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Accurate setting of maximum comfort levels (MCL) during cochlear implant (CI) fitting is essential but subjective, especially in non-cooperative patients. The stapedius reflex (SR) correlates with the MCL and offers an objective measure. Surgical access to the stapedius muscle (SM) is challenging due to its proximity to the facial nerve and sigmoid sinus; a retrofacial approach is preferred. This study evaluated the feasibility of robotic-assisted SM access via this approach. Two cadaveric heads underwent robotic drilling using the HEARO system. Preoperative CT imaging and 3D planning with OTOPLAN defined patient-specific trajectories to the SM while maintaining safe distances from critical structures. Accuracy was assessed with postoperative CT and microscopic dissection. The SM was successfully achieved in both specimens with high precision and minimal invasiveness. Robotic-assisted retrofacial access to the SM is feasible and safe, supporting future precision surgery and closed-loop CI systems with objective SR monitoring.
The absence of force feedback limits efficiency and operational safety in robot-assisted vascular surgery. Precise modelling of the contact between catheter and vascular wall is important for achieving accurate force feedback. The flexible catheter forms dynamic multi-point line contact with the vascular wall and undergoes continuous bending and torsion, making accurate modelling and high-precision registration challenging. In addition, system time delay affects the transparency of the system. This study proposes a multi-information fuzzy fusion prediction method that incorporates prior surgical experience to enable real-time estimation of catheter position and orientation. More specifically, an extended formulation of Fitts' law in a dual-motion collaborative mode is developed to estimate surgical movement time. Experimental results demonstrate that the proposed method exhibits greater system transparency than that of the traditional extrapolation and Kalman prediction method. It can enhance force feedback fidelity. The proposed method can improve surgical safety.
This study investigated the impact of previous abdominal surgery (PAS) on short-term outcomes in robotic resection for colorectal cancer. 517 patients with colon or rectal cancer undergoing robotic resection between 2014 and 2024 were categorised into the no-PAS (n = 359) and PAS (n = 158) groups with further subdivision into minor and major PAS. Thirty-day outcomes and pathologic findings were compared. No significant differences existed between the PAS and no-PAS groups regarding preoperative characteristics. The rates of conversions (0.6% vs. 1.1%), intraoperative complications (2.5% vs. 2.2%), mean number of nodal harvest (32.5 ± 17.4 vs. 32.5 ± 17.1), and surgical margin positivity (2.5% vs. 0.6%) were similar. The minor PAS subgroup demonstrated a higher rate of surgical margin positivity (3.2% vs. 0%, p = 0.04). The results of this study suggest that robotic colorectal cancer surgery can be performed with similar short-term outcomes and comparable oncologic resection quality in patients with PAS.
Continuum manipulators have exceptional bending capabilities and gentle interaction with surrounding tissues; these manipulators have been widely adopted in medical applications. In single-port surgeries, the surgical field is narrow and densely populated with tissues and nerves, often extending beyond the continuum manipulator's dexterous workspace. This study proposes a control strategy designed to balance the trade-off between high dexterity and the spatial limitations of the non-dexterous workspace. This strategy employs Jacobian-based differential kinematics to compute solutions, thereby expanding the reachable workspace boundaries based on dexterity. By integrating the concept of spatial solid angles, the dexterity of the continuum manipulator within the reachable workspace is intuitively analysed. Experimental results indicate that the proposed method can effectively expand the workspace and enhance fault tolerance in spatial matching. The system maintains high trajectory-tracking consistency and orientation continuity within the non-dexterous workspace, thereby improving the accuracy and stability of teleoperation.
Cable-driven continuum robots face an inherent trade-off between stiffness and flexibility, with stiffness enhancement representing a critical challenge in the field. This study presents a stiffness-optimised cable-stayed notched manipulator (CSNM). The Bernoulli-Euler beam theory models elastic beam (EB) deformation for stiffness optimisation, while a simplified piecewise constant-curvature assumption based on tendon lengths is used for kinematics. An evolution-based EB optimisation algorithm achieves uniform stress distribution and enhanced load capacity. Experiments show that the maximum variance of the EB bending angle after optimisation is 0.5°. The maximum motion error of the manipulator on the x-axis and y-axis is 0.21 and 0.32 mm, respectively. Benefitting from the uniform distribution of stress, the load capacity of the manipulator increases by 100% after optimisation. These results validate the structural optimisation and kinematic modelling, highlighting the CSNM's potential for endoscopic applications needing flexibility and high load capacity.
Traditional surgical video recording requires professional personnel to manually adjust the camera capturing position, which leads to low recording efficiency and interference with the surgical process. To address these issues, this study proposes an automatic surgical video capture scheme based on an intelligent surgical video capture robot system. The method utilises the YOLO v5 algorithm and a 3D camera to identify and localise the surgical field area. Additionally, Convex Hull Edge Line Search (CHELS) algorithm is constructed to rapidly solve the optimal capturing position while avoiding obstacles. Finally, Position-Based Visual Servoing (PBVS) is applied to control the camera for precise capture of the surgical field. The detection model for the surgical field achieved an mAP@0.5 of 0.962, and the average solution time of the CHELS is 0.1469s. Automatic surgical video capture schemes can efficiently enable the intelligent and automatic recording of surgical videos.
Comparative data on postoperative outcomes between da Vinci robotic surgery and video-assisted thoracoscopic surgery (VATS) remain limited. This study compared pain, recovery, quality of life, and cost-effectiveness between these approaches. This propensity score-matched retrospective study included 60 patients (30 per group) undergoing thoracic surgery (January 2022-December 2024). Outcomes included VAS pain scores, morphine equivalents, SF-36 quality of life, 3-month chronic pain assessment, and cost-utility analysis. The da Vinci group had lower VAS scores at 4 h, 12 h, 24 h and 48 h (p < 0.001), with 33.6% less morphine consumption. Chest tube duration (4.55 ± 2.06 vs. 6.23 ± 2.41 days, p = 0.005) and hospital stay (5.69 ± 2.46 vs. 7.87 ± 2.83 days, p = 0.002) were shorter. SF-36 physical scores favoured robotic surgery at discharge (p = 0.006). Chronic pain at 3 months trended lower (10.7% vs. 25.0%, p = 0.168). The incremental cost-effectiveness ratio was 570,000 CNY/QALY. Da Vinci robotic surgery is associated with reduced postoperative pain and faster recovery compared with VATS, though cost-effectiveness and long-term benefits require further investigation.
Ureteroscopic lithotripsy is a minimally invasive surgical procedure used to treat kidney stones. It faces challenges like a long learning curve, poor ergonomics, and low control accuracy. This paper proposes a foldable bedside flexible ureteroscopy robot. Integrating Ureteroscopic lithotripsy requirements with miniaturised design, a kinematic model of the robot was established, and the bending hysteresis at the end of the flexible ureteroscope is compensated based on the Bouc-Wen model. xperiments evaluated the straightness of the linear motion joint and the motion accuracy of the rotary joint. The average straightness error is 1.68 mm and the rotation error is 1.46%. The bending accuracy is improved by 69.64% after hysteresis compensation. Overall performance of the robot is validated through the experiment on the kidney model and the animal experiment. The proposed robot satisfies the basic requirements of Ureteroscopic lithotripsy and shows a good performance.
Cervical arthrodesis requires precise pedicle screw placement to ensure safety and effectiveness. Traditional planning and execution are time-consuming and prone to variability. We developed a robot-assisted system integrating three components: an AI-based preoperative planning module, adapted from previous work, to generate patient-specific screw trajectory from 3D CT point-clouds; an intraoperative registration and motion compensation system with optical tracking to align the trajectory with patient anatomy in real time; and a comanipulation control strategy enforcing virtual fixtures and depth limits to guide the robotic arm safely. The system was tested on 3D-printed models and cadaveric specimens. Robotic assistance significantly improved the geometric accuracy of drilling, reducing transverse positional deviations by a factor of two and orientation deviations by a factor of eight compared with freehand procedures. In addition, the average drilling depth overshoot was reduced by 50%. Perforation rates were found to be of the same order as those observed with freehand techniques. The proposed workflow improves trajectory-following accuracy and depth control while preserving intuitive surgeon interaction. These results demonstrate the feasibility of integrating AI-based planning, intraoperative tracking, and collaborative robotics for cervical spine surgery.
To demonstrate the feasibility and mid-term outcomes of Robotic single-port single-incision laparoscopic surgery (RSP-SILS) for endometriosis management. A retrospective analysis was conducted on 50 adult women with endometriosis who underwent RSP-SILS via the da Vinci SP platform between November 2023 and July 2025. Median total operative time was 142 min, robot dock time was 3 min, and robot console time was 99 min. Median estimated blood loss was 25 mL. No conversion occurred. Reported mid-term outcomes included 1 case each of pelvic haematoma, Clostridioides difficile colitis, and umbilical surgical site infection, as well as 3 cases of recurrent pelvic pain. Additionally, learning curve analysis demonstrated that robotic docking time stabilised after approximately 18 cases, suggesting progressive technical familiarisation with the RSP-SILS platform. Our findings suggest that the use of RSP-SILS is a feasible and effective minimally invasive approach for performing complex procedures, specifically for endometriosis management.
To investigate the effect of robot-assisted radical trachelectomy (RRT) with the sleeve technique omitting anti-adhesion devices on postoperative cervical adhesion, perioperative, reproductive observations, and preliminary oncologic follow-up. A retrospective analysis was conducted on 8 early-stage cervical cancer patients who underwent RRT with the sleeve technique. No cervical anti-adhesion devices were used. Patients were followed up to assess the status of cervical adhesion, menstruation recovery, fertility, and recurrence. The FIGO stages of the 8 patients were IA2 (n = 1), IB1 (n = 5), and IB2 (n = 2). All resumed menstruation without cervical adhesion or recurrence during follow-up. Three of them attempted conception, one of whom became pregnant and gave birth to a live singleton via cesarean section in early January 2026. Preliminary clinical observations suggest that RRT with the sleeve technique may help reduce postoperative cervical adhesion without the use of anti-adhesion devices, which implies that individualised cervical adhesion prevention strategies should be considered. This study is a case series and thus does not require clinical trial registration. It has been approved by the Research Ethics Committee of Guangxi Medical University First Affiliated Hospital with the approval number IRB No.2025-E0850.
To report the minimum 18-month follow-up oncological results of the first preliminary descriptive series of robot-assisted radical prostatectomy (RARP) using Versius Robotic Surgical System (VRSS). Data of patients were collected from two Italian centres. Data on demographic variables, surgical results, pre- and postoperative prostatic specific antigen (PSA), needed for post-operative radiotherapy were extracted from the common database. Sixty patients underwent RARP performed by two surgeons at two different centres. Median follow-up time was 29.5 (IQR 23-35) months. Twenty-one (35%) patients had reported positive surgical margins and 18 (30%) presented extracapsular invasion in the final pathology report. Fifty-five (91.7%) patients had undetectable PSA (≤ 0.05 ng/mL) at 40 days follow-up after surgery. Thirteen (21.7%) patients underwent post-operative radiotherapy during our follow-up. Results of our experience with RARP suggest that performing RARP using VRSS oncologic results are comparable with other case studies using other robotic platforms.
During minimally invasive surgeries, the Kambin Triangle infiltration procedure is primarily used as a safe anatomical access route to critical spine structures. Inadequate location of final infiltrations can be critical for inexperienced residents. A mixed reality (MR) navigator simulator for spine infiltration was developed. It combines virtual fluoroscopy simulation (FS) and augmented reality views with 3D-printed lumbar spine patient models. Ten residents of orthopaedics tested the system. Residents showed more infiltration success under MR than FS but with higher risky contacts at the nerve roots. Residents reported an improved understanding of the anatomy and clinical case during MRI guidance and greater ease in locating target points in this condition. The results demonstrate the advantages of combining MR with FS for training minimally invasive spinal procedures to progressively train in a scenario close to reality once the anatomical and safety aspects of the approach have been understood.
This study compares outcomes of robotic Robotic-assisted left renal vein (LRV) transposition with and without proximal left gonadal vein (LGV) transposition for Nutcracker Syndrome (NCS). A retrospective analysis was conducted on 24 NCS patients. Group A (n = 13) had LRV transposition. Group B (n = 11) had combined LRV+ proximal LGV transposition. Outcomes including operative details, complications, symptom resolution, and renocaval pressure gradient (RPG) reduction. Operative time and hospital stay were similar between the groups. However, group B had a higher lymphatic leakage rate (64% vs. 8%; p = 0.0078) and required longer drainage (median 5 vs. 3 days; p = 0.02). Clinical symptoms improved in both groups. Group B achieved substantially greater RPG reduction (70% ± 15% vs. 55% ± 8%; p = 0.004). Robotic LRV and proximal LGV transposition for significant dilation is safe and effective. Despite higher short-term lymphatic morbidity, the combined approach offers greater reduction in RPG, providing a valuable alternative for selected patients. This research was also registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR2500099335 (Link: https://www.chictr.org.cn/bin/project/edit?pid=261879).
Despite improvements in revascularisation, precise donor vessel localization and haemodynamic optimization remain critical challenges in moyamoya disease (MMD) bypass surgery, especially for patients with pre-existing extracranial-intracranial (EC-IC) collaterals. This study evaluates the feasibility of neurosurgical robot-assisted navigation in addressing these challenges. Five consecutive MMD patients who received robot-assisted combined direct (STA-MCA) and indirect bypass from July to October 2023 were analysed retrospectively. Primary outcomes were intraoperative vessel injury rates and 12-month donor vessel patency on DSA/MRA. All STA dissections (5/5) succeeded without MMA injury. Postoperative imaging showed no competitive flow or donor vessel occlusion. All patients exhibited improved cognitive scores and favourable clinical outcomes at 1-year follow-up. Robot-assisted navigation enhances surgical precision in MMD through: Preserving EC-IC collaterals via millimetre-level trajectory planning and optimising anastomosis geometry to prevent competitive flow, which is important for patients with existing collaterals.
This study aimed to explore the effect of BMI on intraoperative conditions and postoperative complications (POCs) in robotic GC surgery. This is a retrospective analysis conducted on 60 patients who have GC and received robotic radical gastrectomy (RG) in our hospital. The patients were allocated into normal (18.5 kg/m2 ≤ BMI < 25 kg/m2) and high-BMI groups (BMI ≥ 25 kg/m2). The effect of BMI on intraoperative conditions and POCs was examined. The results revealed no statistical differences between both groups in terms of surgical procedure (p = 0.669), time of first postoperative flatus (p = 0.172), in-hospital stay (p = 0.454), Retrieved LNs (Lymph nodes) number (p = 1.000) and POCs (p < 0.05). However, the high BMI group had greater intraoperative bleeding (p = 0.018) and longer operating time (p = 0.016). To conclude, BMI may not affect the safety of RG for GC. Nevertheless, high BMI was associated with increased blood loss and prolonged operative time.
Lung resection is a standard treatment for lung cancer. Video-assisted thoracoscopic surgery (VATS) is widely used as a minimally invasive approach. Recent advancements in robotic technology enhances the safety and efficacy of robot-assisted thoracic surgery (RATS). This systematic review and meta-analysis compared the clinical outcomes of RATS and VATS in lung resection. PubMed, ClinicalTrials.gov, and the Cochrane Library were searched from inception to June 2025. Primary outcomes were lymph node yield and operative time. Secondary outcomes included R0 resection, postoperative complications, and recurrence. Data were analysed using Review Manager v5.4.1 with random-effects models. Twenty-nine studies involving 66,406 patients were included. RATS significantly improved lymph node yield (MD 4.54; 95% CI 2.91-6.17) and showed shorter operative time (MD -6.09; 95% CI -13.20-1.03). RATS was associated with higher R0 resection rates, fewer complications, and lower recurrence. The findings support the safety and oncologic effectiveness of RATS.
This study aimed to evaluate the feasibility, safety and effectiveness of the newly developed KangDuo-Surgical-Robot-2000 (KD-SR-2000) in robotic assisted radical prostatectomy (RARP). This prospective, multicenter, single-arm trial was conducted from October 2023 to April 2024. Thirty patients with clinical T1-3 prostate cancer underwent RARP using the KD-SR-2000. The study was approved by the institutional review boards. Perioperative results, early oncologic outcomes, urinary continence, and ergonomic workload (NASA-TLX) were assessed. All surgeries were performed successfully without any conversion. No severe perioperative complications (Clavien-Dindo grade ≥ III) or equipment-related adverse events occurred. Positive surgical margin was observed in five patients (16.7%). One (3.3%) patient experienced PSA persistence at 6 weeks. Urinary continence rate was 66.7% (20/30) at 4 weeks after catheter removal. The median NASA-TLX score was 22.5 (IQR 6-35.25). This study demonstrates the preliminary feasibility, safety and effectiveness of the KD-SR-2000 robotic system in RARP. www.chictr.org.cn: ChiCTR2300076954.
Vibrations in craniotomy surgical robots reduce precision and safety. This study introduces a clamp with a double-arrow negative Poisson ratio structure to suppress vibrations. Finite element simulations and skull drilling experiments were conducted to evaluate the vibration reduction of the optimised clamp design compared with the original. Compared with the original clamp, the double-arrow structure significantly reduced vibration during skull drilling. Specifically, the vibration frequency was reduced by 72.4% on the X-axis, 53.0% on the Y-axis, and 66.9% on the Z-axis. Vibration displacement was also reduced-by 59.0% on the X-axis and 84.5% on the Y-axis. Optimal damping performance was achieved with a lateral spacing of 1.2 mm and longitudinal spacing of 1.37 mm. These results confirm structure's effectiveness in improving vibration stability. The double-arrow clamp effectively reduces vibration in robotic craniotomy. It improves stability and safety through passive structural design, offering a practical alternative to active control methods.
Intraoperative C-arm imaging is essential in orthopaedic and trauma surgery, particularly with the increasing use of minimally invasive techniques. Conventional repositioning is performed by non-scrubbed staff, while robotic imaging systems are mainly limited to hybrid operating rooms. This study presents the first clinical experience with a fully motorised, self-driving mobile 3D-C-arm. In this prospective, single-center study, 300 procedures were analyzed using device log data and perioperative parameters to assess imaging workflow and system performance. Of 300 procedures, 279 were included. Mean procedure time was 104.7 ± 57.4 min, with a C-arm operation time of 31.9 ± 29.1 min, corresponding to a C-arm operation ratio (COR) of 35.2%. Automated positioning accounted for 30.7% of movements, and 37.9% of images were acquired from stored positions. The system enabled sterile-field control and demonstrated potential to support intraoperative imaging workflow. Further comparative studies are required to evaluate its clinical impact.