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.
Robotic ventral hernia repair (VHR) has enabled minimally invasive management of complex abdominal wall hernias. As robotic procedures involve distinct technical demands and require progressive skill acquisition, understanding learning curves (LCs) is essential to define proficiency thresholds, optimize surgical training, and ensure safe implementation of these techniques. This systematic review compared LCs in robotic VHR across surgical techniques. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of major medical databases (PubMed/MEDLINE, EMBASE, Web of Science, Lilacs, and the Cochrane Library) was performed through August 2025, including cohort studies on adult patients undergoing elective robotic VHR. Seven retrospective cohort studies were included, comprising six single-surgeon series: one robotic intraperitoneal underlay mesh (rIPUM), one robotic transversus abdominis release (rTAR), one robotic transabdominal preperitoneal (rTAPP), three robotic enhanced-view totally extraperitoneal (r-eTEP), and one population-based analysis including 12,609 cases. The single-surgeon series predominantly involved patients with class I obesity (mean body mass index range: 31.0-33.0 kg/m2). LC assessment was heterogeneous, employing cumulative sum (CUSUM), risk-adjusted CUSUM (RA-CUSUM), chronological case grouping, and multivariable regression modeling. Across single-surgeon studies, operative efficiency improved earlier than complication-adjusted or technical quality outcomes. Operative-time (OT) proficiency thresholds were reported at 26 cases for rIPUM, 29-38 for r-eTEP, 46 for rTAPP, and 49 cases for rTAR. However, stabilization of complication-adjusted performance required higher volumes, ranging from 51 to 64 cases. Prior experience substantially shortened the LC, reducing OT proficiency for r-eTEP to just 8 cases. In contrast, population-level analysis suggested that 16-19 robotic cases were required to achieve recurrence-related reoperation rates comparable to open or laparoscopic repair. LCs in robotic VHR follow a two-phase, technique-dependent pattern. While operative efficiency is achieved earlier, optimal patient outcomes require higher case volumes.
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.
This study aims to describe a cohort of patients who underwent conversion to total hip arthroplasty (THA), comparing surgical approach and robotic assistance. Patients ≥ 18 years who underwent conversion to THA between January 1, 2015 and May 6, 2024, were retrospectively reviewed, and additionally contacted via telephone for updated patient reported outcome measures (PROMs), including the Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) questionnaire. Surgical approach and robotic assistance were per surgeon preference, with consideration for the approach of the previous hip surgery. Descriptive statistics were calculated, and continuous variables analyzed using the Student's T-Test, the Wilcoxon Ranked Sum Test. Categorical variables were compared using Chi-Squared Tests and Fisher's Exact Tests, and outcomes analyzed with logistic regression in R statistical software. 83 patients met inclusion (53% anterior approach; 26.5% robotic assistance). Conversion via anterior approach demonstrated shorter operative times than posterior (by 45.9 min; p < 0.001), in addition to fewer postoperative transfusions (22.7% vs. 53.8%; p = 0.006). Length of stay (LOS), and fluoroscopy time were not significant. When stratified by previous surgery 37 patients were converted from prior intramedullary nail, 16 via the anterior approach. Mean operative time remained shorter (p = 0.003) and transfusion remained less (p = 0.015) compared to posterior conversion in this subset. Robotic assistance was associated with shorter operative times (by 44.9 min p < 0.001), and shorter LOS (p < 0.001). Zero robotic-assisted patients required transfusion within 24 h postoperatively compared to 50.8% of non-robotic cases (p < 0.001), although transfusion risk was not significant considering approach or robotic assistance after multivariable regression controlling for preoperative hemoglobin. PROMs were equivocal between compared groups (mean HOOS Jr 11.0 ± 5.1, response rate 42.2%). Conversion THA demonstrates acceptable outcomes, with documented overall improvements in postoperative function. The anterior approach and robotic assistance were associated with significantly shorter surgical times, and less risk of transfusion, potentially demonstrating some advantage in this conversion scenario, although patient selection may have also influenced outcomes.
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.
Conversational companion robots have been studied as one approach to ameliorating loneliness in older people. Large language models (LLMs) can enable flexible conversational ability in companion robots, but acceptability and suitability remain uncertain. We explored older people's expectations and concerns regarding an LLM-supported companion robot for loneliness support, with a focus on acceptability rather than efficacy. We conducted a UK-Japan qualitative study comprising hands-on focus groups for community-dwelling older adults in London (n = 17) and a one-week in-home use with follow-up interviews in Osaka among outpatients with mild cognitive impairment (MCI; n = 8). Transcripts were analysed using reflexive thematic analysis; for cross-site reporting, Japan themes/codes were mapped onto the thematic structure generated from the larger UK dataset. Descriptive questionnaire measures and at-home conversational log metrics were collected to contextualise qualitative findings. Participants saw value of the companion robot as a support for older people with loneliness but emphasised that acceptability depends on interaction mechanics and user agency. Three cross-context themes were identified: (1) Practical use and functionality (response latency, turn-taking, desired features, and controllability in home use); (2) Emotional connection and engagement (social presence alongside perceived limits in conversational fit and depth); and (3) Ethical and societal reflections (privacy/data governance, access, and concerns about substituting for human contact). LLM-supported companion robots may provide acceptable low-intensity support for some older people, including those with MCI, provided that usability, user-adjustable control and ethical governance are prioritised. Longer deployments are needed to evaluate potential sustained benefit and burden.
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.
Surgical robots offer improved precision and stability for laparoscopy; nevertheless, their limited portability and high cost impede broader clinical applications. This paper proposes a hand-held surgical robot with an ergonomic handle and isomorphic kinematics to enhance intuitive operability and portability. A preliminary evaluation was conducted through simulated suture tasks, assessing operation time, precision, muscle activity, and cognitive load. Compared to conventional instruments, the hand-held robot enabled novices (n = 8) to suture significantly faster (p = 0.036) with reduced cognitive demand, while showing a non-significant trend towards higher precision (p = 0.206). For surgeons (n = 3), performance and ergonomics were similar between the two instruments. Notably, muscle fatigue did not significantly increase when using the robot. The proposed hand-held surgical robot provides a feasible, intuitive, and convenient solution for minimally invasive surgery (MIS), particularly beneficial for less experienced operators.
Lumbar degenerative disease (LDD) is increasingly common, and causes back and leg pain that impairs quality of life. Lumbar interbody fusion (LIF) is effective for patients with neural compression and segmental instability. Unilateral biportal endoscopic LIF (UBE-LIF) allows for minimally-invasive decompression and fixation, while navigation- and robot-assisted systems improve pedicle screw accuracy and intraoperative guidance. This study compared perioperative outcomes and clinical efficacy of navigation-assisted vs robot-assisted single-level UBE-LIF. Patients with single-level LDD who underwent navigation-assisted (Na group; n = 23) or robot-assisted (Ra group; n = 29) UBE-LIF between January 2020 and December 2024 were retrospectively enrolled. Clinical outcomes were assessed using the Numeric Rating Scale, Oswestry Disability Index, and modified MacNab criteria. Pedicle screw placement and radiological parameters, including disc height, lumbar lordosis, and segmental lumbar lordosis, were evaluated, and IF was assessed at 12 months postoperatively. Endoscopic operative time was shorter in the Na group than in the Ra group (116.74 vs 127.86 min; P = 0.03), whereas screw insertion time and pedicle screw placement were superior in the Ra group (39.55 vs 46.52 min; P = 0.001 and 98.5% vs 92.4%; P = 0.04, respectively). Both groups showed comparable improvements in clinical outcomes, radiological parameters, and fusion rates, with similarly low complication rates. Navigation- and robot-assisted UBE-LIF are safe and effective procedures. Robot-assisted surgery offers higher screw accuracy and faster insertion, while the navigation-assisted approach reduces endoscopic operating time. Clinical outcomes and fusion rates between the 2 techniques are similar.
To analyze the learning curve of robot-assisted percutaneous placement of acetabular anterior column screws. Between January 2021 and January 2024, 30 patients undergoing robot-assisted percutaneous acetabular anterior column screw placement performed by the same surgeon were enrolled, including 21 males and 9 females, aged from 27 to 65 years old with a mean of (45.2±17.6) years old, with a disease course ranging from 1 to 9 days with a mean of (1.1±5.3) days. According to the chronological order of surgery, the patients were divided into an early group, a middle group, and a late group, with 10 cases in each group. The number of screws graded as excellent, good, and poor was recorded in each group. Fluoroscopy times, screw planning time, guide wire adjustment times, and total operation time were compared among groups. The learning curve was analyzed using curve regression. All procedures was successfully completed in all three groups, without intraoperative or postoperative complications. Postoperative coronal CT showed that in the early group, excellent/good screws were 8/2;in the middle group, excellent/good screws were 9/1;in the late group, excellent/good screws were 9/1. All screws were graded as excellent or good (26/4), without cortical perforation or poor grade screws. There was no significant difference in the proportion of excellent and good screws among the three groups (P>0.05). Fluoroscopy times, screw planning time, guide wire adjustment times, and total operation time:the differences were statistically significant between the early group and the middle group, and between the early group and the late group (P<0.05), while no significant difference was found between the middle group and the late group(P>0.05). Curve regression showed that fluoroscopy times, screw planning time, guide wire adjustment times, and total operation time for robot-assisted percutaneous antegrade anterior column screw placement gradually decreased progressively with increasing surgical experience and reached a plateau after approximately 15 cases. The learning curve of robot-assisted percutaneous acetabular anterior column screw placement is relatively steep, and surgical performance tends to stabilize after about 15 cases.
Robot-assisted total knee arthroplasty (TKA) with functional alignment enables precise bone cuts and soft-tissue preservation; however, array placement often requires additional or extended incisions, which may increase surgical invasiveness. To address these limitations, we developed the Minimal-Incision and Minimal-Soft-Tissue-Injury (MISI) technique, combining robotic precision with true minimally invasive principles. The MISI technique utilizes an approximately 10-cm midline incision with a mini-medial parapatellar approach. It allows secure array fixation through the primary incision while applying functional alignment principles to preserve the soft-tissue envelope. Femoral pins are inserted intra-incisionally, and tibial fixation employs a hybrid approach: one intra-incisional pin and a second pin placed through a 5-mm stab incision to reduce skin tension, particularly in flexion. Bone registration and intraoperative planning are performed using the MAKO robotic system within a functional alignment philosophy. All bone cuts are performed using a mobile window technique at 90° flexion, except for the anterior chamfer cut, which is carried out at 120° flexion to allow adequate clearance between the saw blade and the tibial array. This technique was performed in 82 patients, through which we achieved encouraging early wound healing and high patient satisfaction. The MISI technique offers a reproducible, incision-sparing approach to minimize soft-tissue trauma in robotic TKA. Prospective studies evaluating complication rates, recovery, and patient-reported outcomes are warranted to validate its clinical benefits and determine optimal patient selection.
Children with autism spectrum disorder are known to exhibit both social and language difficulties. Speech prosody is known to be easily noticeable, which has been shown to have far-reaching influences in the academic and social life of autistic individuals. This study examined two training programs on the speech prosody of autistic children, who tend to avoid social speech signals. The first program is a lab perceptual training program without social interaction, while the second utilizes a social robot to provide training with controlled, simulated social interaction. Ninety-two children in total were recruited with sixty-nine participants formally diagnosed with ASD and twenty-three children were typically developing children without any language or speech disorder. Our results showed that both lab perceptual training and robot-assisted training with simulated social interactions led to improvement in the use of speech prosody by autistic children. Although social interaction is considered critical in language acquisition for typical population, autistic individuals tend not to prefer social speech signals, which is hypothesized to lead to their social and language deficits. This study hence proposes two successful alternative ways to facilitate their learning of language through lab perceptual training and simulated human-robot interaction.
This review examines the modern role of open partial nephrectomy (OPN), indications for this surgical approach, and outcomes associated with the open technique in the era of robotic surgery. Robotic-assisted partial nephrectomy (RAPN) now predominates for small renal masses and is increasingly applied to larger and more complex masses. Across multiple comparative series and meta-analyses, RAPN offers equivalent oncologic control and functional preservation compared to OPN, while demonstrating reduced perioperative morbidity. Nonetheless, OPN remains valuable for tumors in hostile or re-operative fields, certain hereditary syndromes, solitary kidneys when cold ischemia is preferred, and settings without reliable robotic access. Declining open case exposure during training raises concerns about maintaining surgical competency. OPN remains an important option when use of the approach provides improved surgical exposure, ischemia management, intra-operative safety, or feasibility of nephron sparing. A pragmatic, surgeon-experience-based approach that prioritizes oncologic control, parenchymal preservation, and patient safety best serves individualized care.
Telepresence enables real-time observation and remote mentoring across distances, potentially accelerating the dissemination of advanced minimally invasive techniques. The da Vinci 5 platform integrates Telepresence within the My Intuitive digital ecosystem, facilitating remote case observation, collaboration, and mentoring. This technology paper reports an international telepresence session in which an expert colorectal robotic surgeon located in Daegu, Republic of Korea, provided real-time remote mentoring during a robot-assisted colorectal procedure performed in Saitama, Japan. A representative clinical implementation involved a patient with rectosigmoid cancer (clinical stage T1bN0M0) and obesity (BMI 30.1 kg/m2). The telepresence-mentored segment focused on the most technically demanding phase: peritoneal incision, dissection around the superior rectal artery (SRA), and vascular handling. The mentored phase lasted 40 min. During this segment, the remote mentor provided step-by-step guidance on exposure strategy, traction direction, and plane selection. Additionally, console-integrated objective force visualization ("Force Gauge") was used as a shared reference to optimize retraction. The operation was completed without intraoperative complications (operative time: 214 min; estimated blood loss: 5 mL). These findings demonstrate the feasibility of cross-border telepresence mentoring on the da Vinci 5 platform. Coupling remote mentoring with objective intraoperative force feedback may improve shared situational awareness and support safe decision-making during complex robotic colorectal surgery.
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.
Robot-assisted laparoscopic surgical procedures are commonly perceived to result in fast recovery; however, the postoperative course can be challenging for many patients. We have previously found severe pain and a significant decrease in the patient-reported outcome measure Quality-of-Recovery 15 (QoR-15) in a cohort of patients undergoing robot-assisted upper urinary tract surgery. In similar settings, intrathecal analgesia is sometimes used to improve recovery; however, its benefits have not been established. Therefore, this study aims to examine the effects of intrathecal analgesia in this setting compared with an active comparator intravenous lidocaine. In this randomised, assessor-blinded multicentre trial, 220 patients scheduled for robot-assisted upper urinary tract surgery under general anaesthesia are recruited after obtaining informed consent. They are randomised to receive either intrathecal analgesia or an intraoperative infusion with lidocaine. The primary study outcome is the decrease in QoR-15 from baseline to postoperative day 1. Other outcomes of interest include postoperative pain, length of stay and postoperative complications. Differences in intraoperative haemodynamics and postoperative inflammatory parameters will also be analysed. This study has been approved by the Swedish Medical Products Agency (5.1.1-2023-69740 and 5.1.2-2025-030145). The results of this study will be presented at national and international meetings and submitted for publication in peer-reviewed international medical journals. NCT06349668.
The optimal duration of neoadjuvant hormonal therapy (NHT) for high-risk prostate cancer remains controversial. In this study, we evaluated the association between NHT duration and prostate-specific antigen (PSA) kinetics as well as pathological outcomes in patients who underwent extraperitoneal robot-assisted radical prostatectomy. We retrospectively analyzed the data of 72 patients with high-risk prostate cancer who received NHT followed by extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection at a tertiary hospital in 2025. Patients were stratified into the short-term (NHT, ≤3 months; n=41) and long-term (NHT, >3 months; n=31) groups. PSA response, pathological features, and perioperative outcomes were compared between the two groups. The PSA nadir was significantly lower in patients who underwent long-term NHT than in those who underwent short-term NHT (median 0.02 vs. 0.23 ng/mL). The proportions of patients in whom PSA levels of <0.1 ng/mL (67.74% vs. 29.27%) and <0.2 ng/mL (83.87% vs. 41.46%) were achieved were significantly higher in the long-term group. Pathological analyses demonstrated a significantly lower incidence of extraprostatic extension in patients undergoing long-term NHT (38.71% vs. 70.73%). Operative time and intraoperative blood loss were similar between the groups. In patients with high-risk prostate cancer, undergoing NHT for longer than 3 months was associated with greater suppression of PSA and more favorable pathological outcomes. Particularly, we observed a reduced incidence of extraprostatic extension and no increase in perioperative morbidity. Achieving a substantial PSA response during NHT may be useful as an indicator for optimizing the timing of surgical intervention.
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.
BackgroundMinor hallucinations (MH) affect 30-60% of patients with Parkinson's disease (PD), and are considered precursors to structured visual hallucinations and cognitive decline. While the link between structured visual hallucinations and dementia is well established, the neuropsychological correlates of MH in PD remain unclear; most studies finding no significant cognitive differences between patients with MH and those without any hallucinations.ObjectivesPresence hallucinations (PH) being among the most prevalent MH in PD, we used a robotic procedure delivering somatomotor conflicts inducing PH experimentally to investigate whether sensitivity to such robot-induced PH aids in detecting cognitive differences between patients with MH and without hallucinations.Methods31 PD patients with MH (PD-MH) and 37 without hallucinations (PD-nH) underwent neuropsychological assessment and the robotic procedure inducing PH. The sensitivity to report robot-induced PH was analyzed in relation to cognitive performance in neuropsychological tests.ResultsPD-MH patients reported more robot-induced PH than PD-nH patients, supporting previous findings. While both groups showed comparable performance in neuropsychological testing, we found a significant association between increased sensitivity to the PH-induction and poorer performance in frontal subcortical cognitive functions, in PD-MH patients, but not in PD-nH patients.ConclusionsThese findings demonstrate that sensitivity to robot-induced PH reveals a previously undetected link between MH and frontal subcortical cognitive deficits in PD, pointing to shared underlying mechanisms between executive dysfunction and somatomotor processes involved in MH. This approach offers a novel and clinically valuable means of identifying early cognitive vulnerability that assessments relying only on standard testing may overlook. This study investigated two groups of Parkinson's disease (PD) patients: one group with minor hallucinations (MH) and another without any hallucinations. Using cognitive tests and a robotic task designed to temporarily induce a presence hallucination (hallucination of someone being there when no one is actually present), the study examined the relationship between cognitive impairment and sensitivity to robot-induced presence hallucinations (riPH). While both groups performed similarly on traditional cognitive tests, patients with MH were more sensitive to the riPH procedure. This increased riPH sensitivity was linked to difficulties with cognitive functions, especially attention and executive functions, which are generally supported by the brain's frontal and deeper regions (frontal subcortical network). These results from both tests (riPH, neuropsychology) suggest that elevated sensitivity to riPH is associated with mild signs of cognitive decline in PD patients that traditional tests might not detect. The use of the robotic induction of hallucinations as a tool for assessing cognitive deficits could offer a more sensitive method for identifying cognitive issues earlier in PD, potentially enabling earlier interventions.