Robotic-assisted total joint arthroplasty (RTJA) is increasingly used to improve patient outcomes and reduce revision rates in total joint arthroplasty (TJA). With robotic-assisted total knee arthroplasty (RTKA) projected to exceed 70% of cases by 2030, concern exists about whether orthopaedic residents are being adequately trained. Orthopaedic arthroplasty fellows between 2023 and 2025 completed an anonymous electronic survey assessing exposure to RTJA and conventional TJA (CTJA), impact on fellowship selection, and projected future use. Incomplete responses and non-fellows were excluded. Of 60 respondents, 78% were exposed to RTKA, 52% to robotic-assisted unicompartmental knee arthroplasty (RUKA), and 48% to robotic-assisted total hip arthroplasty (RTHA). Satisfaction with training was higher for conventional procedures: 82 versus 53% (TKA), 97 versus 32% (THA), and 23 versus 31% (UKA). Most felt comfortable performing conventional TKA (CTKA) and THA (CTHA) independently; among robotic procedures, only RTKA had similar comfort levels. Fellowship selection was influenced by a desire for balanced robotic and manual experience (66.7%). While 42% did not believe robotics should be required in residency, most agreed it improved understanding and performance (68% RTKA, 61% RUKA, and 75% RTHA respondents). Robotic exposure during residency was associated with higher satisfaction and preparedness (P < 0.001) and increased support for requiring training in RUKA (P = 0.015) and RTHA (P = 0.006). Regional differences in exposure and satisfaction were also observed. Fellows planning to use robotics in greater than 50% of future cases were more likely to choose robotics-focused fellowships (P = 0.003). Arthroplasty fellows reported high satisfaction with conventional arthroplasty training, whereas satisfaction and self-reported preparedness for robotic-assisted procedures were lower. Prior robotic exposure during residency was associated with higher satisfaction and preparedness, and fellows expressed interest in balanced robotic and manual fellowship experiences. These findings provided a baseline of current trainee perceptions.
Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasia but remains technically demanding because of limited traction, lack of triangulation, and high operator workload, contributing to a steep learning curve. We evaluated a novel endoluminal robotic platform designed to provide surgical-like bimanual triangulation, stable traction/counter-traction, and improved ergonomics while preserving compatibility with standard gastroscopes. The robotic system (Intilume System, Agilis Robotics, Hong Kong, SAR) uses an external positioning cart to drive two 3.5-mm flexible robotic instruments mounted onto a native gastroscope via a cap-and-sheath interface and controlled by compact pen-style motion-tracking controllers enabling seated operation. Available instruments included a bipolar T-knife and a tissue grasper. In a randomized crossover ex vivo porcine stomach study, two gastroenterology fellows without prior ESD experience and two interventional endoscopy fellows with early experience each performed four ESDs (two robotic, two conventional), for a total of 16 procedures. Outcomes included en bloc resection, procedure time, specimen surface area, dissection speed, tissue injury, and operator workload assessed using NASA-TLX, with exploratory OSATS and GEARS evaluations. All procedures were completed (8 robotic, 8 conventional). Robotic ESD achieved 100% en bloc resection versus 75% with conventional ESD (p = 0.47), was significantly faster (14.1 ± 4.3 vs 21.6 ± 7.6 min; p = 0.028), and demonstrated higher dissection speed (36.5 ± 23.4 vs 16.3 ± 10.1 mm2/min; p = 0.05). No muscular injuries occurred with robotic ESD compared with 5/8 conventional cases; no full-thickness injuries occurred. Operator workload was markedly lower with robotic ESD (NASA-TLX 34.7 ± 24.1 vs 75.0 ± 15.4; p = 0.002). In a randomized ex vivo model, a bimanual endoluminal robotic platform compatible with standard endoscopes demonstrated promising improvements in ESD efficiency, tissue control, and operator ergonomics compared with conventional ESD. These preliminary findings support further development and progression to first-in-human feasibility evaluation, with potential to facilitate ESD skill acquisition pending clinical validation.
In the field of colonoscopy, robotic systems have been developed to support or replace human operators due to a shortage of trained endoscopists. We developed the Autonomous Colonoscope Robot System (ACRS), based on the Endoscopic Operation Robot version 4, to evaluate whether expert-derived operational data can enable autonomous colonoscope insertion. ACRS was trained using insertion data obtained from an expert endoscopist operating a standardized colonoscopy training model. Automated insertions were evaluated using Pattern 1 of the model, a highly controlled configuration without substantial loop formation. Completely automated insertions were designated Level 4, whereas insertions requiring some manual assistance were designated Level 3. Level 4 insertion times were compared with manual insertions performed by an expert and trainees. Of the 72 automated insertions at Level 3 or higher, 62 are classified as Level 4, giving a success rate of 86.1% (95% CI, 75.9-93.1%). The average insertion time for Level 4 procedures is 2.92 ± 1.20 minutes, significantly longer than that of the expert (1.43 ± 0.32 minutes), but comparable to the time taken by trainees (2.97 ± 1.32 minutes; errors are standard deviations). ACRS demonstrates proof-of-concept feasibility for autonomous colonoscope insertion under simplified, controlled model conditions. Further validation in more complex models, animal studies, and clinical settings is required before translational application. Colonoscopy is an important test for finding colorectal cancer early. An endoscope is a thin, flexible tube with a camera that is inserted into the colon, but safe and painless insertion requires considerable skill. We developed the Autonomous Colonoscope Robot System (ACRS), based on a master–slave robotic system, in which a doctor’s hand movements are transmitted to a robotic device that holds and moves the endoscope. Using insertion data from an expert doctor in a colonoscopy training model, we trained an artificial intelligence model to control the robot automatically. In a simplified model setting, ACRS achieved fully automated insertion in many trials. This proof-of-concept study may support future development of robotic systems that help make colonoscopy safer and more widely available.
Lumbar spinal stenosis (LSS) often results in pain and functional impairment. The TOPS system is a novel facet replacement prosthesis that offers motion-preserving treatment for LSS, providing dynamic multiaxial stabilization across all three spinal columns while maintaining physiological motion. Although prior studies have demonstrated the safety and efficacy of the TOPS device, evidence regarding robotic assistance in this procedure remains limited. Robotic assistance might enhance the accuracy of pedicle screw placement, optimize device positioning, and shorten the surgical time. The aim of this study was to report preliminary clinical experience with robot-assisted TOPS system implantation for degenerative LSS, focusing on perioperative metrics, patient outcomes, and the safety and feasibility of robotic integration. The authors retrospectively reviewed all patients who underwent robot-assisted TOPS device implantation between April 2024 and August 2025 at a single center. The primary outcome was reoperation. Secondary outcomes included the operative duration, estimated blood loss, symptomatic improvement, implant-related complications, and new or worsening neurological deficit. Eight patients (50% female, median age 69.5 years) with degenerative LSS were included. All patients presented with low back pain and radiculopathy. One patient (12.5%) was treated at L1-2, 1 patient (12.5%) at L2-3, 4 patients (50%) at L3-4, and 2 patients (25%) at L4-5. The median operative duration was 160 minutes (IQR 130.2-170 minutes), with a median estimated blood loss of 175 mL (IQR 150-200 mL). No intraoperative complications occurred, including screw misplacement or the need for repositioning. The median postoperative hospital stay was 3 days (IQR 2.7-3.2 days). Over a median follow-up duration of 7 months (IQR 3-11 months), all patients reported symptomatic improvement. No patient required reoperation or experienced implant-related complications such as device malfunction, migration, or screw loosening. One patient developed an asymptomatic seroma detected on follow-up MRI. No complication was attributed to robotic assistance or the TOPS implant. Robot-assisted implantation of the TOPS device appears safe and technically feasible for patients with degenerative LSS. Robotic assistance might facilitate accurate screw placement without the need for intraoperative adjustments, eliminate the need for conversion to fusion, and correlate with low morbidity and favorable clinical outcomes. Future prospective studies with larger cohorts and longer follow-up are warranted to validate these findings and assess the long-term durability of outcomes.
Minimally invasive surgery (MIS) has revolutionized rectal cancer treatment by reducing postoperative pain and hospital stay and improving recovery. Total mesorectal excision (TME), introduced by Heald, is the gold standard for rectal cancer and emphasizes autonomic nerve preservation, which is crucial for bowel, bladder, and sexual function. Robotic systems, Like the Indian SSI Mantra Robot, address the challenges of laparoscopy, offering enhanced dexterity and 3D vision, especially beneficial in the narrow pelvis. This prospective study included 92 patients with biopsy-proven rectal adenocarcinoma who underwent robotic surgery using the SSI Mantra system between November 2023 and March 2025. Key intraoperative, postoperative, and functional outcomes were analyzed. Detailed description of port placement, patient positioning, and nerve-preserving dissection techniques has been explained in this study. Among 92 patients (64% male, median age 56), most had middle (51%) or low (34%) rectal tumors. Neoadjuvant therapy was used in 95% of patients. Sphincter-preserving surgery was achieved in 88%. Median operative time was 220 min, with low blood loss (157 ml) and a 2% conversion rate. R0 resection was achieved in 98.9%, with a mean of 21 lymph nodes harvested. Early recovery was favorable: 98% resumed oral diet on day 1, with low morbidity (13% minor, 2% major complications) and no mortality. Bladder dysfunction occurred in ~ 10% and sexual dysfunction in ~ 20%. Average hospital stay was 4.9 days. Results were found to be comparable to our own results of robotic rectal cancer surgery on a well-established Da Vinci robot system. The Indian SSI Mantra Robot is a safe and effective platform for rectal cancer surgery, delivering excellent oncologic and functional outcomes, comparable to established robotic systems like Da Vinci. This study supports its wider adoption in colorectal MIS.
Segmentectomy has been shown to be comparable with lobectomy for small lung cancers; however, it is unclear the degree to which the expansion and adoption of robotics have affected the use of segmentectomy. We aim to compare the use of segmentectomies performed between adopters and nonadopters of robotic surgery. A retrospective case-control analysis was conducted using the National Cancer Database from 2010 to 2021. Sustained robotic adoption was defined as facility performance of ≥90% of lung resections robotically for 2+ consecutive years from 2016 onwards. Time periods for facilities were categorized by pretransition (<50% usage), transition (50%-90%) and posttransition (≥90%). For all facilities, the proportion of segmentectomies performed for <2 cm lung nodules was quantified along with clinical outcomes. In total, 10,045 cases of lung resection across 57 facilities met inclusion criteria. National use of segmentectomy increased from 5% in 2011 to 12% in 2019-2021. The proportion of segmentectomies performed for nodules meeting criteria has increased more with sustained robotic adopters (5.5% to 12.0%) compared with control facilities (4.0% to 6.3%) (difference-in-difference = 4.3%; 95% CI, 2.6%-6.0%). There was an increase in mean lymph node harvest for segmentectomy with sustained adopters (5.1 to 11.4) compared with control facilities (6.02 vs 10.2). Facilities with sustained robotic adoption were more likely to have increased uptake of segmentectomy compared with control facilities. There was also an associated increase in mean lymph node sampling. With continued uptake of robotics, we expect to see greater use of segmentectomy for lung resection for nodules meeting criteria.
The combination of robotic assistance with the DAA represents a convergence of accuracy-driven technology and minimally invasive surgical philosophy. Technology-assisted hip arthroplasty has gained increasing attention as a mean to improve surgical accuracy, reduce complications, and improve long-term outcomes. In parallel, the direct anterior approach (DAA) has emerged as a popular muscle-sparing technique associated with early recovery and reduced postoperative pain in many reports. Current evidence suggests that total hip replacement (THR) using robotic technology achieves better acetabular socket orientation, a higher proportion of implants placed within predefined safe zones, and reduced variability compared with conventional techniques. Additionally, improved postoperative limb length and the horizontal femoral offset has been consistently reported. Despite these radiographic advantages, functional and patient-reported outcomes remain largely comparable between robotic and conventional THR. The safety profile of robotic arm-assisted THR via DAA appears comparable to conventional approaches, with no consistent reduction in complication rates, although improved accuracy may reduce outlier-related failures. The learning curve remains a consideration, as both DAA and robotic systems are independently associated with increased technical demands and operative time during early adoption. From an economic perspective, the high capital cost and uncertain long-term benefits continue to limit widespread adoption, particularly in high-volume centers with established outcomes. In conclusion, robotic-assisted THR via the DAA offers enhanced surgical precision and improved early recovery but has yet to demonstrate clear superiority in many patient-reported and long-term outcomes. Well-conducted, prospective clinical studies are needed to establish the role of these newer arthroplasty techniques.
The aim of this network meta-analysis was to collectively synthesize the evidence on computer-assisted implant surgery (CAIS), with its static, dynamic, and robotic types, for delayed implant placement in single-tooth spaces, in order to explore whether robotic surgery provides comparable accuracy to other implant placement techniques, based on homogenous data from studies with the same design and population. Literature search was performed in Scopus, MEDLINE/PubMed, and Cochrane library, screening for randomized clinical trials, in which delayed implant placement was performed in single-tooth spaces, reporting information on at least one aspect of platform, apex, and angle deviation. A frequentist network meta-analysis was performed. Eleven studies were included. All CAIS methods demonstrated significantly less deviation compared with freehand implant placement. Robotic CAIS ranked the highest among all techniques and showed significantly less apex deviation than static CAIS (MD= -0.42, 95% CI -0.71; -0.13), as well as lower angle deviation compared with both static and dynamic surgery (MD= -1.65, 95% CI -2.89; -0.40, and MD= -1.26, 95% CI -2.39; -0.13, respectively). The certainty of evidence in the outcomes of the meta-analysis ranged from very low to moderate. Robotic surgery provides high accuracy for delayed implant placement in single-tooth edentulous sites, superior to other CAIS methods. Nevertheless, the low number of studies available and limited evidence necessitate further exploration of its overall performance, in order to validate these conclusions. This study offers strong insight into the performance of robotic CAIS, and how it compares with the other well-established treatment modalities, thus demonstrating the potential of this technology to reach superior accuracy, which can be utilized in cases demanding high precision, such as immediacy with prefabricated components, or flapless surgery.
Against the backdrop of a rising organic composition of capital driven by industrial automation, this paper examines how industrial robot adoption is associated with worker health in China and how these effects vary across groups, with particular attention to the role of labor-market institutions. Using data from the China Family Panel Studies matched with regional measures of industrial robot penetration, the analysis considers three health-related outcomes: subjective health change, objective health, and mental health. We further test the mechanisms underlying the direct health effects in manufacturing and explore the channels consistent with the cross-sector spillover patterns observed in non-manufacturing by focusing on workers' labor-market position and on the substitutability and complementarity of labor across sectors. The results indicate that, in terms of direct effects, robot adoption is associated with significant declines in all three health measures among workers in the manufacturing sector. For workers in non-manufacturing sectors, the estimates provide suggestive evidence of cross-sector spillovers, with effects differing across health dimensions. Moreover, the health consequences of robot adoption exhibit substantial heterogeneity across worker groups, suggesting uneven health effects among workers. Overall, the findings suggest that, as capital deepening reshapes labor processes, strengthening health-risk protection and improving access to medical insurance may help mitigate adverse health consequences, especially for more vulnerable workers.
Autonomous robotic-assisted surgery (RAS) has emerged as a promising objective in biomedical technology, further enhanced by miniaturization toward microrobotic-assisted surgery (μ-RAS). This reduction in scale promises minimally invasive, partially or fully automated surgical procedures, with the potential to reduce patient recovery times, lower medical costs, and enable previously unavailable procedural options. This perspective highlights the specific advances in RAS that potentially map to the microscale (μ-RAS), organized across five surgical domains: endovascular, endoluminal, laparoscopic, ophthalmic, and orthopedic. We examine both clinical demands and technological advances in surgical robotics and identify the key innovations required for progress across these surgical fields. Our contribution is distinct in combining the perspectives of both surgical experts and bioengineering innovators, outlining a roadmap for the advancement and eventual integration of autonomous RAS and μ-RAS into mainstream surgical practice.
Human-robot collaboration (HRC) is increasingly prevalent in hospitality and tourism, yet its affective implications for employees remain insufficiently understood. Drawing on Affective Events Theory and the Effort-Recovery Model, this study proposes state job apathy as a novel low-activation affective mechanism linking daily HRC to next-morning customer-directed behaviors, specifically enacted incivility toward customers and customer stewardship behavior. We further examine psychological detachment as a recovery-based moderator of this spillover process. A 10-day consecutive daily diary study was conducted with 206 hospitality and tourism employees in China, yielding 1016 matched within-person observations. Multilevel path analyses revealed that daily HRC frequency was positively associated with end-of-day state job apathy, which in turn predicted greater enacted incivility and reduced customer stewardship behavior the following morning. State job apathy partially mediated these cross-day relationships. Psychological detachment was also found to moderate the carryover of state job apathy to next-morning customer-directed behaviors: the indirect effects of HRC via apathy were significant when psychological detachment was low, but non-significant when psychological detachment was high. These findings advance HRC research by identifying a low-arousal affective pathway that complements existing threat-based accounts, suggesting that the potential behavioral risks associated with robot collaboration extend beyond the workday into subsequent customer interactions. Practically, the results highlight the importance of recovery-supportive workplace practices and job redesign strategies to mitigate the cumulative affective implications of robot-intensive work environments.
Obesity remains a common barrier to kidney transplantation, with many centers enforcing strict body mass index (BMI) cutoffs due to concerns regarding surgical complexity and postoperative complications. Robotic kidney transplantation (RKT) has emerged as a minimally invasive alternative that may mitigate obesity-associated surgical risks. However, outcomes across granular BMI subgroups, particularly among patients with morbid obesity (BMI ≥40 kg/m2), remain incompletely characterized. We performed a retrospective cohort study of adult patients undergoing RKT at a single academic transplant center between November 2021 and September 2025. Patients were stratified by BMI into two primary cohorts (BMI <30 vs ≥30 kg/m2) with a secondary subgroup analysis comparing those with BMI 30-40 vs ≥40 kg/m2. Demographic characteristics, intraoperative metrics, and 30-day postoperative outcomes were compared. A total of 104 patients underwent RKT, with 26 patients with BMI<30 kg/m2, 53 with BMI between 30 and 40 kg/m2, and 25 with BMI ≥40 kg/m2. No significant differences were observed between BMI <30 and ≥30 cohorts in operative time, ischemia times, estimated blood loss, length of stay, delayed graft function, or 30-day readmission. Patients with BMI <30 had a higher rate of 30-day all-cause reoperation (15% vs 3%, p=0.03). In subgroup analysis, patients with BMI ≥40 demonstrated comparable intraoperative parameters and postoperative complication rates to those with BMI 30-40, with no significant differences in graft or patient survival. Robotic kidney transplantation is associated with comparable perioperative outcomes across BMI categories, including among patients with morbid obesity. These findings challenge rigid BMI-based exclusion criteria and support a more individualized approach to transplant candidacy in the era of robotic surgery.
Single-port (SP) robotic thoracic surgery is a minimally invasive option for mediastinal tumor resection; however, intercostal access remains challenging due to narrow intercostal spaces and the risk of postoperative neuralgia. This report describes 2 cases of posterior paravertebral mediastinal schwannoma resected using a floating intercostal port technique with the da Vinci SP system. In each case, a small uniportal incision was made at the lowest feasible intercostal space without rib spreading, and the SP metal port was positioned in a floating configuration above the intercostal space to reduce nerve compression while allowing safe instrument deployment. Complete tumor resection was achieved in both patients without intraoperative complications. Postoperative recovery was uneventful, with minimal pain and no intercostal neuralgia. The floating intercostal port technique may facilitate safe and effective SP robotic resection of selected posterior mediastinal tumors while preserving the advantages of intercostal access and supporting early recovery.
Retrospective Cohort Study. To characterize the utility and value of surgical dashboarding when adopting robotic technology into surgical practice. The adoption of robotics assisted with navigation (RAN) for pedicle screw placement in adolescent idiopathic scoliosis (AIS) has shown similar intraoperative performance and safety profile when compared to freehand (FH) technique. Prospectively enrolling patients in the Surgeon Performance Program (SPP) Quality Improvement Registry allows surgeons to identify areas for improvement and analyze performance individually or compared to peers. This study employs SPP dashboarding metrics to compare quality and safety outcomes using RAN versus FH in AIS surgery in AIS patients who underwent posterior spinal fusion by a single surgeon from 2016-2022. Demographics and radiographs were summarized with descriptive statistics. Surgical measures, radiographic outcomes, and complications from the SPP were compared between RAN and FH groups and against national means using t-tests, Wilcoxon tests, Fisher's exact tests, and chi-squared tests as appropriate. The cohort included 215 patients (121 FH, 94 RAN), had a mean age of 15.3 years and was mostly female (82%). Demographics and preoperative radiographic measures did not differ between groups. Dashboarding revealed RAN had significantly longer mean surgical time (240 mins vs. 192 mins; P<0.001) and higher curve correction (70% vs. 60%; P=0.003) than FH patients. There were no differences in complication rates (P=0.3) or EBL (P=0.4) found between RAN and FH. Compared to national averages, quartiles for surgical time, EBL, and complications were the same for each group. There were no deep infections, neurologic deficits, or return to OR for malpositioned screws in either group. SPP dashboarding results effectively compared RAN and FH techniques in spinal surgery, revealing increased surgical time but higher curve correction in RAN patients, but comparable EBL and safety profiles across groups.
Efficient large-scale 3D reconstruction of orchard environments is essential for robotic inspection and precision agriculture, yet existing methods struggle with unstructured scenes, variable illumination, and computational bottlenecks. We propose InspectGaussian, a coarse-to-fine Gaussian reconstruction framework tailored for orchard inspection robots. The pipeline integrates an RGB-D-based data acquisition strategy using ORB-SLAM3, which is enhanced by a dense mapping module for robust large-scale pose estimation and point cloud generation. A divide-and-conquer strategy is then employed: individual plant views are extracted via a YOLO-World-based detection and 3D matching algorithm, followed by plant-specific reconstruction using an improved 3D Gaussian Splatting (3DGS) method incorporating depth regularization and region-aware refinement. Experimental results in citrus orchards demonstrate that InspectGaussian achieves 96% average precision and 93% recall in plant view extraction, while surpassing state-of-the-art methods in reconstruction fidelity (31.226 PSNR, 0.915 SSIM, 0.067 LPIPS) and point cloud accuracy (7 mm error). These results confirm its effectiveness in capturing fine structural and textural details while maintaining scalability and efficiency. This framework provides a practical solution for high-throughput, in-field plant phenotyping and lays the foundation for intelligent orchard monitoring and management.
Brachytherapy is a widely accepted treatment for prostate cancer, in which subsequent radiation-associated enteric-type urethral adenocarcinoma is extremely rare. An 83-year-old man with a history of cholecystitis, appendicitis, and hyperlipidemia who had undergone brachytherapy 20 years earlier presented with dysuria. Transurethral resection of the prostate revealed enteric-type urethral adenocarcinoma. Imaging showed a space-occupying lesion extending from the prostatic to the membranous urethra without distant metastasis. The patient received three cycles of gemcitabine and cisplatin as neoadjuvant chemotherapy, followed by robot-assisted radical cystectomy after confirmation of tumor shrinkage. At 18 months postoperatively, he remained alive with no evidence of recurrence. This case illustrates a rare secondary enteric-type urethral adenocarcinoma after brachytherapy and highlights a potential therapeutic strategy for its management. Enteric‐type urethral adenocarcinoma arising as a radiation‐associated secondary malignancy is extremely rare.Neoadjuvant chemotherapy followed by robot‐assisted radical cystectomy (RARC) may achieve curative outcomes in patients with secondary enteric‐type urethral adenocarcinoma after brachytherapy.Even many years after treatment, secondary malignancy should be included in the differential diagnosis when patients who have undergone brachytherapy develop lower urinary tract symptoms.
Soft Everting Robots (SER) are a subclass of soft robotic systems that move by body eversion, enabling highly compliant and adaptive locomotion. These properties make them attractive for medical use, particularly in endoluminal procedures such as colonoscopy or vascular navigation. A structured literature review was performed following the PRISMA methodology. In total, 50 publications were identified that explicitly investigated SER in medical contexts. The publications were categorized by application area, technical design aspects, and reported challenges. Recurring issues include safe interaction with delicate tissue, prevention of leakage, miniaturization to anatomical constraints, sterility and reusability concepts, and reliable navigation in tortuous pathways. SER are additionally compared against related technologies - as these often surface in SER-related searches and can be confused with SER approaches - and the commercialization landscape is briefly outlined. By consolidating these findings, the review provides a structured overview of the state of the art and outlines guidelines for design, control, and the potential future clinical implementation of SER.
Robotic liver transplantation (rLT) has emerged as a minimally-invasive approach to the liver transplant operation, but global experience remains limited and fragmented. A synthesis of existing data and outcomes is needed to define its current role and inform wider adoption. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched for English-language human studies reporting rLT published between January 1, 2021, and October 31, 2025. Methodological quality was assessed using Joanna Briggs Institute tools (case reports/series) and the MINORS tool (observational cohorts). Pooled event rates and means with 95% confidence intervals (CI) were calculated using fixed- or random-effects models according to heterogeneity. Publication bias was assessed with Egger's test. This trial is registered with PROSPERO, number CRD420251111186. Ten studies published between 2021 and 2025, encompassing 93 rLT procedures from five countries, met inclusion criteria; three larger series were eligible for meta-analysis. Most cases were living-donor right lobe grafts performed with the Da Vinci Xi platform in highly selected, low-to-intermediate MELD (Model for End-Stage Liver Disease) recipients without severe portosystemic shunting. Pooled rates were 7.0% (95% CI 3.0-15.8) for bleeding, 3.1% (0.6-13.9) for wound infection, 9.2% (4.3-18.5) for acute kidney injury, 8.5% (3.9-17.7) for biliary complications, 3.2% (0.8-12.0) for portal vein events, and 4.3% (1.4-12.4) for hepatic artery thrombosis, with no detected statistical heterogeneity (I2 = 0% for all pooled complication endpoints). Conversion to open surgery occurred in 2.9% (0.6-13.1), major morbidity (Clavien-Dindo ≥3a) in 17.2% (9.9-28.2), and pooled 6-month survival was 98.0% (86.9-99.7). Robotic liver transplantation is technically feasible, associated with low perioperative morbidity, and has excellent short-term survival in carefully selected recipients treated at experienced centres. Multicentre registries, robust benchmarking against open LT, and standardised training pathways may accelerate implementation. No specific funding was received for this study.
To determine whether robotic pancreatoduodenectomy (RPD) is non-inferior to open pancreatoduodenectomy (OPD) in terms of postoperative functional recovery, without compromising safety or oncological quality. Multicentre, single masked, phase 3, non-inferiority randomised controlled trial. Seven tertiary high volume pancreatic centres in China, 15 June 2020 to 28 November 2024. 268 adults with resectable pancreatic or periampullary disease. Participants were randomised to receive standardised RPD (n=142) or OPD (n=126), with enhanced recovery pathways. The primary outcome was time from surgery to postoperative functional recovery, defined as adequate pain control without parenteral analgesia, ≥50% oral intake without intravenous fluids, independent mobilisation, and absence of active intra-abdominal infection. The restricted mean event time (RMET) within 40 days was a summary for time from surgery to postoperative functional recovery. Secondary outcomes included operative metrics, disease related outcomes, length of stay, postoperative morbidity, including complications of Clavien-Dindo grade II or higher (defined as complications requiring drug treatment or more intensive intervention), and hospital admission costs. Overall, 254 of 268 randomly assigned participants (mean age 62 years; 172 (64.2%) men) underwent surgery, completed follow-up, and were included in the modified intention-to-treat population; 14 did not undergo surgery. In the modified intention-to-treat population, the RMET was 12.1 days (95% confidence interval (CI) 11.2 to 13.1) in the RPD group and 16.0 days (14.5 to 17.5) in the OPD group (difference -3.9 days, 95% CI -5.6 to -2.2; P<0.001). Operative time was longer in the RPD group (300 minutes (interquartile range (IQR) 240-360 minutes) versus 270 (210-300) minutes in the OPD group, P<0.001) but postoperative length of stay was shorter in the RPD group (13 (IQR 11-16) days v 16 (13-20) days, P<0.001). Overall postoperative morbidity was 31.1% (41/132) in the RPD group versus 36.1% (44/122) in the OPD group and incidence of any complications of Clavien-Dindo grade II or higher was 23.5% (31/132) versus 34.4% (42/122), respectively. 90 day mortality was 0.8% (1) in the RPD group and 2.5% (3) in the OPD group. Median total costs of hospital admission (including readmission cost) were higher in the RPD group than in the OPD group (¥130 905 (£14 369; $19 351; €16 628) (IQR ¥114 853-¥152 547) v ¥108 071 (¥92 134-¥128 035), difference ¥22 834 (95% CI ¥16 744 to ¥30 522); P<0.001). In high volume centres with credentialled surgeons, RPD met the non-inferiority margin for time from surgery to postoperative functional recovery, with comparable disease related outcomes and overall burden from postoperative complications. To generate wider system level efficiency gains, the implementation of RPD should take account of institutional expertise, procedural volume, acquisition of robotic surgical platforms and maintenance costs, and the potential for shorter hospital stay. ClinicalTrials.gov NCT04400357.
The introduction of the drop-in gamma probe has advanced intraoperative molecular imaging during prostate cancer surgery. We have been able to convert the sensor's numeric readout to tomographic images, so-called robotic-SPECT (RoboSPECT) and investigate how this is impacted by radiopharmaceutical avidities and drop-in scan metrics. The gamma sensor readout was registered with its 3D position and orientation, allowing a custom reconstruction algorithm to generate RoboSPECT images. Evaluations occurred in 21 patients; 10 sentinel node procedures (SN; primary prostate cancer) and 11 PSMA-radioguided surgery (recurrent prostate cancer). RoboSPECT findings were related to respective pre- and intra-operative controls, including preoperative PSMA-PET/CT and/or SPECT/CT images and fluorescence detection (SN only). RoboSPECT proved to be safe and applicable in a range of conditions. In the SN-group, 26 SN-SPECT/CT lesions were successfully identified with SN-RoboSPECT (100%); 3 were tumor positive (sensitivity 100%). Only 73% of SNs were surgically visible with fluorescence imaging. For the PSMA guided group, the 14 lesions identified on PSMA-PET/CT were all visualized with PSMA-RoboSPECT (100%); 18 specimens were tumor positive (sensitivity 78% for both PSMA-PET/CT and PSMA-RoboSPECT). Preoperative PSMA-SPECT/CT only identified 4 PSMA-lesions (29%). No false positives were seen for roboSPECT and all final resection margins were clean. At 6-months 0% of the SN-patients and 20% of PSMA-patients showed biochemical recurrence. RoboSPECT provides 3D context that extends the utility of drop-in gamma tracing and assists the alignment between pre- and intra-operative target perception. Here SN-RoboSPECT clearly outperformed fluorescence SN imaging and PSMA-RoboSPECT outperformed preoperative PSMA-SPECT/CT imaging.