity score matching, supporting the robotic technique as an effective strategy. Prospective studies are warranted to evaluate long-term outcomes, including recurrence, and to assess cost-effectiveness to optimize evidence-based surgical decision-making.
<b>Introduction:</b> Robotic platforms are increasingly used in colorectal surgery. Versius<sup></sup> is a modular robotic system whose safety and feasibility are currently being evaluated in routine clinical practice.<b>Aim:</b> To assess the safety, feasibility, and short-term oncologic outcomes of Versius-assisted colorectal cancer surgery in a single center during a two-year implementation period.<b>Material and methods:</b> A retrospective observational study was conducted, including patients undergoing elective robotic colorectal cancer resection using the Versius system between December 5, 2022, and August 27, 2025. Demographic characteristics, operative parameters (skin-to-skin time, docking time, console time, blood loss, conversions), intra- and postoperative complications (Clavien-Dindo classification), reoperations, 30-day readmissions and mortality, length of stay, and oncologic outcomes (resection margins, lymph node yield, mesorectal quality) were analyzed.<b>Results:</b> A total of 191 patients were included (51.8% male, mean age 69.7 9.8 years). The most common procedures were anterior resection (41.4%) and right hemicolectomy (26.7%). The median skin-to-skin operative time was 225 minutes (IQR 185-269). Median length of stay was 6 days (IQR 5-7). Conversion to laparotomy occurred in 8 patients (4.2%). Postoperative complications occurred in 40 patients (20.9%), including minor complications (Clavien-Dindo I-II) in 26 (13.6%) and major complications (≥III) in 14 (7.3%). Reoperation was required in 13 patients (6.8%), and 30-day readmission occurred in 6 (3.1%). One perioperative death was recorded (0.5%). Median lymph node yield was 22 (IQR 14-25), and ≥12 nodes were retrieved in 87.9% of patients. Complete mesorectal excision was achieved in 75.3%, with a combined rate of complete and nearly complete excision of 95.7%.<b>Conclusions:</b> Versius-assisted colorectal cancer surgery is feasible and safe in a center with established laparoscopic expertise. Acceptable complication rates and adequate oncologic parameters support its implementation in routine colorectal practice.
The prognostic relevance of surgical staging in patients with high-intermediate-risk and high-risk endometrial cancer remains uncertain. In this cohort study, we investigated the prognostic role of robot-assisted laparoscopic staging surgery among patients with clinically early-stage endometrial carcinoma at a high-intermediate-risk or high-risk for recurrence. Clinical data of women with clinically International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage I–II, grade 3 endometrioid or non-endometrioid EC who were intended to undergo robot-assisted laparoscopic staging surgery were retrospectively collected from a single tertiary referral center. The procedure consisted of total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and, when feasible, para-aortic lymphadenectomy, with additional omentectomy and peritoneal biopsies performed in a subset of cases. Survival outcomes were assessed using Kaplan–Meier analysis, with additional subgroup analyses by histological subtype. A total of 166 patients, of which 154 patients (92.8%) with FIGO 2009 stage I and 12 patients (7.2%) with FIGO 2009 stage II were included, comprising various histological subtypes, including 64 (38.6%) with endometrioid carcinoma, 52 (31.3%) with serous carcinoma, 11 (6.6%) with clear cell carcinoma, and 27 (16.3%) with carcinosarcoma. Thirty-two patients (19.3%) were reclassified as having FIGO stage disease III–IV based on final pathology. The 5-year disease-specific survival was 25.5% for upstaged patients compared with 73.1% for those who were not upstaged. Robot-assisted laparoscopic staging provides valuable prognostic information in clinically early-stage endometrial cancer with a high-intermediate-risk or high-risk of recurrence. These findings underscore the value of surgical staging in informing prognosis and guiding adjuvant treatment decisions. The online version contains supplementary material available at 10.1007/s11701-026-03316-6.
Octogenarians undergoing surgical management for benign prostatic obstruction (BPO) present unique challenges because of age-related comorbidities and frailty, which may impact perioperative outcomes. This study evaluates 30-day complications in octogenarian patients undergoing laser enucleation of prostate (LEP), robotic simple prostatectomy (RSP), and open simple prostatectomy (OSP) as reported in a large U.S. national database. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried for octogenarian patients who underwent BPO surgery from 2010 to 2023. Procedures were categorized using Current Procedural Terminology codes. Outcomes assessed included 30-day complications, readmission, and reoperation. Of 136,991 patients undergoing BPO surgery, 1,798 were octogenarians (LEP = 1,222; RSP = 93; OSP = 483). LEP patients had shorter median operative times (94 vs 123 and 153 minutes, p < 0.0001), shorter hospital stays (1 vs 3-6 days, p < 0.0001), and higher rates of discharge to home (96.8% vs 85.3%, p = 0.016). Transfusions were more frequent after OSP (27.5% vs 3.2%, p < 0.0001). Urinary tract infections were more common following RSP (9.7% vs 3.7-5.8%, p = 0.009). OSP was associated with higher rates of return to the operating room (4.6% vs 1.1-2.3%, p = 0.023) and prolonged hospitalization beyond 30 days (3.4% vs 0-1.5%, p = 0.016). Independent predictors of complications included higher ASA class, dependent functional status, longer operative time, and undergoing OSP vs LEP. LEP demonstrated superior perioperative outcomes with shorter operative times, lower transfusion rates, and a higher likelihood of discharge to home, supporting its preference in octogenarians. RSP provided intermediate outcomes, whereas OSP was associated with the highest morbidity.
We evaluated the clinical impact of textbook outcome (TO) in patients with stage I gastric cancer (GC) who underwent minimally invasive surgery (MIS). Moreover, we identified the risk factors associated with achieving TO in these patients. Patients were selected from the database of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital between 2005 and 2025. Our definition of TO comprised 10 items: complete (potentially curative) resection, R0 resection, retrieval of more than 16 lymph nodes, no intraoperative complications, no severe postoperative complications (Clavien-Dindo grade III or higher), no reintervention after surgery, no unplanned ICU/HCU admission, no readmission within 30 days after discharge, no prolonged hospital stay (defined as more than 21 days after surgery), and no mortality within 30 days after surgery. We analyzed 889 patients who underwent MIS and were pathologically diagnosed with stage I GC. Among them, 621 patients (69.8%) achieved TO, whereas 268 patients (30.2%) did not. The most frequent reason for failure to achieve TO was prolonged hospital stay (>21 days after surgery) (17.5%), followed by postoperative surgical complications (15.4%). In the multivariate analysis, age [odds ratio (OR)=1.619), BMI (OR=1.849), and type of gastrectomy (OR=1.674) were identified as independent risk factors for failure to achieve TO. The 5-year overall survival (OS) rate was 97.5% in patients who achieved TO and 94.7% in those who did not, showing a significant difference between the two groups (p=0.041). The TO achievement rate was approximately 70%, and failure to achieve TO was associated with age, preoperative BMI, and type of gastrectomy. Achievement of TO was associated not only with favorable short-term outcomes but also with improved long-term oncological outcomes.
Robotic pancreatic surgery in children remains rarely reported. Central pancreatectomy (CP) offers a parenchyma-sparing option for benign or low-grade malignant tumors. Adult data suggest externalized duct stents may mitigate postoperative pancreatic fistula (POPF), but pediatric evidence is lacking. A systematic search of MEDLINE, Embase and the Cochrane Library (November 2025) identified reports of robotic pancreatic resection in pediatric patients. Data on pathology and perioperative outcomes were extracted. We additionally provide a technical description of a reproducible surgical approach applied in two consecutive pediatric patients undergoing robotic CP with Roux-en-Y duct-to-mucosa pancreaticojejunostomy (PJ) and externalized pancreatic duct stent at a high-volume pancreatic center. A detailed video documents the step-by-step technique. Perioperative and 6-month outcomes are reported. Ten case reports were included. Indications were solid pseudopapillary tumor (SPT) (n = 7), insulinoma (n = 2), and pancreatic neuroendocrine tumor (NET) (n = 1). Procedures comprised distal pancreatectomy (DP) (n = 5), pancreatoduodenectomy (PD) (n = 2), CP (n = 1), and enucleation (n = 2). PJ was used in all reconstructive procedures, and no study reported stent placement. POPF occurred in 1 patient after CP; other complications were infrequent. The described technique was applied in two pediatric: one developed biochemical leak (BL) and one grade B POPF, managed conservatively. At 6 months, pancreatic function was preserved with no recurrence. Robotic CP with PJ and externalized pancreatic duct stent is technically feasible in selected pediatric patients. However, given the limited evidence and lack of comparative data, no conclusions can be drawn regarding effectiveness. These findings are hypothesis-generating and require validation in multicenter studies. The online version contains supplementary material available at 10.1007/s11701-026-03424-3.
To evaluate changes in acid-base equilibrium in plasma and urine according to the Stewart’s approach, in gas exchange and in respiratory mechanics during robotic-assisted surgery. Prospective observational study on patients undergoing robotic-assisted surgery. Acid-base equilibrium in plasma and urine was measured after 10 min from general anesthesia induction (T0), after 2 h from pneumoperitoneum administration (T1) and after 10 min from pneumoperitoneum interruption (T2). In the same timepoints respiratory mechanics, gas exchange and hemodynamics variables were measured. Seventy-three patients were enrolled. The apparent strong ion difference did not change during the whole study. Urine sodium and chloride concentration did not change throughout the study, although sodium absolute excretion decreased. Urinary anion gap increased from 35 [26–42] at T0 to 39 [28–53] mEq L− 1 at T2. At T1, a significant increase in arterial carbon dioxide partial pressure (45 [42–51] vs. 41 [37–45] mmHg) as well as a consequent reduction in arterial pH (7.36 [7.3–7.38] vs. 7.41 [7.37–7.44]) compared to T0 was found. At T2, arterial carbon dioxide partial pressure and arterial pH decreased but never returned to baseline. The behavior of acid-base equilibrium in plasma and urine was independent from fractional sodium excretion. Pneumoperitoneum did not alter plasma strong ion difference or urinary electrolytes concentration, although it induced respiratory acidosis with acidemia. The absence of any compensatory change in urinary electrolytes was probably related to the hemodynamic effect of pneumoperitoneum on the kidneys, resulting in a reduction in absolute excretion of sodium. The online version contains supplementary material available at 10.1007/s11701-026-03392-8.
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