Review of emerging surgical robotic technology

Awareness of the Role of Artificial Intelligence in Health Care among Undergraduate Nursing Students: A Descriptive Cross-Ssectional Study

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize healthcare by improving efficiency and reducing errors; however, challenges such as inadequate funding and lack of awareness among healthcare professionals hinder its integration into healthcare service delivery.

AIM

To assess the awareness of undergraduate student nurses regarding the role of AI in healthcare.

DESIGN

A descriptive cross-sectional design was used.

SETTINGS

The study was conducted at two nursing colleges in Pakistan: The Foundation University College of Nursing and the Institute of Nursing Wah Medical College.

PARTICIPANTS

A sample of 162 student nurses was selected, consisting of BSc Nursing students from the two nursing institutions.

METHODS

Data were collected using a pre-validated questionnaire adapted from Ahmad et al. (2023), comprising multiple-choice and Likert scale questions. The questionnaire assessed demographic information and awareness of AI, including barriers and advantages of AI in healthcare. Descriptive statistics were used for data analysis. Frequencies and percentages were calculated for demographic variables and responses from participants.

RESULTS

Of the total sample, 59.9 % of students had heard of AI in healthcare, while only 43.8 % had the requisite technical skills to understand AI literature. Additionally, 38.3 % had never encountered AI applications in their profession. The primary barriers to AI education were the lack of specialized courses (35.8 %) and mentorship (41.4 %), while key benefits included faster healthcare procedures (51.2 %) and a reduction in medical errors (32.7 %).

CONCLUSIONS

Although many student nurses are aware of AI, there is a substantial gap in technical knowledge and practical application. To address this, nursing curricula should include dedicated AI courses and practical training modules. Enhanced educational resources and support networks are crucial for overcoming existing barriers and leveraging AI's potential to transform healthcare practices.

Short-term outcomes and the learning curve for laparoscopic right hemicolectomy using the ArtiSential: a multicenter pooled analysis

BACKGROUND

Minimally invasive surgery for colorectal cancer has demonstrated significant advantages over traditional methods, but laparoscopic procedures remain technically challenging. ArtiSential is an articulated handheld laparoscopic system designed to offer greater maneuverability similar to robotic surgery, while addressing cost constraints. However, its clinical efficacy in right hemicolectomy (RHC) for right-sided colon cancer remains underexplored.

METHODS

A multicenter, retrospective study was conducted from January 2021 to October 2022, enrolling 511 patients who underwent laparoscopic RHC for right-sided colon cancer. Of these, 167 patients underwent ArtiSential-assisted RHC, while 344 underwent conventional RHC. Propensity-score matching (PSM) was used to balance baseline variables. Additionally, we employed cumulative sum analysis to evaluate the learning curve associated with ArtiSential use.

RESULTS

After PSM, each group consisted of 165 patients, with no significant differences in baseline clinical characteristics. The median operation time was 148 min for both procedures (p = 0.423). No significant differences were observed in complication rates, including intraoperative blood loss, open conversion, postoperative ileus, anastomotic leakage, or wound complications between ArtiSential-assisted RHC and conventional RHC. Moreover, the total expenses were not different between the groups. Cumulative sum analysis indicated that surgeons reached proficiency with ArtiSential after an average of 19 cases.

CONCLUSION

ArtiSential-assisted RHC proves to be a safe and feasible option, yielding comparable outcomes to conventional RHC with no significant differences in intraoperative or postoperative metrics. Surgeons can achieve proficiency with ArtiSential after performing an average of 19 cases. These findings suggest that ArtiSential could be a valuable addition to the minimally invasive surgical toolkit for right-sided colon cancer treatment.

Seven years of pediatric robotic-assisted surgery: insights from 105 procedures

Robotic-assisted surgery (RAS) has recently expanded its role in pediatric patients. We conducted a retrospective review of 105 cases over 7 years (2017-2024) to evaluate outcomes, efficiency, and training experiences. A total of 105 children (58 boys, 47 girls) aged 2-15 years underwent robotic-assisted procedures using the Da Vinci Xi system. The most common indications were ureteropelvic junction obstruction (n = 33), varicocele (n = 29), and primary obstructive megaureter (n = 16). Two senior surgeons performed the procedures, training seven junior surgeons via the dual-console system. Statistical analysis included paired t-tests for docking time and operative duration comparisons, and Fisher's exact test for categorical variables. Docking time significantly improved over time from 45 to 15 min (median 25 min) (p = 0.001). The total operative time significantly decreased over time (p = 0.001), with a median of 125 min (range 50-250). Robotic system-related issues were reported in 3/105 (2.8%). Conversion to laparoscopy was necessary in 1 (0.9%). Postoperative complications (Clavien grade 3b) occurred in 2/105 (1.8%) patients, requiring reintervention. The median hospital stay was 2 days (range 1-7). Monthly case volume increased from 1-2 to 4-7. Our 7 year experience with pediatric RAS demonstrates its safety, effectiveness, and growing role, especially in pediatric urology. It offers ergonomic advantages and facilitates training but is still limited by cost, larger instrument size (8 mm), and longer setup times compared to laparoscopy. Future developments, such as smaller robotic instruments and single-port technology, may help overcome these limitations and expand the applicability of RAS to younger and smaller patients.

Evaluating the safety, feasibility, and outcomes of the Senhance robotic system in robot-assisted radical prostatectomy: a systematic review and single-arm meta-analysis

With the continuous advancement of robotic-assisted surgical platforms, evaluating the safety and feasibility of emerging systems is essential. This study aims to systematically assess the Senhance robotic system in performing radical prostatectomy for prostate cancer. This investigation employed a systematic review paired with a single-arm meta-analysis, conducted in line with PRISMA standards and with the study protocol pre-registered in the PROSPERO database (CRD42025636976). We queried major databases-including PubMed, Web of Science, Embase, and the Cochrane Library-for articles published until December 2024 that focused on the utilization of the Senhance robotic system in radical prostatectomy. Relevant data were extracted on key surgical parameters (e.g., duration of the procedure, intraoperative blood loss, length of hospital stay, and catheter removal time), as well as on postoperative pain levels and oncological outcomes (including positive surgical margin rates, biochemical recurrence, and urinary incontinence), in addition to overall complication rates. All analyses were performed using Stata 18 SE; heterogeneity among studies was quantified using the I2 statistic, and the stability of the results was assessed through a leave-one-out sensitivity analysis. Five studies encompassing a total of 567 patients were included. The pooled estimates demonstrated a mean operative time of 200.05 min (95% CI 188.44-211.67) and a mean intraoperative blood loss of 257.02 mL (95% CI 216.18-297.86). The mean hospital stay and catheter removal time were 6.20 days (95% CI 4.70-7.70) and 11.07 days (95% CI 9.26-12.89), respectively. Oncological and functional outcomes revealed a positive surgical margin rate of 30% (95% CI 26-33%), a urinary incontinence rate of 14% (95% CI 4-23%), and a biochemical recurrence rate of 5% (95% CI 1-8%). Postoperative pain, measured by VAS scores, improved from 3.11 on day 1 to 0.38 at discharge. Despite significant heterogeneity in several outcomes, sensitivity analyses confirmed the stability of these findings. Our findings indicate that the Senhance robotic platform is a promising tool for radical prostatectomy, delivering oncological and functional outcomes that align with established surgical methods while also offering potential cost benefits. These results support its feasibility as an alternative to traditional systems. However, to solidify its role in urological practice, further research-especially well-designed randomized controlled trials-is necessary to confirm these initial observations and optimize its clinical application.

Robotic-assisted versus laparoscopic surgery for colorectal cancer in high-risk patients: a systematic review and meta-analysis

BACKGROUND

Evidence of superiority of robotic-assisted surgery for colorectal resections remains limited. This systematic review and meta-analysis aims to compare robotic-assisted and laparoscopic surgical techniques in high-risk patients undergoing resections for colorectal cancer.

METHODS

Systematic searches were performed using Pubmed, Embase and Cochrane library databases from inception until December 2024. Randomised and non-randomised studies reporting outcomes of robotic-assisted or laparoscopic resections in the following high-risk categories were included: obesity, male gender, the elderly, low rectal cancer, neoadjuvant chemoradiotherapy and previous abdominal surgery. Comparative meta-analyses for all sufficiently reported outcomes were completed. Risk of bias was assessed using the ROBINS-I and RoB 2 tools for non-randomised and randomised studies, respectively.

RESULTS

48 studies, including a total of 34,846 patients were eligible for inclusion and 32 studies were utilised in the comparative meta-analyses. Conversion to open rates were significantly lower for robotic-assisted surgery in patients with obesity, male patients and patients with low rectal tumours (obese OR 0.41 [CI 0.32-0.51], p < 0.00001); male gender (OR 0.28 [CI 0.22-0.34], p < 0.00001); low tumours OR 0.10 [CI 0.02-0.58], p = 0.01). Length of stay was significantly reduced for robotic-assisted surgery in patients with obesity (SMD 0.25 [CI - 0.41 to - 0.09], p = 0.002). Operative time was significantly longer in all subgroups (obesity SMD 0.57 [CI 0.31-0.83], p < 0.0001; male gender SMD 0.77 [CI 0.17-1.37], p = 0.01; elderly SMD 0.50 [CI 0.18-0.83], p = 0.002; low rectal tumours SMD 0.48 [CI 0.12-0.84], p = 0.008; neoadjuvant chemoradiotherapy SMD 0.72 [CI 0.34-1.09], p = 0.0002; previous surgery SMD 1.55 [CI 0.05-3.06], p = 0.04). When calculable, blood loss, length of stay, complication rate and lymph node yield were comparable in all subgroups.

CONCLUSIONS

This review provides further evidence of non-inferiority of robotic-assisted surgery for colorectal cancer and demonstrates conversion rates are superior in specific, technically challenging operations.

Colorectal endoscopic submucosal dissection in the USA: The current state and future perspectives

Endoscopic submucosal dissection (ESD) is a transformative advancement in the endoscopic management of superficial gastrointestinal lesions. Initially conceived for the treatment of early gastric cancer, ESD has demonstrated proficiency in achieving en-bloc resection of superficial gastrointestinal lesions. ESD has experienced widespread acceptance in Japan and East Asia; however, its adoption in the USA remains delayed. This initial hesitancy could be attributed to procedural complexity and training demands; nonetheless, recently, ESD has been gaining popularity in the USA. This is due to the advancements in endoscopic technology, tailored training programs, and cumulative evidence regarding the efficacy and safety of ESDs. This review aimed to deliberate the historical progress, current implementation, and prospective trajectory of ESDs in the USA. With ongoing clinical research, technological integration, and educational efforts, ESD is likely to become the gold standard for managing large gastrointesitinal lesions. This progress marks an imperative step toward less invasive, more precise, and patient-centric approaches regarding advanced therapeutic endoscopy in the USA.

The environmental impact of multi-specialty robotic-assisted surgery: a waste audit analysis

Modern advances in medicine and technology have led to an increase in robotic-assisted surgery (RAS) cases. However, concerns have been raised about the potential environmental impact of RAS. Despite this, only limited quantitative evidence is currently available. Therefore, this study aims to objectively quantify the environmental impact of a multi-specialty RAS caseload at an Australian public tertiary hospital. An analysis was performed to quantify the amount of waste produced on a consecutive multi-specialty RAS caseload performed between August 2016 and March 2023 at a major public hospital. The weight of each instrument and consumable was measured and the total weight of discarded waste was calculated for each RAS case. A total of 671 patients underwent RAS using the da Vinci Xi System, including Urology (n = 341, 50.8%), Cardiothoracic (n = 158, 23.5%), Gynaecology (n = 107, 16.0%), and Colorectal (n = 65, 9.7%). Overall, the amount of waste was 2,948.9 kg, with single-use items contributing the largest volume (93.9%). Cardiothoracic generated the lowest average weight of waste per case (3.04 kg) while Colorectal generated the highest (5.27 kg). Overall, the da Vinci Xi instrument arm drape was the single item with the largest contribution to the total weight of waste (32.9%). RAS generates substantial waste, primarily from single-use items. These findings underscore the need for strategies to mitigate the environmental footprint of RAS as its adoption continues to grow.

Comparison of perioperative outcomes and prognosis between Da Vinci surgical system and Hinotori system in urologic tumor surgery: evidence from controlled trials

The objective is to evaluate the clinical efficacy and compare perioperative outcomes comparing the Da Vinci and Hinotori robotic systems in the treatment of urological tumors. We systematically reviewed an observational controlled study comparing the two systems in urologic tumor surgery. Six studies, published between 2023 and 2024, involving 904 patients, were included. Surgical parameters and postoperative outcomes were analyzed using Review Manager 5.4, p < 0.05 considered statistically significant. The Da Vinci system demonstrated significantly shorter operation time (OT) (WMD = 22.48, p < 0.001) and robotic intervention time (RIT) (WMD = 23.35, p < 0.001) compared to the Hinotori system. No significant differences were observed in estimated blood loss (EBL), major complications (MC), positive surgical margin rate (PSM), or biochemical recurrence (BCR) between the two groups. Sensitivity analysis confirmed the robustness of these findings, although moderate to high heterogeneity was noted in some outcomes. The Da Vinci robotic system is more efficient in terms of operation and robotic intervention time. However, both the Hinotori and Da Vinci systems provide comparable functional and oncologic outcomes. Given the novelty of the Hinotori system, further prospective studies with larger sample sizes are needed to validate these findings and assess long-term outcomes.

Advancements in Micro/Nanorobots in Medicine: Design, Actuation, and Transformative Application

In light of the ongoing technological transformation, embracing advancements that foster shared benefits is essential. Nanorobots, a breakthrough within nanotechnology, have demonstrated significant potential in fields such as medicine, where diagnostic and therapeutic applications are the primary focus areas. This review provides a comprehensive overview of nanotechnology, robots, and their evolving role in medical applications, particularly highlighting the use of nanorobots. Various design strategies and operational principles, including sensors, actuators, and nanocontrollers, are discussed based on prior research. Key nanorobot medical applications include biomedical imaging, biosensing, minimally invasive surgery, and targeted drug delivery, each utilizing advanced actuation technologies to enhance precision. The paper further examines recent progress in micro/nanorobot actuation and addresses important considerations for the future, including biocompatibility, control, navigation, delivery, targeting, safety, and ethical implications. This review offers a holistic perspective on how nanorobots can reshape medical practices, paving the way for precision medicine and improved patient outcomes.

Camera sheath with transformable head for minimally invasive surgical instruments

INTRODUCTION

This paper presents a camera sheath that can be assembled to various minimally invasive surgical instruments and provide the localized view of the instrument tip.

MATERIAL AND METHODS

The advanced transformable head structure (ATHS) that overcomes the trade-off between the camera resolution and the instrument size is designed for the sheath. Design solutions to maintain the alignment between the camera's line of sight and the instrument tip direction during the transformation of the ATHS are derived and applied to the prototype of the sheath.

RESULTS

The design solution ensured proper alignment between the line of sight and the tip direction. The prototype was used with the curved micro-debrider blades in simulated functional endoscopic sinus surgery (FESS). Deep regions of the sinus that were not observable with the conventional endoscopes was accessed and observed using the prototype.

CONCLUSIONS

The presented camera sheath allows the delivery of the instrument and camera to the surgical site with minimal increase in port size. It may be applied to various surgeries to reduce invasiveness and provide additional visual information to the surgeons.

Surgeons' fatigue in minimally invasive and open surgery: A review of the current literature

Technological advancements have revolutionized surgical methods, with laparoscopic and robotic surgeries offering significant benefits over traditional open procedures. These benefits include reduced intraoperative blood loss, shortened hospital stays, faster recovery, and improved cosmetic outcomes. However, the learning curve for laparoscopic surgery remains a challenge. Robotic systems, like the da Vinci Surgical System, address many limitations of laparoscopic surgery, including limited range of motion and tremors, and offer superior ergonomics. Despite concerns over cost and tactile feedback, innovations like telesurgery and augmented reality are enhancing robotic surgery's potential. Moreover, robotic surgery generally results in less blood loss, fewer complications, and quicker recovery compared to open surgery. Robotic surgery tends also to be less physically demanding for surgeons, reducing fatigue and musculoskeletal strain. However, research also reveals that many surgeons still experience discomfort, particularly in the neck and shoulders, emphasizing the need for ergonomic training and improved workstation setups. The review also explores the impact of pre-procedure fatigue on surgical performance, noting that fatigue can impair performance on surgical simulators, particularly among residents. Despite this, studies showed that performing consecutive surgeries in a single day does not appear to adversely affect patient outcomes. Overall, ergonomic interventions are crucial in both laparoscopic and robotic surgeries to enhance surgeon efficiency and well-being, and further research is needed to optimize these surgical methods and understand the long-term impacts of fatigue on performance and patient outcomes.

Comparison of short- and mid-term outcomes between the Senhance digital laparoscopic system and laparoscopic colectomy: a propensity score matching study

BACKGROUND

The Senhance digital laparoscopic system (Senhance) is a surgical robot approved for use in Japan after the da Vinci system. Our institution was the first to introduce this system, which has been used primarily for gastrointestinal surgery. Featuring tactile feedback, eye-movement-controlled camera operation, stereoscopic vision, and magnification, the short-term postoperative outcomes of the Senhance in abdominal surgery have been documented. This study aimed to evaluate the safety and feasibility of Senhance by examining mid-term postoperative outcomes.

METHODS

Between January 2018 and December 2020, 743 patients underwent colorectal cancer colectomy at our institution. We compared 50 cases of Senhance-assisted colectomy with 430 laparoscopic colectomy cases using 1:1 propensity score matching, adjusting for covariates such as sex, age, tumor location, BMI, ASA-PS, cT, and cN. Short- and mid-term surgical outcomes were compared between the Senhance (S) and laparoscopic (L) groups.

RESULTS

After matching, 47 patients were included in each group. There were no significant differences in the patient backgrounds. The operative time was significantly longer in the S group compared to the L group (median: 240 [101-378] minutes vs. 191 [100-370] minutes, p < 0.01). No significant differences were observed in postoperative complications of Clavien-Dindo grade 2 or higher within 30 days post-surgery, and no robot-related adverse events were reported. The 3-year disease-free survival rates were 88.7% in the S group and 77.1% in the L group (p = 0.178; HR, 1.423; 95% CI 0.916-2.211). The overall survival rate was 97.7% in both groups (p = 0.897; HR, 1.202; 95% CI 0.075-19.26).

CONCLUSION

Senhance-assisted colectomy is safe with mid-term outcomes comparable to laparoscopic surgery. However, the extended operation time remains challenging, necessitating further studies, including randomized controlled trials and multicenter studies, to validate these findings.

A pan-European survey of robotic training for gastrointestinal surgery: European Robotic Surgery Consensus (ERSC) initiative

BACKGROUND

There has been a recent rapid growth in the adoption of robotic systems across Europe. This study aimed to capture the current state of robotic training in gastrointestinal (GI) surgery and to identify potential challenges and barriers to training within Europe.

METHODS

A pan-European survey was designed to account for the opinion of the following GI surgery groups: (i) experts/independent practitioners; (ii) trainees with robotic access; (iii) trainees without robotic access; (iv) robotic industry representatives. The survey explored various aspects, including stakeholder opinions on bedside assisting, console operations, challenges faced and performance assessment. It was distributed through multiple European surgical societies and industry, in addition to social media and snowball sampling, between December 2023 and March 2024.

RESULTS

A total of 1360 participants responded, with valid/complete responses from 1045 participants across 38 European countries. Six hundred and ninety-five (68.0%) experts and trainees were not aware of a dedicated robotic training curriculum for trainees, with 13/23 (56.5%) industry representatives not incorporating training for trainees in their programme. Among trainees with access to robotic systems, 94/195 (48.2%) had not performed any robotic cases, citing challenges including a lack of certified robotic trainers and training lists. Both experts and trainees agreed that trainees should start bedside assisting and operating on the console earlier than they currently do. Assessment tools of trainee performance were not being used by 139/479 (29.0%) participants.

CONCLUSION

This pan-European survey highlights the need for a standardised robotic curriculum to address the gap in visceral training, assessment and certification. A greater emphasis may be required on implementing robotic training earlier through simulation training, dual console learning, bedside assisting, key clinical performance indicators, and assessment tools. The findings will guide the development of a pan-European consensus on the essential components of a comprehensive training programme for GI robotic surgery.

Smart Force Sensing in Robot Surgery Utilising the Back Electromotive Force

Since the introduction of robot-assisted laparoscopic surgery, efforts have been made to incorporate force sensing technologies to monitor critical components and to provide force feedback. The advanced laparoscopic robotic system (AdLap RS) is a robotic platform that aims to make robot technology more sustainable through the use of the fully reusable shaft-actuated tip-articulating (SATA) instruments. The SATA instrument driver features electronics and sensors exposed to the sterile environment, which complicate the sterilisation process. The aim of this study was to develop and validate smart sensing in stepper motors using the back electromotive force in a newly developed Smart SATA Driver (SSD), eliminating the need for sensors in the sterile environment.

METHODS

The stepper drivers were equipped with TMC2209 ICs featuring StallGuard technology to measure back EMF. The tip was actuated up until a set StallGuard threshold value was reached, at which the resulting tip force was measured. This cycle was repeated ten times for a range of threshold levels. A regression analysis with a power series model was used to determine the quality of the fit.

RESULTS

The SSD is capable of exerting tip forces between 2.4 and 8.2 N. The back EMF force test demonstrated a strong correlation between obtained StallGuard values and measured tip forces. The regression analysis showed an R-squared of 0.95 and a root Mean squared error of 0.4 N.

DISCUSSION

The back EMF force test shows promise for force feedback, but its accuracy limits real-time use due to back EMF fluctuations. Future improvements in motor stability and refining the back EMF model are needed to enable real-time feedback.

CONCLUSION

The strong correlation during the back EMF force test shows its potential as a low-budget method for detecting motor stalls and estimating tool-tissue forces without the need for sensors in laparoscopic instruments.

Internet of Robotic Things: Current Technologies, Challenges, Applications, and Future Research Topics

This article focuses on the integration of the Internet of Things (IoT) and the Internet of Robotic Things, representing a dynamic research area with significant potential for industrial applications. The Internet of Robotic Things (IoRT) integrates IoT technologies into robotic systems, enhancing their efficiency and autonomy. The article provides an overview of the technologies used in IoRT, including hardware components, communication technologies, and cloud services. It also explores IoRT applications in industries such as healthcare, agriculture, and more. The article discusses challenges and future research directions, including data security, energy efficiency, and ethical issues. The goal is to raise awareness of the importance of IoRT and demonstrate how this technology can bring significant benefits across various sectors.

Baseline dependent differences in the perception of changes in visuomotor delay

Introduction

The detection of, and adaptation to delayed visual movement feedback has been extensively studied. One important open question is whether the Weber-Fechner Laws hold in the domain of visuomotor delay; i.e., whether the perception of changes in visuomotor delay depends on the amount of delay already present during movement.

Methods

To address this, we developed a virtual reality based, continuous hand movement task, during which participants had to detect changes in visuomotor mapping (delay): Participants (N = 40) performed continuous, auditory-paced grasping movements, which were measured with a data glove and transmitted to a virtual hand model. The movements of the virtual hand were delayed between 0 and 700 ms with the delay changing repeatedly in a roving oddball design. Participants had to indicate any perceived delay changes by key press. This design allowed us to investigate detection accuracy and speed related to the magnitude of the delay change, and to the "baseline" delay present during movement, respectively.

Results

As expected, larger delay changes were detected more accurately than smaller ones. Surprisingly, delay changes were detected more accurately and faster when participants moved under large > small delays.

Discussion

These results suggest that visual movement feedback delay indeed affects the detection of changes in visuomotor delay, but not as predicted by the Weber-Fechner Laws. Instead, bodily action under small delays may have entailed a larger tolerance for delay changes due to embodiment-related intersensory conflict attenuation; whereas better change detection at large delays may have resulted from their (visual) saliency due to a strong violation of visuomotor predictions.

Calibration and Closed-Loop Control Improve Performance of a Force Feedback Device

Interaction accuracy and transparency of force feedback devices (FFDs) are crucial in applications like remote surgery, where high force feedback accuracy (FFA) ensures the safety of delicate procedures. However, few studies have introduced the force calibration of FFDs, especially addressing the low FFA issue in high dynamic motions. This paper proposes a calibration method and a closed-loop control (CLC) strategy for an FFD to enhance its FFA. Tailored calibration models were developed by decoupling factors causing feedback force errors. The CLC was achieved by modeling the FFD's kinematics, statics, and dynamics and integrating force and current information. Experimental results show that the integration of the models and CLC significantly improved FFA, evidenced by a reduction in mean absolute error (MAE) from 0.843 N to 0.054 N and a mean relative absolute error (MRAE) from 18.89% to 1.52% in static conditions. In dynamic motions, the MAE reduced from 3.10 N to 0.370 N, and the MRAE declined from 117.66% to 22.57%. With human-in-the-loop, the CLC reduced the MAE by about 93% and the MRAE by about 92%. The ablation study showed the effectiveness of each calibration model. Our methodology can be applied to similar motor-driven FFDs.

Making surgical education intuitive: A surgical robotics primer for pre-clinical medical students

BACKGROUND

As robotic surgeries increase nationwide, residency programs are implementing commensurate curriculum. Medical student exposure and comfort with these surgeries, however, is lagging. This program sought to improve student interest and confidence through additional robotic exposure.

METHODS

A two-part educational program was implemented at an academic institution. Part-one included a surgeon-led lecture and part-two a hands-on robotics primer where students were exposed to 3-D anatomy and instrumentation via robotic console. Data was collected via RedCap and analyzed for significance (p ​< ​0.05).

RESULTS

Thirty-two students participated in part one, ten of which were selected for part two. The majority (82 ​%) reported being interested or very interested in pursuing additional robotic experiences and 40 ​% reported improved confidence in actively assisting in a robotics case (p ​< ​0.005).

CONCLUSION

Conducting robotic exposure events improves medical students' confidence and interest in seeking future robotic surgery experiences. As robotic surgery expands, medical students have shown to benefit from earlier exposure.

Clinical and in vitro application of robotic computer-assisted implant surgery: a scoping review

In recent years, the emergence and application of robotic computer-assisted implant surgery (r-CAIS) has resulted in a revolutionary shift in conventional implant diagnosis and treatment. This scoping review was performed to verify the null hypothesis that r-CAIS has a relatively high accuracy of within 1 mm, with relatively few complications and a short operative time. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). From the 3355 publications identified in the PubMed, Scopus, Web of Science, and Google Scholar databases, 28 were finally included after a comprehensive review and analysis. The null hypothesis is partly accepted, as r-CAIS has a relatively high accuracy (coronal and apical deviation within 1 mm), and no significant adverse events or complications have been reported to date, although additional confirmatory studies are needed. However, there is insufficient evidence for a shorter surgical time, and further clinical research on this topic is required.

Comparison of the safety and efficacy of laparoscopic single-incision triangulated umbilical surgery pyeloplasty with traditional three-hole surgery in a pediatric tertiary center

OBJECTIVE

To report the application of laparoscopic single-incision triangulated umbilical surgery (SITUS) pyeloplasty in children with ureteropelvic junction obstruction (UPJO) and compare its feasibility and efficacy with traditional three-hole laparoscopic pyeloplasty.

METHODS

Data from children with UPJO who underwent SITUS between July 2018 and August 2021 were included in this retrospective study and patients who were treated with traditional laparoscopic pyeloplasty were chosen for comparison. Thirty-two patients from SITUS group and 72 patients from traditional group were reviewed. The clinical characteristics, complications, and follow-up results were collected and compared.

RESULTS

The preoperative demographic data and imaging parameters, including sex, surgical side, age, BMI, and preoperative anterior-posterior pelvic diameter (APD), showed no significant differences between the two groups. The median surgical time was 135 min (IQR: 119.75-160.5) in SITUS group, while 163.5 min (IQR: 141.25-187.5) in the traditional group (p = 0.0008). Two Clavien-Dindo III complications (6.25%) in SITUS group and 11 (15.3%) in the traditional group were recorded (p = 0.335). The success rate was 100% (32/32) in SITUS group and 94% (68/72) in the traditional group (p = 0.309).

CONCLUSION

SITUS pyeloplasty is a feasible and effective laparo-endoscopic single-site (LESS) technique for pediatric patients with excellent cosmetic results comparable to the conventional laparoscopic pyeloplasty. More cases and longer follow-up periods are needed to determine the exact outcomes of the modified LESS technique.

Global trends and hotspots in robotic surgery over the past decade: a bibliometric and visualized analysis

Since its introduction, robotic surgery has experienced rapid development and has been extensively implemented across various medical disciplines. It is crucial to comprehend the advancements in research and the evolutionary trajectory of its thematic priorities. This research conducted a bibliometric analysis on the literature pertaining to robotic surgery, spanning the period from 2014 to 2023, sourced from the Web of Science database. The objective was to delineate the publication trends and trace the development of research topics within the domain of robotic surgery. From 2014 to 2023, there has been a consistent upward trend in the annual volume of publications concerning robotic surgery. The United States emerges as the leading country in terms of both the number of publications (n=3402) and citations (n=57731). The Journal of Robotic Surgery has the highest number of publications (n=506), while IEEE Transactions on Robotics has the highest number of citations (n=53). Yonsei University is the institution with the greatest number of publications (n=196), and the University of Washington has the highest average citation count (n=30). Alexandre Mottrie is the author with the most publications and citations (n=70 publications, n=1816 citations). Keyword analysis revealed seven distinct clusters: (1) applications and techniques of robotic surgery; (2) urological surgery and associated complications; (3) gastrointestinal diseases and surgical interventions; (4) robotic thyroid surgery and related complications; (5) gynecological diseases and corresponding surgical procedures; (6) Da Vinci robot and its training; (7) pulmonary diseases and associated surgeries. Artificial intelligence (AI) has been identified as a newly emerging keyword in the field. The corpus of literature on robotic surgery has seen a steady rise over the past decade, marked by extensive collaboration among various countries, institutions, and researchers. This study has delineated the global trends, identified research hotspots, highlighted emerging topics, and outlined the foundational knowledge within the field of robotic surgery. Looking forward, the integration of AI with robotic surgery is poised to offer substantial benefits and is anticipated to become a pivotal trend and area of focus in the field's future advancement.

Impact of innovative technologies on quality and safety in surgery

Technological advancements gradually lead to the revision and transformation of healthcare, training, and research. Surgery is a field of medicine where the collaboration of human resources and the application of innovative technologies could elevate faithfulness and efficiency. The article, exploring the technologies and analyzing them in terms of their reliability, the benefits of performing precision surgeries, the effectiveness in the outcome of surgery with less psychosomatic fatigue, and the improvements in the training process for surgeons, emphasizes the safety and quality that can be achieved. The study was conducted by searching the relevant papers mainly from 2016-2024 using different online databases such as Web of Science, Google Scholar, and PubMed to examine the impact of adopting new technologies in medicine. This paper highlights that the use of innovative technologies in a wide range of surgical procedures could, by adapting interdisciplinary procedures, provide significant results in issues related to safety, quality, reliability, and training.

Upcoming multi-visceral robotic surgery systems: a SAGES review

BACKGROUND

Robotic surgical procedures continue to increase both in the United States (US) and worldwide. Several novel robotic surgical platforms are under development or undergoing regulatory approval. This review explores robotic platforms that are expected to reach US consumers within the next 2-3 years.

METHODS

The SAGES Robotic Platforms Working Group identified robotic surgery platforms in various stages of development and selected multi-visceral systems nearing or completing the US Food and Drug Administration (FDA) approval process. We outline key system components including architecture, unique features, development status, regulatory approval, and expected markets.

RESULTS

We identified twenty robotic platforms that met our selection criteria. Ten companies were based in North America, and ten were based in Europe or Asia. Each system is described in detail and key features are summarized in table form for easy comparison.

CONCLUSION

The emergence of novel robotic surgical platforms represents an important evolution in the growth of minimally invasive surgery. Increased competition has the potential to bring value to surgical patients by stimulating innovation and driving down cost. The impact of these platforms remains to be determined, but the continued growth of robotic surgery seems to be all but assured.

Single-Port Versus Multi-Port Robotic Retroperitoneal Partial Nephrectomy: A Propensity Score-Matched Comparison

Objective: To compare the surgical results of retroperitoneal (RP) robot partial nephrectomy (PNx) using either a single-port robot (SP) or a multi-port robot (MP). Materials and Methods: We retrospectively reviewed all RP robotic PNx performed at a single institution from September 2021-when the SP robot was introduced to the institution-through April 2023. In total, 125 patients underwent the surgery; 81 patients were treated with surgery using a MP robot whereas 44 patients were treated with surgery using a SP. All MP surgeries were performed with da Vinci Xi (Intuitive, Sunnyvale, California, USA), while all SP surgeries were performed with da Vinci SP (Intuitive, Sunnyvale, California, USA). We performed a propensity score-matching (PSM) analysis of these 125 patients. Results: There was no significant difference between the two groups after PSM. In terms of operation time, that for MP was 103.68 ± 21.89 minutes whereas that for SP was 95.43 ± 32.22 minutes (p-value = 0.164). Meanwhile, in terms of console time, that for MP was 70.95 ± 21.92 minutes whereas that for SP was 64.14 ± 32.06 minutes (p-value = 0.248). In terms of estimated blood loss was 90.91 ± 91.06 mL in MP and 92.27 ± 104.30 mL in SP (p-value = 0.948). Lastly, there was a statistically significant difference in warm ischemic time, as it was 17.18 ± 6.56 minutes in MP and 13.82 ± 4.59 in SP (p-value = 0.007). There were no statistically significant differences between MP and SP in any other surgical outcomes. Conclusions: SP robot RP PNx demonstrated comparable outcomes to those achieve using MP procedures. This means SP robot RP PNx can be considered a preferable and more convenient surgical approach than conventional methods, particularly when dealing with small renal masses located in the posterior side of the kidney.

Evolution of minimally invasive cholecystectomy: a narrative review

BACKGROUND

Laparoscopic cholecystectomy, being a prevalent abdominal surgical procedure, has transitioned through various innovative stages aimed at reducing the procedure's invasiveness. These stages encompass Single-Incision Laparoscopic Cholecystectomy (SILC), Mini Laparoscopic Cholecystectomy (MLC), Natural Orifice Transluminal Endoscopic Surgery (NOTES), and Robotic-Assisted Laparoscopic Cholecystectomy (RALC). The purpose of this review is to trace the evolution of minimally invasive cholecystectomy techniques, assess their status, and identify emerging trends and challenges in the field.

METHOD

An extensive review was performed to explore the evolution and characteristics of SILC, MLC, NOTES, and RALC. The approach involved an in-depth examination of literature available on PubMed, coupled with a critical assessment of surgical outcomes, associated complications, and technical hurdles posed by these methods.

RESULTS

SILC, despite its potential for reduced scarring, exhibits an elevated risk of bile duct damage and incisional hernia occurrences. MLC, mirroring the standard technique closely, presents minor benefits without amplifying postoperative complications, hence, positing itself as a feasible choice for routine elective cholecystectomy. NOTES, although still facing technical challenges, the hybrid transvaginal procedure is gaining clinical interest. RALC, heralded for its augmented precision and dexterity, emerges as a potential future avenue, although necessitating further exploration to ascertain its efficacy and safety.

CONCLUSION

The progression of laparoscopic cholecystectomy methodologies embodies the surgical society's aspiration to minimize invasiveness whilst enhancing patient outcomes. This review endeavors to offer a structured discourse on SILC, MLC, NOTES, and RALC, aspiring to aid the ongoing deliberation on the judicious selection of surgical techniques in clinical practice.

Flexible Piezoelectric Sensor Enhanced by Ordered Piezoelectric Composite Material for Three-Dimensional Force Detection

With the rapid development of intelligent devices, the demand for high-performance flexible sensors with three-dimensional force perception capabilities has become increasingly prominent. In this study, we utilized dielectrophoresis regulation to achieve an ordered arrangement of lead zirconate titanate particles in piezoelectric composite films, enhancing the pressure sensitivity by approximately 4.06 times compared to randomly distributed composite films. Furthermore, an additional bump structure was constructed to convert three-dimensional forces into different compression states on the sensing units of the film, enabling effective decoupling of three-dimensional forces. Experimental results demonstrated that the three-dimensional piezoelectric force sensor exhibited sensitivity values of 0.2524, 0.1702, and 0.1946 V/N in three directions within the range of 1-9 N. Additionally, the sensor possesses significant advantages such as rapid response (4 ms), good repeatability, and simple manufacturing. These characteristics offer a viable strategy for self-powered wearable devices and human-machine interactions in intelligent devices.

Implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer

This study aimed to assess the safety and feasibility of the Robocare nursing model in patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer. A total of 68 patients who underwent da Vinci robot-assisted radical gastrectomy for gastric cancer in our department from January 2022 to June 2022 were enrolled in this study and were assigned to a control group (n = 34) and an intervention group (n = 34). The control group received standard perioperative nursing care, while the intervention group received the Robocare model along with standard care. We compared the differences in postoperative hospital stay length, the incidence of postoperative complications, readmission rates within one month after discharge, and satisfaction with nursing care between the two groups. Compared to the control group, patients in the intervention group exhibited a significantly shorter postoperative hospital stay (mean 8.94 days vs. 9.76 days, P < 0.05) without an increase in the incidence of postoperative complications (26.5% vs. 29.4%, P > 0.05). In addition, there was no significant difference in readmission rates within 1 month after discharge between the two groups (14.7% vs. 5.9%, P > 0.05). Patient satisfaction was significantly higher in the intervention group compared to the control group (96.34% vs. 91.96%, P < 0.05). The implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer may reduce the length of postoperative hospital stays without increasing the incidence of postoperative complications, while also enhancing patient satisfaction with nursing care.

Early outcomes of robotic versus video-thoracoscopic anatomical segmentectomy: a propensity score-matched real-world study

OBJECTIVES

Minimally invasive anatomic segmentectomy for the resection of pulmonary nodules has significantly increased in the last few years. Nevertheless, there is limited evidence on the safety and feasibility of robotic segmentectomy compared to video-assisted thoracic surgery. This study aimed to compare the real-world early outcomes of robotic and video-thoracoscopic surgery in anatomic segmentectomy.

METHODS

Single-centre cohort study including all consecutive patients undergoing segmentectomy by either robotic or video-thoracoscopic from June 2018 to November 2023. Propensity score case matching analysis generated 2 matched groups undergoing robotic or video-thoracoscopic segmentectomy. Short-term outcomes were analysed and compared between groups.

RESULTS

204 patients (75 robotic and 129 video-thoracoscopic patients) were included. After matching, 146 patients (73 cases in each group) were compared. One 30-day death was observed in the robotic group (P = 1). Two conversions to thoracotomy occurred in the robotic, and none in the video-thoracoscopic group (P = 0.5). Surgical time was longer in the robotic group (P = 0.091). There were no significant differences between robotic and video-thoracoscopic groups in postoperative complications (13.7% vs 15.1%, P = 1), cardiopulmonary complications (6.8% vs 6.8%, P = 1), major complications (4.1% vs 4.1%, P = 1), prolonged air leak (4.1% vs 5.5%, P = 1), arrhythmia (1.4% vs 0%, P = 1) and reoperation (2.7% vs 2.7%, P = 1). Median length of stay was 3 days (interquartile range 2-3 days) in the robotic group vs 3 days (interquartile range 2.5-4 days) in the video-thoracoscopic group (P = 0.212).

CONCLUSIONS

Robotic segmentectomy is a safe and feasible alternative to video-thoracoscopy, as no significant differences in early postoperative outcomes were found between the 2 techniques.

A Delphi-based exploration of factors impacting blood loss and operative time in robotic prostatectomy

This study aims to investigate factors influencing the implementation of robotic-assisted radical surgery, with a specific focus on their effects on blood loss and operative time. Radical prostatectomy was chosen as the case study due to its complexity and diverse surgical activities. The study employed a three-round Delphi approach involving 25 surgeons from three countries: UK, Australia, and China. The collected data were analysed using non-parametric tests. The Delphi study showed significant correlations between the degree of difficulty and blood loss (Z = 2.698, ρ < 0.007), as well as between team coordination and blood loss (Z = 3.499, ρ < 0.0001). However, no significant relationship was found between operative time and blood loss. Surgeons reported that neurovascular bundle (NVB) release and pelvic lymph node dissection require high team coordination. NVB release is particularly challenging and poses a higher risk of blood loss. Additionally, a large prostate increases the difficulty of prostate dissection, prolongs operative time for bladder neck and NVB dissection, and leads to a considerable overall increase in operative time. The manuscript shows that effective team coordination plays a crucial role in reducing blood loss and operative time during surgical activities. When the team coordinates well, clear and efficient verbal communication suffices, reducing the need for physical proximity during robotic-assisted surgeries.

Untethered & Stiffness-Tunable Ferromagnetic Liquid Robots for Cleaning Thrombus in Complex Blood Vessels

Thrombosis is a significant threat to human health. However, the existing clinical treatment methods have limitations. Magnetic soft matter is used in the biomedical field for years, and ferromagnetic liquids exhibit tunable stiffness and on-demand movement advantages under magnetic fields. In this study, a ferromagnetic liquid robot (FMLR) is developed and applied it to thrombus removal in complex blood vessels. The FMLR consisted of Fe3O4 magnetic nanoparticles and dimethyl silicone oil. The FMLR can pass through a narrow complex maze through shape deformation by tailoring the intensity and direction of the external magnetic field. Finite element simulation analysis is used to validate the mechanism of controllable FMLR movements. Importantly, the storage modulus of FMLR can be tuned from 0.1 to 2018 Pa by varying the external magnetic intensity, ensuring its effectiveness in removing rigid and stubborn thrombi present on the vascular walls. Toward medical robotic applications, FMLR can be used in telerobotic neurointerventional. Experiments demonstrating the capability of FMLR to remove thrombi in the ear veins of rabbits are conducted. This study introduces an efficient approach for thrombus elimination, broadening the utilization of FMLRs within the realm of clinical medicine.

Enhancement of reactive oxygen species production by ultra-short electron pulses

The development of laser-driven accelerators-on-chip has provided an opportunity to miniaturize devices for electron radiotherapy delivery. Laser-driven accelerators produce highly time-compressed electron pulses, on the 100 fs to 1 ps scale. This delivers electrons at high peak power yet low average beam current compared with conventional delivery devices, which generate pulses of approximately 3 µs. The biophysical effects of this time structure, however, are unclear. Here, we use a Monte Carlo simulation approach to explore the effects of the electron beam time structure on the production of reactive oxygen species (ROS) in water. Our results show a power law increase in the generation of hydroxyl ions per deposited electron with decreasing pulse length over the pulse length range of 10 µs to 100 fs. Similar trends were observed for hydrogen peroxide, superoxide, hydroperoxyl, hydronium and solvated electrons. In practical terms, this indicates a fourfold increase in the efficiency of free radical production for sub-picosecond pulses, relative to that of conventional microsecond pulses, for the same number of deposited electrons.

Fellow perceptions of robotic surgery preparedness for fellowship

INTRODUCTION

Many surgical fellowship programs incorporate robotic surgery, yet not all residency programs offer robotic training for residents. Given the variability of pre-fellowship robotic exposure, the goal of this study was to explore whether standardized robotic skills assessment would be useful to fellows at the start of their training.

METHODS

In partnership with the Fellowship Council, we surveyed current fellows of accredited Thoracic, Colorectal, HPB, and Advanced GI/MIS/Bariatrics/Foregut Fellowship programs. Main outcome measurements included amount of robotic exposure during residency, fellows' robotic skills at the start of fellowship, and fellows' attitudes towards a standardized skills assessment.

RESULTS

In total, 78 fellows completed the survey. Mean percentage of cases performed robotically during fellowship was 38.1% (SD ± 32.25%). From our respondents, 46% had no robotic curriculum during residency and 86.9% felt a standardized robotic curriculum during residency would have been beneficial. When asked if they started fellowship with adequate robotic skills to operate autonomously, 31% strongly agreed, but 24.4% strongly disagreed. The majority of fellows reported their fellowship program did not conduct an assessment of their robotic skills (71.5%), or provide a specific robotic curriculum (75.6%). On the other hand, 73.3% felt a formal proficiency assessment at the start of fellowship would be helpful for individualized support and training.

CONCLUSIONS

Given the significant variability in resident exposure to robotic surgery, a standardized robotic curriculum during residency would likely be beneficial. Additionally, a robotic skills assessment at the start of fellowship could help provide a tailored training experience for fellows interested in this skillset.

Engineering Principles and Bioengineering in Global Health

Medical technology plays a significant role in the reduction of disability and mortality due to the global burden of disease. The lack of diagnostic technology has been identified as the largest gap in the global health care pathway, and the cost of this technology is a driving factor for its lack of proliferation. Technology developed in high-income countries is often focused on producing high-quality, patient-specific data at a cost high-income markets can pay. While machine learning plays an important role in this process, great care must be taken to ensure appropriate translation to clinical practice.

Reducing annotating load: Active learning with synthetic images in surgical instrument segmentation

Accurate instrument segmentation in the endoscopic vision of minimally invasive surgery is challenging due to complex instruments and environments. Deep learning techniques have shown competitive performance in recent years. However, deep learning usually requires a large amount of labeled data to achieve accurate prediction, which poses a significant workload. To alleviate this workload, we propose an active learning-based framework to generate synthetic images for efficient neural network training. In each active learning iteration, a small number of informative unlabeled images are first queried by active learning and manually labeled. Next, synthetic images are generated based on these selected images. The instruments and backgrounds are cropped out and randomly combined with blending and fusion near the boundary. The proposed method leverages the advantage of both active learning and synthetic images. The effectiveness of the proposed method is validated on two sinus surgery datasets and one intraabdominal surgery dataset. The results indicate a considerable performance improvement, especially when the size of the annotated dataset is small. All the code is open-sourced at: https://github.com/HaonanPeng/active_syn_generator.

Robotics in interventional endoscopy-evolution and the way forward

The integration of robotics into gastrointestinal (GI) endoscopy represents a transformative advancement and bears the potential to bridge the gap between traditional limitations by offering unprecedented precision and control in diagnostic and therapeutic procedures. This review explores the historical progression, current applications and future potential of robotic platforms in GI endoscopy. Originally designed for surgical applications, robotic systems have expanded their reach into endoscopy, potentially enhancing procedural accuracy and reducing ergonomic strain on practitioners. Natural Orifice Transluminal Endoscopic Surgery (NOTES) emerged as a promising technique, leveraging natural orifices to perform minimally invasive surgeries. Despite its initial potential, several factors, including limitations of the available instrumentations and lack of reliable closure techniques, hindered its widespread adoption and progress. Conventional endoscopic tools often fall short in terms of triangulation, traction and degrees of freedom, necessitating the adoption of robotic interventions. Over recent decades, robotic endoscopy has significantly evolved, focusing on both diagnostic and complex therapeutic procedures such as endoscopic sub-mucosal dissection (ESD) and endoscopic full-thickness resection (EFTR). Various robotic platforms demonstrate enhanced safety and efficiency in GI procedures. As the field progresses, the emphasis on clinical validation, advanced training and the exploration of new applications remains crucial. Continuous innovation in robotic technology and endoscopic techniques promises to overcome existing limitations, further revolutionizing the management of GI diseases and improving patient outcomes.

Deep Learning-Based Fine-Tuning Approach of Coarse Registration for Ear-Nose-Throat (ENT) Surgical Navigation Systems

Accurate registration between medical images and patient anatomy is crucial for surgical navigation systems in minimally invasive surgeries. This study introduces a novel deep learning-based refinement step to enhance the accuracy of surface registration without disrupting established workflows. The proposed method integrates a machine learning model between conventional coarse registration and ICP fine registration. A deep-learning model was trained using simulated anatomical landmarks with introduced localization errors. The model architecture features global feature-based learning, an iterative prediction structure, and independent processing of rotational and translational components. Validation with silicon-masked head phantoms and CT imaging compared the proposed method to both conventional registration and a recent deep-learning approach. The results demonstrated significant improvements in target registration error (TRE) across different facial regions and depths. The average TRE for the proposed method (1.58 ± 0.52 mm) was significantly lower than that of the conventional (2.37 ± 1.14 mm) and previous deep-learning (2.29 ± 0.95 mm) approaches (p < 0.01). The method showed a consistent performance across various facial regions and enhanced registration accuracy for deeper areas. This advancement could significantly enhance precision and safety in minimally invasive surgical procedures.

Analyzing the emergence of surgical robotics in Africa: a scoping review of pioneering procedures, platforms utilized, and outcome meta-analysis

Purpose

Surgical practice globally has undergone significant advancements with the advent of robotic systems. In Africa, a similar trend is emerging with the introduction of robots into various surgical specialties in certain countries. The need to review the robotic procedures performed, platforms utilized, and analyze outcomes such as conversion, morbidity, and mortality associated with robotic surgery in Africa, necessitated this study. This is the first study examining the status and outcomes of robotic surgery in Africa.

Methods

A thorough scoping search was performed in PubMed, Google Scholar, Web of Science, and African Journals Online. Of the 1,266 studies identified, 16 studies across 3 countries met the inclusion criteria. A meta-analysis conducted using R statistical software estimated the pooled prevalences with the 95% confidence interval (CI) of conversion, morbidity, and mortality.

Results

Surgical robots are reportedly in use in South Africa, Egypt, and Tunisia. Across four specialties, 1,328 procedures were performed using da Vinci (Intuitive Surgical), Versius (CMR Surgical), and Senhance (Asensus Surgical) surgical robotic platforms. Urological procedures (90.1%) were the major procedures performed, with robotic prostatectomy (49.3%) being the most common procedure. The pooled rate of conversion and prevalence of morbidity from the meta-analysis was 0.21% (95% CI, 0%-0.54%) and 21.15% (95% CI, 7.45%-34.85%), respectively. There was no reported case of mortality.

Conclusion

The outcomes highlight successful implementation and the potential for wider adoption. Based on our findings, we advocate for multidisciplinary and multinational collaboration, investment in surgical training programs, and policy initiatives aimed at addressing barriers to the widespread adoption of robotic surgery in Africa.

Advances of surgical robotics: image-guided classification and application

Surgical robotics application in the field of minimally invasive surgery has developed rapidly and has been attracting increasingly more research attention in recent years. A common consensus has been reached that surgical procedures are to become less traumatic and with the implementation of more intelligence and higher autonomy, which is a serious challenge faced by the environmental sensing capabilities of robotic systems. One of the main sources of environmental information for robots are images, which are the basis of robot vision. In this review article, we divide clinical image into direct and indirect based on the object of information acquisition, and into continuous, intermittent continuous, and discontinuous according to the target-tracking frequency. The characteristics and applications of the existing surgical robots in each category are introduced based on these two dimensions. Our purpose in conducting this review was to analyze, summarize, and discuss the current evidence on the general rules on the application of image technologies for medical purposes. Our analysis gives insight and provides guidance conducive to the development of more advanced surgical robotics systems in the future.

Human-Robot Interaction and Social Robot: The Emerging Field of Healthcare Robotics and Current and Future Perspectives for Spinal Care

Recent advances in robotics technology and artificial intelligence (AI) have sparked increased interest in humanoid robots that resemble humans and social robots capable of interacting socially. Alongside this trend, a new field of robot research called human-robot interaction (HRI) is gaining prominence. The aim of this review paper is to introduce the fundamental concepts of HRI and social robots, examine their current applications in the medical field, and discuss the current and future prospects of HRI and social robots in spinal care. HRI is an interdisciplinary field where robotics, AI, social sciences, design, and various disciplines collaborate organically to develop robots that successfully interact with humans as the ultimate goal. While social robots are not yet widely deployed in clinical environments, ongoing HRI research encompasses various areas such as nursing and caregiving support, social and emotional assistance, rehabilitation and cognitive enhancement for the elderly, medical information provision and education, as well as patient monitoring and data collection. Although still in its early stages, research related to spinal care includes studies on robotic support for rehabilitation exercises, assistance in gait training, and questionnaire-based assessments for spinal pain. Future applications of social robots in spinal care will require diverse HRI research efforts and active involvement from spinal specialists.

Learning curve of robotic pancreatoduodenectomy by a single surgeon with extensive laparoscopic pancreatoduodenectomy experience

With the development of robotic systems, robotic pancreatoduodenectomies (RPDs) have been increasingly performed. However, the number of cases required by surgeons with extensive laparoscopic pancreatoduodenectomy (LPD) experience to overcome the learning curve of RPD remains unclear. Therefore, we aimed to analyze and explore the impact of different phases of the learning curve of RPD on perioperative outcomes. Clinical data were prospectively collected and retrospectively analyzed for 100 consecutive patients who underwent RPD performed by a single surgeon. This surgeon had previous experience with LPD, having performed 127 LPDs with low morbidity. The learning curve for RPD was analyzed using the cumulative sum (CUSUM) method based on operation time, and perioperative outcomes were compared between the learning and proficiency phases. Between April 2020 and November 2022, one hundred patients (56 men, 44 women) were included in this study. Based on the CUSUM curve of operation time, the learning curve for RPD was divided into two phases: phase I was the learning phase (cases 1-33) and phase II was the proficiency phase (cases 34-100). The operation time during the proficiency phase was significantly shorter than that during the learning phase. In the learning phase of RPD, no significant increases were observed in estimated blood loss, conversion to laparotomy, severe complications, postoperative pancreatic hemorrhage, clinical pancreatic fistula, or other perioperative complications compared to the proficiency phases of either RPD or LPD. A surgeon with extensive prior experience in LPD can safely surmount the RPD learning curve without increasing morbidity in the learning phase. The proficiency was significantly improved after accumulating experience of 33 RPD cases.

Robot-assisted versus conventional laparoscopic surgery for rectal cancer

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of robot-assisted surgery for rectal cancer resection.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery

The advent of catheter-based minimally invasive surgical instruments has provided an effective means of diagnosing and treating human disease. However, conventional medical catheter devices are limited in functionalities, hindering their ability to gather tissue information or perform precise treatment during surgery. Recently, electronic catheters have integrated various sensing and therapeutic technologies through micro/nanoelectronics, expanding their capabilities. As micro/nanoelectronic devices become more miniaturized, flexible, and stable, electronic surgical catheters are evolving from simple tools to multiplexed sensing and theranostics for surgical applications. The review on multifunctional electronic surgical catheters is lacking and thus is not conducive to the reader's comprehensive understanding of the development trend in this field. This review covers the advances in multifunctional electronic catheters for precise and intelligent diagnosis and therapy in minimally invasive surgery. It starts with the summary of clinical minimally invasive surgical instruments, followed by the background of current clinical catheter devices for sensing and therapeutic applications. Next, intelligent electronic catheters with integrated electronic components are reviewed in terms of electronic catheters for diagnosis, therapy, and multifunctional applications. It highlights the present status and development potential of catheter-based minimally invasive surgical devices, while also illustrating several significant challenges that remain to be overcome.

Laparoscopic versus open liver resection for colorectal liver metastasis: an umbrella review

INTRODUCTION

This study comprehensively compared laparoscopic liver resection (LLR) to open liver resection (OLR) in treating colorectal cancer liver metastasis (CRLM).

METHODS

A systematic review of relevant literature was conducted to assess a range of crucial surgical and oncological outcomes.

RESULTS

Findings indicate that minimally invasive surgery (MIS) did not significantly prolong the duration of surgery compared to open liver resection and notably demonstrated lower blood transfusion rates and reduced intraoperative blood loss. While some studies favored MIS for its lower complication rates, others did not establish a statistically significant difference. One study identified a lower post-operative mortality rate in the MIS group. Furthermore, MIS consistently correlated with shorter hospital stays, indicative of expedited post-operative recovery. Concerning oncological outcomes, while certain meta-analyses reported a lower rate of cancer recurrence in the MIS group, others found no significant disparity. Overall survival and disease-free survival remained comparable between the MIS and open liver resection groups.

CONCLUSION

The analysis emphasizes the potential advantages of LLR in terms of surgical outcomes and aligns with existing literature findings in this field.

SYSTEMATIC REVIEW REGISTRATION

[website], identifier [registration number].

Research on Artificial-Intelligence-Assisted Medicine: A Survey on Medical Artificial Intelligence

With the improvement of economic conditions and the increase in living standards, people's attention in regard to health is also continuously increasing. They are beginning to place their hopes on machines, expecting artificial intelligence (AI) to provide a more humanized medical environment and personalized services, thus greatly expanding the supply and bridging the gap between resource supply and demand. With the development of IoT technology, the arrival of the 5G and 6G communication era, and the enhancement of computing capabilities in particular, the development and application of AI-assisted healthcare have been further promoted. Currently, research on and the application of artificial intelligence in the field of medical assistance are continuously deepening and expanding. AI holds immense economic value and has many potential applications in regard to medical institutions, patients, and healthcare professionals. It has the ability to enhance medical efficiency, reduce healthcare costs, improve the quality of healthcare services, and provide a more intelligent and humanized service experience for healthcare professionals and patients. This study elaborates on AI development history and development timelines in the medical field, types of AI technologies in healthcare informatics, the application of AI in the medical field, and opportunities and challenges of AI in the field of medicine. The combination of healthcare and artificial intelligence has a profound impact on human life, improving human health levels and quality of life and changing human lifestyles.

Handheld robotic device for endoscopic neurosurgery: system integration and pre-clinical evaluation

The Expanded Endoscopic Endonasal Approach, one of the best examples of endoscopic neurosurgery, allows access to the skull base through the natural orifice of the nostril. Current standard instruments lack articulation limiting operative access and surgeon dexterity, and thus, could benefit from robotic articulation. In this study, a handheld robotic system with a series of detachable end-effectors for this approach is presented. This system is comprised of interchangeable articulated 2/3 degrees-of-freedom 3 mm instruments that expand the operative workspace and enhance the surgeon's dexterity, an ergonomically designed handheld controller with a rotating joystick-body that can be placed at the position most comfortable for the user, and the accompanying control box. The robotic instruments were experimentally evaluated for their workspace, structural integrity, and force-delivery capabilities. The entire system was then tested in a pre-clinical context during a phantom feasibility test, followed up by a cadaveric pilot study by a cohort of surgeons of varied clinical experience. Results from this series of experiments suggested enhanced dexterity and adequate robustness that could be associated with feasibility in a clinical context, as well as improvement over current neurosurgical instruments.

Scope transition and early arterial inflow control provide safe and comfortable dissection in robotic distal pancreatectomy

PURPOSE

We describe details and outcomes of a novel technique for optimizing the surgical field during robotic distal pancreatectomy (RDP) for distal pancreatic lesions, which has become common with potential advantages over laparoscopic surgery.

METHODS

For suprapancreatic lymph node dissection and splenic artery ligation, we used the basic center position with a scope through the midline port. During manipulation of the perisplenic area, the left position was used by moving the scope to the left medial side. The left lateral position is optionally used by moving the scope to the left lateral port when scope access to the perisplenic area is difficult. In addition, early splenic artery clipping and short gastric artery dissection for inflow block were performed to minimize bleeding around the spleen. We evaluated retrospectively the surgical outcomes of our method using a scoring system that allocated one point for blood inflow control and one point for optimizing the surgical view in the left position.

RESULTS

We analyzed 34 patients who underwent RDP or R-radical antegrade modular pancreatosplenectomy (RAMPS). The left position was applied in 14 patients, and the left lateral position was applied in 6. Based on the scoring system, only the 0-point group (n = 8) had four bleeding cases (50%) with splenic injury or blood pooling; the other 1-point or 2-point groups (n = 13, respectively) had no bleeding cases (p = 0.0046).

CONCLUSION

Optimization of the surgical field using scope transition and inflow control ensured safe dissection during RDP.

Interference Morphology of Free-Growing Tendrils and Application of Self-Locking Structures

Organisms can adapt to various complex environments by obtaining optimal morphologies. Plant tendrils evolve an extraordinary and stable spiral morphology in the free-growing stage. By combining apical and asymmetrical growth strategies, the tendrils can adjust their morphology to wrap around and grab different supports. This phenomenon of changing tendril morphology through the movement of growth inspires a thoughtful consideration of the laws of growth that underlie it. In this study, tendril growth is modeled based on the Kirchhoff rod theory to obtain the exact morphological equations. Based on this, the movement patterns of the tendrils are investigated under different growth strategies. It is shown that the self-interference phenomenon appears as the tendril grows, allowing it to hold onto its support more firmly. In addition, a finite element model is constructed using continuum media mechanics and following the finite growth theory to simulate tendril growth. The growth morphology and self-interference phenomenon of tendrils are observed visually. Furthermore, an innovative class of fluid elastic actuators is designed to verify the growth phenomena of tendrils, which can realize the wrapping and locking functions. Several experiments are conducted to measure the end output force and the smallest size that can be clamped, and the output efficiency of the elastic actuator and the optimal working pressure are verified. The results presented in this study could reveal the formation law of free tendril spiral morphology and provide an inspiring idea for the programmability and motion control of bionic soft robots, with promising applications in the fields of underwater rescue and underwater picking.

Robot-assisted versus laparoscopic pancreatoduodenectomy: a pan-European multicenter propensity-matched study

BACKGROUND

The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort.

METHODS

An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009-2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien-Dindo ≥III).

RESULTS

Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P < .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P < .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P < .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P < .001), and a higher R0-resection rate (73.2% vs 84.4%; P < .001).

CONCLUSION

This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.

A Minimally Invasive Robotic Tissue Palpation Device

OBJECTIVE

Robot-assisted minimally invasive surgery remains limited by the absence of haptic feedback, which surgeons routinely rely on to assess tissue stiffness. This limitation hinders surgeons' ability to identify and treat abnormal tissues, such as tumors, during robotic surgery.

METHODS

To address this challenge, we developed a robotic tissue palpation device capable of rapidly and non-invasively quantifying the stiffness of soft tissues, allowing surgeons to make objective and data-driven decisions during minimally invasive procedures. We evaluated the effectiveness of our device by measuring the stiffness of phantoms as well as lung, heart, liver, and skin tissues obtained from both rats and swine.

RESULTS

Results demonstrated that our device can accurately determine tissue stiffness and identify tumor mimics. Specifically, in swine lung, we determined elastic modulus (E) values of 9.1 ± 2.3, 16.8 ± 1.8, and 26.0 ± 3.6 kPa under different internal pressure of the lungs (PIP) of 2, 25, and 45 cmH2O, respectively. Using our device, we successfully located a 2-cm tumor mimic embedded at a depth of 5 mm in the lung subpleural region. Additionally, we measured E values of 33.0 ± 5.4, 19.2 ± 2.2, 33.5 ± 8.2, and 22.6 ± 6.0 kPa for swine heart, liver, abdominal skin, and muscle, respectively, which closely matched existing literature data.

CONCLUSION/SIGNIFICANCE

Results suggest that our robotic palpation device can be utilized during surgery, either as a stand-alone or additional tool integrated into existing robotic surgical systems, to enhance treatment outcomes by enabling accurate intraoperative identification of abnormal tissue.