In 2018, Inoue et al.1 introduced a systematic classification of the extent of dissection along the celiac axis (CA) and hepatic artery (HA) during open pancreaticoduodenectomy (PD). Three levels of perivascular dissection were defined according to surgical indication: level 1, limited organ resection without oncological dissection for benign or low-grade malignant lesions; level 2, formal lymphadenectomy with preservation of the perivascular nerve plexus for borderline or low-grade malignancies; and level 3, radical dissection, including perineural clearance for pancreatic cancer. As robotic PD is increasingly adopted, it should reproduce the same oncological standards established in open surgery.2-4 However, a standardized robotic technique capable of achieving all levels of the Inoue classification has not yet been clearly described. This video article aims to present a stepwise robotic approach to CA-HA dissection consistent with these principles. We present a comprehensive surgical video demonstrating a standardized robotic technique to achieve graded dissection of the CA and HA from level 1 to level 3. A supplementary video specifically illustrates advanced CA-HA dissection in the setting of vascular involvement requiring resection and reconstruction. Independently of the dissection level, three constant technical principles are systematically applied: (1) arterial control through vessel loop encirclement of the HA to avoid undue manipulation; (2) a selective and stepwise use of robotic instruments according to the depth of dissection, with monopolar curved scissors used to develop the superficial planes and Maryland bipolar forceps employed for precise periadventitial skeletonization of the arterial structures, thereby minimizing mechanical and thermal injury to the arterial wall. Energy sealing devices such as the vessel sealer (Intuitive Surgical, Sunnyvale, CA, USA) are used selectively and only away from major arteries, mainly for lymphatic or venous division and for final hemostasis once lymph nodes have been mobilized from the arterial wall. Alternatively, cold dissection with scissors can be used for precise arterial divestment, as previously described by Kauffman et al.5; (3) a structured four-hand robotic strategy involving two experienced hepato-pancreato-biliary surgeons to optimize exposure and vascular safety, with one surgeon operating at the console and a second surgeon assisting at the bedside to provide dynamic retraction, suction, and vascular control. All three levels of CA-HA dissection according to the Inoue classification were successfully achieved robotically. The robotic platform enabled stable magnified visualization and precise skeletonization along vascular and perineural planes. Advanced dissections, including circumferential perineural clearance, were feasible without intraoperative arterial injury or uncontrolled vascular complications, even during level 3 dissections or when vascular resection and reconstruction were required. A graded clearance of the CA and HA according to the Inoue classification can be safely reproduced during robotic PD, supporting standardization of oncological principles across different levels of perivascular dissection.
Robotic surgery has changed pediatric urology more and more by giving pediatric urologists less invasive options for complicated reconstructive surgeries. Thanks to advances in technology, pediatric urologists can now execute procedures with better dexterity, 3-dimensional visibility, and accuracy. These are especially important for congenital malformations that need precise dissection. Robotic-assisted laparoscopic pyeloplasty is now the most prevalent technique. It boasts success rates that are similar to those of open surgery and benefits including less pain, shorter hospital stays, and better appearance. Robotic ureteral reimplantation is also a safe and successful alternative to open repair for vesicoureteral reflux and primary obstructive megaureter, although it takes longer to learn how to do it. More and more often, complex surgeries like heminephrectomy, augmentation ileocystoplasty, Mitrofanoff appendicovesicostomy, and bladder neck reconstruction are being done with robots, and the results are looking excellent. Robotic methods in pediatric uro-oncology are changing, but it's important to choose patients carefully because of worries about tumor spilling. Robotic surgery is a useful technique in pediatric urology because it is more precise, comfortable, and quick to recover from, even if it costs more and takes longer to do. As robotic surgery becomes more common and its technology improves, it is likely to become a major part of both simple and complicated pediatric urology treatments in the future.
Valgus knee deformity, which is less common, is not a mirror image of varus knee deformity and poses unique technical challenges in total knee arthroplasty (TKA). Although the lateral parapatellar approach may be advantageous for severe valgus knee, the medial approach is often preferred due to surgeons' limited familiarity with valgus TKA and the lateral approach. Recently, robotic technology has demonstrated superior accuracy in bone resection and soft-tissue balancing during TKA. Hence, we introduce the application of robotic technology for valgus knees via the lateral approach in TKA. As the standard patella drill template of the onlay oval patellar implant was designed for the medial approach, we created a reversed-asymmetric patella drill template for the lateral approach. In the recent cases, patellar tracking following prosthesis implantation was also evaluated using robotic technology. We included cases of primary TKA performed for Ranawat classification types II and III with uncorrectable valgus knee alignment, as well as for valgus deformity > 20°. In TKA, arthrotomy was performed via the lateral approach, and the patella was retracted medially. After soft-tissue balancing was adjusted, bone resection was performed using the Mako robotic system. The patella was replaced with an onlay oval patellar implant using our novel patella drill template in the lateral approach. Patellar tracking on the femoral trochlear groove after implantation was visualized and assessed using robotic technology. The surgical procedures were performed smoothly in 10 knees of 9 patients. The pre-operative limitations of knee extension, Visual Analog Scale scores, and radiographic knee alignment significantly improved following TKA. Pre-operatively, the tibiofemoral joint gaps were tighter laterally in both extension and flexion; post-operative medial laxity was effectively corrected. The accuracy and precision of prostheses positioning were confirmed radiographically. Patellar tracking was found to be appropriate after replacement with the oval patellar implant. The combination of robotic assistance, the lateral approach, and onlay oval patellar implants using our originally developed patella drill template showed feasibility for precise bone resection, optimal soft-tissue balancing, and proper patellar tracking for TKA in cases of valgus knee deformity.
Uniportal robotic-assisted thoracic surgery (URATS) combines the precision of robotic systems with the minimal invasiveness of single-incision surgery. However, its widespread adoption is currently limited by technical challenges regarding external robotic arm collision and setup complexity. We aimed to evaluate the feasibility, safety, and early adaptation of URATS using a standardized "vertical parallel" docking strategy during our initial experience. Data from the first 12 consecutive patients undergoing URATS anatomical lung resections were retrospectively analyzed. A strict vertical parallel docking configuration was employed, stacking the robotic arms linearly within the incision to prevent collision. The early learning trends were assessed using trend analysis of docking and console times. The cohort included 7 lobectomies, 4 segmentectomies, and 1 pneumonectomy. All procedures were successfully completed without conversion to thoracotomy or multiportal RATS. Median total operative time was 211 minutes (range, 122-368 min). A rapid standardization of the setup phase was observed, with median docking time stabilizing at 5 minutes (range, 4-7 min). Correlation analysis demonstrated rapid adaptation to the setup process within the initial cases (Spearman ρ = -0.92; P <⁠0.001). Console times fluctuated according to patient-specific complexity (eg, obesity, adhesions) rather than case sequence. No major intraoperative complications occurred. URATS is a safe and feasible technique for complex anatomical resections, including pneumonectomy, even during the initial experience. The adoption of a vertical parallel docking strategy may shorten the initial adaptation phase by preventing robotic arm collisions, thereby making the procedure more reproducible.
Robotic-assisted systems have been developed to improve the accuracy and reproducibility of total knee arthroplasty (TKA). While outcomes have been widely studied, the effects of these systems on intraoperative workflow and surgical team workload have received less attention. The aim of this study was to compare procedural setup, efficiency, workload, and ergonomics between the VELYS robotic-assisted solution (VRAS) and computer-navigated TKA (NAVI). Twenty patients who underwent primary TKA performed by a single surgeon, using a single implant type, were enrolled in this research (10VRAS, 10NAVI). Procedural efficiency was assessed by reference to an AI-backed process digital twin platform. Workload was evaluated using NASA-TLX questionnaires, objective ergonomic measures (power tool holding times, retractor holding times, and leg holding times), and a tray analysis. The mean total operating room (OR) time was 69.4 min for the VRAS group and 72.9 min for the NAVI group, with no significant difference. The preparation (22 min) and the breakdown times (12.6 vs.11.7 min) were equivalent. The skin-to-skin times averaged 34.3 min for the VRAS group versus 38.9 min for the NAVI group. NASA-TLX scores revealed significantly lower mental, physical, and temporal demands, reduced effort and frustration, and better perceived performance of the surgeon in the VRAS group (p < 0.05). The instrument burden was similar, 5 trays (21.5 kg) for VRAS and 4 trays (20.9 kg) for NAVI. The objective workload was reduced for the VRAS group, with shorter power tool holding (2.7 vs. 7.7 min, p < 0.001), retractor holding (7.8 vs. 13.0 min, p = 0.01), and leg holding times (3.4 vs. 4.7 min, p = 0.02). Compared with navigated TKA, robotic assistance did not prolong overall OR time and was associated with lower measured NASA-TLX scores. These findings suggest that robotic-assisted TKA may offer workflow and ergonomic advantages, although further studies with larger samples are needed to confirm these preliminary observations. Level 4, retrospective study.
Vascular injury during total knee arthroplasty (TKA) is rare, but potentially catastrophic, leading to ischemia, the need for vascular repair, or limb loss. Robotic-assisted TKA (RA-TKA) incorporates computed tomography (CT)-based three-dimensional planning, intraoperative balancing, and haptic boundaries that may reduce intraoperative saw excursion and mitigate neurovascular risk. This study compared the incidence of vascular injuries between RA-TKA and conventional manual TKA (M-TKA). A retrospective query of a nationwide insurance claims database (2010 to 2022) identified 2,522,651 primary TKAs (21,921 RA-TKA; 2,500,730 M-TKA). The RA-TKA was defined by robotic-assisted procedure codes and CT scan within 60 days of surgery. Vascular injuries within 30 days of surgery were identified using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis and procedure codes. A 1:5 nearest-neighbor matching algorithm controlled for age, sex, and comorbidities. Before matching, RA-TKA patients differed in age, sex, and comorbidity profiles compared with M-TKA. After matching, the cohorts were well-balanced. Multivariable logistic regressions calculated odds ratios (OR) with 95% confidence intervals (CI) for vascular complications, with significance set at P < 0.05. Popliteal artery injuries occurred in 49 M-TKA (0.002%) and zero RA-TKA (0%) cases. After adjustment, RA-TKA was associated with significantly lower odds of vascular injury compared with M-TKA (adjusted OR 0.21, 95% CI 0.05 to 0.86, P = 0.030). The absolute risk difference was 0.002%, corresponding to a number needed to treat of 50,000. In this large national cohort, RA-TKA was associated with a substantially reduced risk of popliteal artery injury compared with M-TKA. While rare overall, the catastrophic consequences of vascular injury underscore the clinical importance of this association. As TKA utilization rises, robotic platforms may offer a meaningful clinical benefit by helping surgeons reduce the incidence of these devastating neurovascular complications.
For robotic applications requiring compliance and safety in rehabilitation training, physical human-robot collaboration, and unstructured environments, this study proposes a variable-stiffness joint design method, termed TSDV, based on the mean-coil-diameter variation mechanism of a torsion spring. First, the variation of the mean coil diameter of a cylindrical torsion spring with joint deflection angle is analyzed. On this basis, a structural scheme for stiffness modulation is proposed by constraining the inward contraction of the spring inner diameter. The joint mainly comprises a torsion spring, an internal slotted sleeve, and a ball-guiding sleeve, and features a compact architecture, a wide stiffness regulation range, coaxial alignment with the robot joint axis, and both passive and active stiffness modulation modes. Subsequently, a nonlinear stiffness model of the variable-stiffness joint system is established using an energy-based method, and the validity of the theoretical model is verified through numerical simulations and finite-element analysis. The results show that both the output torque and the joint stiffness exhibit tunable nonlinear characteristics with respect to the deflection angle and regulation parameters. Finally, experiments are conducted on a TSDV prototype. The experimental results demonstrate that, under motor actuation, the proposed joint can achieve both passive and active stiffness regulation. When the deflection angle reaches 1.2 rad, the output torque range increases from 0 to 3.8 Nm to 0-9.2 Nm. Moreover, when the slotted sleeve fully suppresses the variation of the torsion spring inner diameter, the joint exhibits a locking function and transitions into a rigid joint. These findings indicate that the proposed variable-stiffness joint offers a compact structure, a large stiffness regulation range, and high control resolution, thereby providing a new approach for safe interaction and compliant actuation in robotic systems.
Bariatric surgery (BS) is the most effective treatment for sustained weight loss and improvement of obesity-related comorbidities. Robotic BS (RBS) offers enhanced precision and ergonomics; however, local data remain limited. This retrospective real-world study included consecutive adults (≥18 years) who underwent single-surgeon robotic-assisted primary BS using the da Vinci® Surgical System (October 2012-December 2024), with complete perioperative and follow-up data. A total of 545 patients were analyzed with a mean age of 42.98 ± 11.15 years and a mean body mass index (BMI) of 44.55 ± 6.66 kg/m2). Sleeve gastrectomy (SG) was the most common procedure (72.48%), followed by Roux-en-Y gastric bypass (RYGB, 17.61%) and one-anastomosis gastric bypass (OAGB, 9.91%). Mean docking and operative times were 6.25 ± 2.29 and 99.84 ± 29.21 minutes, respectively. Intraoperative events were infrequent (console-related 2.57%, bedside-related 4.04%, instrument-related 3.12%), with no conversions. Mean intensive care unit (ICU) and hospital stays were 0.25 ± 0.45 and 2.42 ± 0.56 days. Thirty-day complications occurred in 2.02% of patients, comprising grade I (1.10%), grade II (0.73%), and grade III (0.18%) events. Between 1 month and 1 year, 1.28% experienced minor (grade I) complications. At 1 year, mean BMI decreased to 32.68 ± 4.02 kg/m2, with no mortality. Outcomes in patients with BMI ≥ 50 kg/m2 were comparable, supporting the safety and feasibility of RBS in grade IV obesity. RBS proved safe, efficient, and effective, with low complications and consistent outcomes, supporting its use for obesity management in high-volume centers.
Robotic-assisted total knee arthroplasty (RATKA) has garnered attention in the field of orthopedic surgery. It has been developed to improve surgical precision and prosthesis alignment in comparison to conventional total knee arthroplasty (CTKA). It utilizes advanced robotic workflow systems as opposed to manual jig-based techniques. This review evaluated perioperative and radiographic outcomes to assess the overall safety and effectiveness of RATKA with CTKA. A comprehensive search for randomized and quasi-randomized control trials was conducted across 3 databases, PubMed/MEDLINE, Cochrane Library and Embase, from 1st January 2021 to 1st January 2026. Studies were chosen that compared RATKA to CTKA, where the primary indication was knee osteoarthritis. The primary objectives were operative time, length of stay, adverse events and blood loss. The secondary objectives were hip-knee-ankle (HKA) angle and absolute deviation of HKA angle from 180° (ΔHKA). The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Risk of bias was assessed using the Cochrane risk of bias tool (RoB 2). Quantitative analysis performed using the RevMan 5.4 software package. Results were presented using mean difference (MD), 95% confidence interval (CI), and risk ratio (RR). A total of 12 controlled trials were identified that met the inclusion criteria, with a total of 2269 participants. Meta-analysis revealed a statistically significant difference in operative duration, with RATKA taking longer than CTKA (MD = 23.81, 95% CI = 13.39 to 34.24, P <0.00001). There were no statistically significant differences in hospital stay (MD = 0.11, 95% CI = -0.19 to 0.42, P = 0.47), intraoperative blood loss (MD = 9.00, 95% CI = -9.46 to 27.46, P = 0.34) and adverse events (RR = 0.80, 95% CI = 0.54 to 1.18, P = 0.28). However, a statistically significant difference was identified in postoperative mechanical alignment, favoring RATKA. Postoperative HKA angle (MD: 0.71°, 95% CI: 0.43 to 1.00, P <0.00001) and absolute deviation from 180° ΔHKA (MD = -1.33, 95% CI -2.12 to -0.55, P = 0.009). RATKA is associated with longer operating times but is associated with improved mechanical alignment. The intraoperative blood loss, length of hospitalization and complications were comparable to CTKA. Considering these findings, further studies are required to assess the long-term implications and clinical benefits of RATKA.
The Hugo™ RAS platform (Medtronic®), featuring an open-console design and modular configuration, represents a novel alternative to established robotic systems. Limited large-scale series of colorectal procedures using this platform have been published. This study aimed to evaluate the feasibility, safety, and learning curve of implementing the Hugo™ RAS platform for colorectal surgery in a center without prior robotic experience. We retrospectively analyzed 100 consecutive adult patients (median age 68 years; 51% male) undergoing elective colorectal resection using Hugo™ RAS between April 2023 and December 2024. Surgical indications included malignancy (78%), benign neoplasia, and inflammatory disease. Primary outcomes included operative time, blood loss, conversion rate, oncologic adequacy, complications (Clavien-Dindo classification), and length of stay. Learning curves were assessed via CUSUM analysis. Median operative time was 180 min (IQR 147.5-240.0), with blood loss of 50 mL (IQR 50-100). No conversions occurred. R0 resection was achieved in 93% of applicable cases, with median lymph node harvest of 20. Overall morbidity was 28%, including 5% major complications (Clavien-Dindo ≥ IIIb) and zero grade IV/V events. Median stay was 6 days. Male patients had significantly higher complication rates (39.2% vs 16.3%, p = 0.011). Comparing first versus last 50 cases, complications decreased from 34% to 22% (p = 0.181), while major complications remained stable. CUSUM analysis revealed stabilization after approximately 50 cases. The Hugo™ RAS platform enabled safe and effective colorectal surgery with zero conversions and oncologic outcomes meeting established benchmarks. The learning curve stabilized at 50 cases with progressive reduction in minor complications. These results support Hugo™ RAS as a valuable addition to minimally invasive colorectal surgery.
This study aimed to clarify the comparative clinical efficacy and safety of open (OKPE), laparoscopic (LKPE), and robotic-assisted (RAKPE) approaches for Kasai portoenterostomy in patients with biliary atresia (BA). We retrospectively analyzed 50 patients diagnosed with type III BA who underwent Kasai portoenterostomy between January 2015 and December 2024. Based on the surgical approach, patients were categorized into three groups: OKPE (n = 21), LKPE (n = 18), and RAKPE (n = 11). Clinical characteristics, perioperative indicators, and short-term outcomes, including jaundice clearance (JC) at 6 months and one-year survival with native liver (SNL), were compared among the groups. RAKPE was associated with a significantly longer operative time compared to LKPE and OKPE (310 ± 39 vs. 230 ± 34 vs. 200 ± 74 min; P < 0.001). OKPE showed shorter fibrous cone dissection time (47 ± 11 vs. 66 ± 7 vs. 66 ± 9 min; P < 0.001) and less dissection blood loss [2(2-3) vs. 4(3-5) vs. 3(2-4) mL; P < 0.001]. Conversely, minimally invasive approaches achieved faster oral feeding [10 (8-10) vs. 4.5 (4-5) vs. 4 (4-5) days; p < 0.001] and shorter hospital stay [29 (23-36) vs. 19 (15-27) vs. 18 (17-28) days; P = 0.003]. No significant differences were observed across the three groups regarding 6-month JC rates (67% vs. 61% vs. 55%; P = 0.81), postoperative cholangitis incidence (55% vs. 44% vs. 38%; P = 0.66), or one-year SNL rates (71% vs. 72% vs. 64%; P = 0.85). OKPE, LKPE, and RAKPE demonstrate comparable short-term efficacy and safety for type III BA. While OKPE offers technical advantages in hilar dissection, minimally invasive approaches significantly optimize postoperative recovery. Surgical technique selection should be individualized based on patient characteristics, surgeon experience, and institutional resources.
Bone marrow involvement (BMI) upstages lymphoma and influences prognosis and treatment. Conventional bone marrow trephine biopsy (BMTB) may miss patchy or extrapelvic disease. This study compared the diagnostic performance of automated-robotic-arm (ARA)-assisted 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT)-guided bone marrow biopsy with BMTB in treatment-naive lymphoma. In this prospective single-centre study, 169 treatment-naive lymphoma patients underwent baseline 18F-FDG PET/CT and bilateral posterior iliac crest BMTB. Among these, 44 patients with focal FDG-avid marrow lesions (unifocal or multifocal) underwent ARA-assisted PET/CT-guided bone marrow biopsy. Histopathological findings from PET/CT-guided biopsy and BMTB were used to establish the final diagnosis of BMI. Diagnostic performance parameters were calculated with 95% confidence intervals (CIs) using Wilson score method. Comparisons were performed using Fisher's exact test. Of the 44 patients with focal FDG-avid marrow lesions, 40 had lymphomatous BMI on final diagnosis. PET/CT-guided biopsy yielded 37 true positives, four true negatives, and three false-negatives, with no false-positive. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 92.5% (95% CI: 80.1-97.4%), 100% (95% CI: 51.0-100.0%), 100% (95% CI: 90.6-100.0%), 57.1% (95% CI: 25.0-84.2%), and 93.2% (95% CI: 81.8-97.7%), respectively. Conventional BMTB demonstrated significantly lower sensitivity (52.5%) and accuracy (56.8%) (P < 0.001). ARA-assisted PET/CT-guided metabolic bone marrow biopsy demonstrates superior sensitivity and accuracy than conventional iliac crest trephine biopsy. It improves detection of lymphomatous BMI, boosts diagnostic confidence and reduces over-staging risk. It may play a selective problem-solving tool for focal FDG-avid marrow lesions.
Trans-oral robotic surgery is a minimally invasive surgical approach for the treatment of oropharyngeal squamous cell carcinoma (OPSCC), with superior functional outcomes compared to open surgery. However, its oncologic and functional outcomes are still debated in comparison to definitive radiotherapy (RT) or chemoradiotherapy (CRT). A systematic search was conducted in PubMed, Scopus, and Embase, and relevant studies were selected in accordance with the PRISMA guidelines. Overall survival, disease-specific survival, and swallowing function are compared between TORS and primary RT or CRT using random-effects models. Dysphagia was assessed using the MD Anderson Dysphagia Index (MDADI) and the Functional Oral Intake Scale (FOIS). A total of 15 studies comprising 6767 patients (2423 underwent TORS and 4344 underwent upfront RT or CRT) were included. Overall survival was significantly better after TORS (HR 0.51; 95% CI 0.42-0.62; p < 0.0001), in all stages of disease, but not in HPV-positive cases. No significant difference was found in progression-free survival (HR 0.81; 95% CI 0.50-1.29; p = 0.374). MDADI and FOIS scores were not significantly different among the two groups (MD 0.8; 95% CI -2, -3.5; p = 0.578; and MD 0.2; 95% CI -0.3, -0.7; p = 0.469; respectively). Compared to baseline, MDADI scores were decreased in both groups; but the decline was almost two-fold larger in the RT/CRT group (MD 3.5; 95% CI 3.1-3.9; p < 0.001). TORS with or without adjuvant treatment was associated with higher overall survival compared to definitive RT/CRT. TORS was also associated with less decline in functional outcomes compared to baseline. Considering the non-randomized nature of most available studies, these results should be interpreted with caution. Future studies are warranted to determine the optimal treatment strategies for patients with OPSCC and to investigate the implications of HPV status on treatment selection.
Optic nerve sheath diameter (ONSD) serves as a reliable surrogate marker for intracranial pressure (ICP) during robotic assisted laparoscopic radical prostatectomies (RARP). ICP elevation is greater in patients above 60 years due to impaired cerebral autoregulation and compliance. While total intravenous anaesthesia with propofol has demonstrated better control over ONSD compared to inhalational anaesthetics, the latter's dose-dependent vasodilatory effects on cerebral vessels remain understudied. This trial is aimed to compare the effects of isoflurane and desflurane on ONSD in elderly patients undergoing RARP. Secondary goals include incidence of neurological complications, delayed recovery and duration of hospital stay. A prospective randomised controlled study was conducted on 54 elderly patients aged 60 years and above, undergoing RARP. These patients were randomised to receive isoflurane or desflurane for maintenance of anaesthesia. ONSD measurements and hemodynamic parameters were obtained at baseline, during pneumoperitoneum and postoperatively. Recovery profiles, complications and duration of hospital stay were recorded. Data were analysed using the Pearson Chi-square test, independent sample t -test and Mann-Whitney test. A total of 50 patients were analysed. While mean ONSD values were raised from baseline intraoperatively in both groups, values remained within normal limits without significant intergroup differences. ONSD values returned to baseline in all patients at the end of surgery. Neither group exhibited post-operative complications nor delayed recovery. Isoflurane and desflurane exhibit comparable and safe profiles in terms of ICP elevation during RARP. Both agents are effective for maintenance of anaesthesia in elderly patients requiring steep Trendelenburg positioning for RARP.
Robotic platforms have revolutionized arthroplasty through precision and patient-specific planning, yet introduce cyber-physical vulnerabilities in interconnected surgical ecosystems. Recent incidents, including the 2026 cyber-attack, highlight operational risks despite low direct intraoperative threats. Proactive cybersecurity, via FDA-aligned secure design, institutional audits, and surgeon vigilance, is imperative to safeguard patient safety and trust in precision orthopedics.
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In minimally invasive surgery for upper gastric and esophagogastric junction cancers, linear staplers are commonly used, and reports of circular‑stapled reconstruction have declined in parallel with the decrease in open surgery. Lower mediastinal reconstruction during robot‑assisted gastrectomy also remains technically challenging. This study describes our surgical technique and preliminary experience with transhiatal lower mediastinal anastomosis using a circular stapler. Twelve patients who underwent robot‑assisted total or proximal gastrectomy with lower mediastinal reconstruction between March 2023 and December 2025 were included. Total operative time, blood loss, reconstruction time, length of hospital stay, postoperative complications, and esophageal transection length were evaluated separately for robot‑assisted total gastrectomy (RTG) and robot‑assisted proximal gastrectomy (RPG). No patient required conversion to open surgery.In the RTG group (n=6), the operative time, reconstruction time, blood loss, and hospital stay were 498.0 ± 61.1 minutes, 36.2 ± 8.4 minutes, 175 ± 117.3 g, and 14.3 ± 2.7 days, respectively.In the RPG group (n=6), these values were 345.8 ± 51.5 minutes, 75.6 ± 14.0 minutes, 75.0 ± 98.7 g, and 14.3 ± 2.7 days.Postoperative complications included one anastomotic stricture and one Grade B pancreatic fistula, both in the RPG group. No anastomotic leakage occurred in either group. The esophageal transection length was 35.2 ± 14.0 mm in the RTG group and 25.5 ± 7.9 mm in the RPG group, and all resection margins were negative. Circular staplers are feasible and safe for lower mediastinal reconstruction in robot‑assisted total and proximal gastrectomy.
This study compared the learning curves and clinical outcomes of osteotomy guide robot and guide plate-based robot-assisted total knee arthroplasty (TKA). From January to May 2023, 100 patients were prospectively enrolled to receive either a guide plate-based robot or an osteotomy guide robot-assisted total knee arthroplasty. The thickness of the osteotomy planned by the robot and the actual thickness were recorded in real time during the operation, as was the time taken for each step in the operation, including bone registration and osteotomy. The SF-12, HSS score, and FJS of the patients before surgery and 6 weeks and 24 months after surgery were also collected. For surgeon 1, the average operating time with the guide plate-based robot and osteotomy guide robot was 98.16 ± 9.68 and 118.52 ± 15.95 min, respectively; the difference was significant. The average time of the last 10 cases was shorter than that of the first 10 cases. The inflection points of the osteotomy learning curve of surgeon 1 with two robotic systems were at case 5 and case 9. The average operative times for Surgeon 2's two robotic surgery groups were 104.52 ± 12.65 min and 105.76 ± 33.03 min, respectively. The inflection points of the osteotomy learning curves using the two robotic systems occurred at case 13, respectively. Patients who underwent guide plate-based robot or osteotomy guide robot-assisted TKA had similarly improved knee recovery, reflected in the SF-12, HSS score, and FJS. There was no significant difference in the osteotomy learning curve between the two robotic systems. The improvement in knee functional recovery was similar after the guide plate-based robot and the osteotomy guide robot-assisted TKA. Level II.
Locomotion in animals such as fish, snakes, inchworms, and octopuses exhibits a remarkable diversity, with each species utilizing distinct body morphologies and movement strategies. Currently, no existing kinematic model is capable of describing the full range of locomotion exhibited by these animals. Addressing this challenge holds important implications for both the study of biomechanics of animals and the development of bioinspired robots. In this work, we propose a general kinematic model that integrates the curvature equation with a nonlinear oscillator. Through parameter adjustments, its morphology can transition between the motions of various animals. It is the most versatile kinematic model to date for describing multimodal locomotion of animals so far as we know. By translating the general kinematic model into a motion control algorithm and combining it with virtual simulation, we create a motion optimization framework that substantially simplifies the complexity of multimodal control for bionic robots with diverse actuation mechanisms, thereby enhancing their maneuverability. Using fish locomotion as an example, we validate the methodology on an untethered multijoint robotic fish, successfully enabling the robotic fish to perform cruising and various fast turn motions, thereby demonstrating its effectiveness in guiding motion control. This work is believed to have laid the foundation for the study of bionic motion and bioinspired robots.
Thymic epithelial tumors (TETs) are rare malignancies with heterogeneous histology, clinical presentation, and outcomes. Although clinical guidelines have remained largely unchanged, the management of TETs has evolved through advances in staging, radiotherapy and surgical techniques. This study describes the population of TET patients in the Netherlands diagnosed between 2017 and 2024 and aims to evaluate trends in incidence, treatment patterns, and outcomes, with particular attention to differences between high- and low-volume centers. All patients with a new diagnosis of TET between 2017 and 2024 were identified from the Netherlands Cancer Registry database. Poisson regression, chi-square test, logistic regression and Cox-hazard models were used for analysis. A high-volume center was defined as performing > 10 TET surgeries a year. In total, 1083 patients were included of whom 81,3% had thymoma and 15,5% thymic carcinoma. The overall crude incidence was 7.3 per 1000,000 with a rising trend over time. Chemotherapy was administered in 17,5% of patients and radiotherapy in 16,3%. Surgery was performed in 75,3% of patientswith a shift from open to robotic-assisted thoracoscopic surgery as the preferred approach. Among operated patients, 9,7% received postoperative radiotherapy. Complete resection (R0) was achieved in 84,4% of resections and was associated with improved survival (p = 0.003). Surgery for TET was performed across 25 different centers in the Netherlands. High-volume centers performed more robotic procedures and achieved higher R0 resection rates compared with low-volume centers. The incidence of TETs in the Netherlands increased and treatment strategies evolved over time. Complete resection remains the most important prognostic factor for survival. High-volume centers achieved higher rates of R0 resection, strongly supporting further centralization of TET care, including centralization of surgery.