BACKGROUND:Precise temperature control is critical for safe, effective laser ablation in minimally invasive tumour treatment, but current models lack full understanding of multi-physics coupling during the process. METHODS:Using poroelastic theory, we developed a fully coupled optical-thermal-fluid-solid model for high-fidelity temperature prediction to optimise surgical protocols. Ex vivo experiments in pork tissue with precise needle positioning and multi-point temperature measurements validated the model. RESULTS:Simulations showed thermal expansion in elastic tissues induces fluid backflow to the heating zone (thermal focussing). A smaller beam waist enhances optical penetration, while higher porosity reduces peak temperature and promotes diffusion. Validation yielded a maximum prediction error ≤ 1.73°C. CONCLUSIONS:This study provides a theoretical basis for precise temperature control and tissue damage prediction in laser therapy, with particular relevance to prostate tumour treatment.
INTRODUCTION:Robotic-assisted surgery is now the standard for elective colorectal procedures, but its use in emergencies remains limited. This study describes the feasibility of a dedicated emergency robotic programme for acute complicated diverticulitis. METHODS:We retrospectively analysed a prospectively maintained database (2020-2023). Of 31 patients undergoing robotic surgery for suspected complicated diverticulitis, 19 met inclusion criteria and underwent robotic left colectomy or Hartmann's procedure. RESULTS:Median total procedure time was 171 minutes (IQR 42) and median total OR time was 235 minutes (IQR 55), with no conversions to open surgery. Overall 30-day morbidity was 47.4% (9/19) and mortality was 10.5% (2/19), broadly consistent with published laparoscopic/open outcomes, though no concurrent comparator group was analysed. CONCLUSION:This initial, uncontrolled experience suggests that a dedicated emergency robotic programme for acute complicated diverticulitis is technically feasible. These hypothesis-generating results warrant confirmation through prospective, comparative studies before conclusions about safety or superiority can be drawn.
BACKGROUND:Single-port robotic cholecystectomy offers minimally invasive benefits. This trial evaluated the feasibility and safety of a novel system, MicroPort SA-1000. METHODS:In this dual centre, single-arm, prospective study, eligible patients underwent single-port robot-assisted cholecystectomy with MicroPort SA-1000. The primary endpoint was the completion rate, while secondary endpoints included estimated blood loss, operating time, hospital length of stay and complications. RESULTS:From June 2023 to December 2023, a total of 44 patients from two centres were enrolled, and all patients underwent single-port robot-assisted cholecystectomy without conversion. The median EBL was 10 mL (range 5-200 mL). The total operative time was 88.43 ± 25.87 minutes. The median LOS was 2.5 days (range 1-7 days). No serious surgery-related adverse events were observed. CONCLUSIONS:The novel single-port robot demonstrated feasibility and safety in cholecystectomy with effective triangulation, controlled operative time and reduced trauma. Larger studies are needed to validate its performance across different surgical fields. TRIAL REGISTRATION:This study was registered at https://www.chictr.org.cn/showproj.html?proj=258677 (ChiCTR2500107401).
INTRODUCTION:Contemporary gastro-oesophageal reflux disease (GERD) management increasingly relies on objective diagnosis and phenotype-based treatment selection, prompting reassessment of robot-assisted antireflux surgery beyond simple comparison with laparoscopy. METHODS:A narrative review of PubMed/MEDLINE, Web of Science and guideline-based sources addressing robotic antireflux and hiatal hernia surgery, with emphasis on case complexity, reconstructive demands and recent comparative evidence. RESULTS:Robotic surgery appears safe and feasible, with perioperative outcomes and mid-term symptom control generally comparable to those of laparoscopy. Superiority in routine primary procedures remains unproven, whereas potential advantages appear more relevant in giant or paraoesophageal hernia (PEH) repair, revisional foregut surgery, complex mediastinal dissection and demanding hiatal reconstruction. CONCLUSIONS:Robot-assisted antireflux surgery should be viewed as a selectively deployed precision platform for complex foregut reconstruction rather than as a universal alternative to laparoscopy.
BACKGROUND:Remote telesurgery allows surgeons to operate over a distance using robotic systems and advanced networks. This review aims to compare remote telesurgery with local minimally invasive surgery (MIS) regarding patient outcomes and system-level outcomes. METHODS:A PRISMA-compliant systematic review (PROSPERO CRD42023474196) searched six databases to 1 August 2025 for studies comparing remote telesurgery with local MIS in living patients. RESULTS:Among 5737 records, one retrospective cohort met the criteria. It compared 5G-enabled remote robotic pelvic fracture surgery (n = 80) with local robotic surgery (n = 80). Remote procedures had lower blood loss (20 vs. 50 mL) and shorter incisions (1.25 vs. 1.5 cm). Operative time did not significantly differ between groups (p = 0.177), and complications, hospital stay, and functional outcomes were similar. CONCLUSIONS:Comparative data on telesurgery remain limited, and healthcare system benefits are unproven. Future studies should incorporate direct comparisons and systematically evaluate system-level outcomes.
BACKGROUND:Single-incision laparoscopic surgery (SILS) for rectal cancer has seen limited adoption due to its steep learning curve and technical demands. The advent of single-port robotic surgery (SPRS) may address these limitations by improving ergonomics and precision. METHODS:This retrospective multicentre study compared the perioperative and pathological outcomes of SPRS and SILS in patients undergoing low anterior or intersphincteric resection for rectal cancer from 2014 to 2024 at two hospitals. RESULTS:Among 110 patients (56 SPRS, 54 SILS), the SPRS group showed significantly shorter operative time (179.95 vs. 318.15 minutes, p < 0.001) and hospital stay (6.04 vs. 9.41 days, p = 0.030). SPRS was also associated with fewer postoperative complications (8.9% vs. 27.8%, p = 0.013). Stoma formation was less frequent in the SPRS group (28.6% vs. 50.0%, p = 0.031). SPRS yielded more harvested lymph nodes (22.70 vs. 16.83, p = 0.002). CONCLUSION:SPRS offers clinical advantages over SILS and may be preferable in selected rectal cancer patients.
BACKGROUND:Intraoperative imaging has evolved beyond white-light visualisation to include fluorescence imaging, colour enhancement, artificial intelligence (AI), and molecular-targeted imaging. However, these modalities are typically used independently. METHODS:This narrative review synthesises current multimodal intraoperative imaging and presents representative clinical images and conceptual illustrations to demonstrate complementary visual information. RESULTS:White-light imaging provides anatomical context; colour enhancement improves tissue contrast; fluorescence imaging adds functional information; AI supports real-time recognition; and molecular imaging enables biologically specific visualisation. These modalities collectively form layered visual information that enhances intraoperative understanding. CONCLUSIONS:Colour-guided surgery is proposed as a conceptual framework integrating multimodal imaging into a unified intraoperative guidance system and may provide a conceptual basis for future evaluation of multimodal intraoperative guidance in robotic and minimally invasive surgery.
BACKGROUND:Robotic surgery has significantly advanced colorectal procedures, yet achieving an optimal anastomotic technique remains challenging. The Robotic Intracorporeal Single-Stapled Anastomosis (RiSSA) has been introduced to overcome the limitations of the conventional double-stapled approach, such as intersecting staple lines and 'dog ears', which are potential structural weak points. METHODS:A comprehensive search of PubMed, Embase, Scopus, and Web of Science was performed through March 2026 using the keywords 'robotic colorectal anastomosis', 'robotic single-stapled anastomosis', and 'RiSSA'. RESULTS:RiSSA was reviewed from its origin to recent applications, focussing on its technical rationale, procedural steps, and indications, including colorectal cancer, inflammatory bowel disease, and gynaecological conditions such as deep endometriosis. Advantages and limitations were critically assessed. CONCLUSIONS:Available evidence suggests that RiSSA is a feasible and promising technique; however, high-quality prospective studies are needed to better define its comparative benefits and its long-term oncological and functional outcomes.
BACKGROUND:Endoscopic retrograde cholangiopancreatography (ERCP) cannulation requires precise manipulation under fluoroscopic guidance. This study proposes a teleoperated robotic system for ERCP cannulation and evaluates its simulator-based performance. METHODS:A teleoperated robotic system incorporating a Chebyshev-based mechanism and a ring-type master interface was developed. Manipulation performance was assessed using Fitts' law-based insertion experiments, catheter-tip trajectory analysis, and a simulator-based cannulation task. RESULTS:Robotic manipulation showed a Fitts' law relationship comparable to conventional manual operation. Trajectory analysis showed higher path efficiency and lower jerk in the robotic condition, indicating improved trajectory-related motion quality. In the simulator-based cannulation task, the robotic condition showed slightly longer initial task completion times, whereas both robotic and conventional conditions showed comparable changes in task completion time across repeated trials. CONCLUSIONS:This study demonstrates the feasibility of a teleoperated robotic system for simulator-based ERCP cannulation tasks. Further validation with expert endoscopists and more realistic ERCP environments is required.
BACKGROUND:This study assessed the real-world hepatotoxicity of third-generation aromatase inhibitors (AIs) for breast cancer using pharmacovigilance approaches. METHODS:FAERS data (Q1 2004-Q1 2025) were analysed using a data-driven disproportionality analysis framework incorporating traditional frequentist metrics and an information-theoretic Bayesian network. RESULTS:A total of 24 liver-related adverse events and 7 clinical outcomes were extracted in this study. Letrozole associated with the highest number of hepatotoxicity cases and showed the highest BCPNN-supported reporting signal. Exemestane exhibited the earliest hepatotoxicity onset (median 49 days), significantly earlier (p = 0.047) than anastrozole (61.5 days) and letrozole (56 days). CONCLUSION:AIs present distinct hepatotoxic profiles. Exemestane requires early vigilance due to its rapid onset, while letrozole exhibits the highest signal. Proactive liver monitoring and individualised management are crucial. Future research should integrate artificial intelligence with multi-modal real-world data for predictive risk assessment.
BACKGROUND:Robot-assisted ophthalmic surgery requires precise manipulation about a remote centre of motion (RCM). Conventional systems often employ mechanically fixed RCMs, limiting alignment flexibility, motion compensation, and tool exchange capability. This work presents HYPER-OPS, a hybrid parallel-serial ophthalmic robot featuring a software-controlled RCM and tool exchange capability. METHODS:A compact six-degree-of-freedom manipulator was developed using a dual-layer five-bar linkage. The system features software-controlled RCM functionality and passive magnetic tool exchange. Kinematic, workspace and structural analyses were performed, followed by experimental validation. RESULTS:The robot achieved the workspace required for ophthalmic procedures while enabling configurable RCM placement. Finite element analysis predicted a maximum deformation of 0.045 mm and a first natural frequency of 56 Hz. Experiments demonstrated RCM position errors below 0.2 mm and tool exchange repeatability of 0.39 mm. CONCLUSION:HYPER-OPS provides a compact platform for ophthalmic surgery with improved flexibility for alignment, motion compensation and workflow automation.
INTRODUCTION:In a robotic breast ultrasound (US) system (RBUS), ensuring patient safety, comfort, and high compliance is critical. METHOD:To improve low system compliance, this study proposes a Variable Admittance Control based on the Critical Damping Ratio (VAC-CDR). This algorithm enhances force control accuracy and compliance by adaptively adjusting damping and stiffness coefficients. Furthermore, a Breast Surface Adaptive Control Strategy (BrS-ACS) is introduced. This strategy adjusts the alignment of the probe with the normal of the breast surface. Meanwhile, the influence of admittance parameters on compliance is experimentally analysed, with an error band used for evaluation. RESULTS:The simulation and experimental validation demonstrate that the VAC-CDR algorithm achieves excellent compliance, robustness, and a force control precision of 0.4 N, while the BrS-ACS ensures accurate and reliable scanning of the US probe. CONCLUSION:This study contributes to the advancement of automated US image scanning.
BACKGROUND:This retrospective study compared two reconstruction techniques in 50 patients undergoing robotic proximal gastrectomy: the novel Upper-Dome Overlap Single-flap valvuloplasty (UDOS) and the conventional Kamikawa anastomosis. METHODS:Perioperative data, anastomotic time, complication rates, nutritional outcomes, lower oesophageal sphincter pressures, and health-related quality of life scores were compared between the two groups. RESULTS:Compared with Kamikawa, the UDOS technique significantly reduced anastomosis time by 39.8% (25.9 vs. 43.0 min). Perioperative safety and early complication rates were comparable. The UDOS group demonstrated a favourable trend in reducing late complications, with a lower incidence of anastomotic stenosis (4.0% vs. 16.0%) and no cases of reflux oesophagitis (0% vs. 8.0%). Both groups achieved similar post-operative nutritional outcomes, lower oesophageal sphincter pressures, and health-related quality of life scores. CONCLUSIONS:UDOS offers a technically more efficient alternative to Kamikawa anastomosis with equivalent perioperative safety and potential benefits for reducing long-term complications, meriting further investigation.
BACKGROUND:Autonomous Robotic Ultrasound Systems (ARUS) enable standardized breast cancer screening, but accurate breast localization and the nonlinear deformation of soft tissue hinder stable contact-force control. METHODS:We propose a framework integrating visual perception with compliant control. An adaptive gradient-based edge detector extracts the nipple position, and a Variable Damping Admittance Control based on a Breast Biomechanical Model (VDAC-BBM) is developed, which compensates for tissue deformation via a biomechanical prior and dynamically tunes the damping parameter in real time to suppress force error. RESULTS:Phantom and human experiments showed force tracking error ≤ 0.4 N, with disturbance recovery speed improved by 16.5%-21.3% over conventional admittance control across the tested target forces. CONCLUSION:Embedding a biomechanical prior into the control strategy enhances force compliance and stability during robotic scanning of deformable soft tissue, providing a technical basis for clinical translation.
BACKGROUND:Most reported experience with robotic kidney transplant (RKT) has been limited to right-sided graft implantation, with left-sided implantation considered technically challenging. METHODS:We retrospectively reviewed consecutive left-sided RKTs at two transplant centres (01/2023-02/2026). A standardized operative technique with an accompanying surgical video is presented, and perioperative and postoperative outcomes are analysed. RESULTS:Seventeen patients underwent left-sided RKT. Fifteen were for retransplants, and two were for contraindications to right-sided implantation. Median warm ischaemia time was 37 min, operative time 229 min, and length of stay 4 days. No conversions to open surgery, intraoperative complications, or major postoperative complications occurred. Delayed graft function developed in five patients. At a median follow-up of 12.1 months, all patients were alive with functioning grafts. CONCLUSIONS:RKT with left-sided graft implantation is technically feasible and safe in experienced robotic transplant centres and was associated with favourable short-term outcomes.
INTRODUCTION:This study evaluates clinical and health-related-quality-of-life (HRQOL) outcomes following robotic choledochal cyst (CDC) excision with intracorporeal Roux-en-Y hepaticojejunostomy. METHOD:Prospectively maintained data from 17 consecutive patients undergoing robotic CDC excision with the da Vinci Xi system (January 2017-October 2024) were retrospectively analysed. RESULTS:Fifteen patients were female; median age was 22 year. Cyst types included Ia(6), Ic(3), IVa(5), II(1), and VIb(2). Median operative time was 360 min, blood loss 50 mL, and hospital stay 4 days. Postoperative complications occurred in three patients, including one clinically-relevant grade-B postoperative-pancreatic-fistula requiring image-guided drainage (Clavien-Dindo IIIa), one biochemical POPF, and one episode of mild acute-pancreatitis. At a median follow-up of 36.5-month (IQR 35-43), no anastomotic strictures, malignancy, or biliary complications were noted. At 12-month, the median Gastrointestinal-Quality-of-Life-Index (GIQLI) score was 135 (IQR 133.5-136). CONCLUSION:Robotic CDC excision with intracorporeal reconstruction appears feasible and safe in selected patients, with favourable perioperative and functional outcomes.
BACKGROUND:Teleoperated flexible bronchoscopy lacks distal haptic feedback, increasing the risk of unobservable iatrogenic tissue trauma during endoluminal exploration. METHODS:This study proposes a robot-assisted bronchoscopy system integrated with a dual-modal safety framework. A visual module utilises image moments to provide predictive alerts for collision avoidance. Concurrently, a Transformer-based network estimates distal interaction torques from proximal actuation, enabling real-time haptic perception at the leader console. RESULTS:Phantom validations across fragile tissue rupture, sidewall approximation, and luminal exploration tasks demonstrated the framework's efficacy. The visual warnings helped decrease excessive force contacts, while the learning-based estimator delivered reliable distal force perception. CONCLUSIONS:The proposed dual-modal teleoperated safety architecture resolves the trade-off between operational dexterity and safety in flexible bronchoscopy. By integrating predictive visual warnings and real-time haptic feedback, the system improves the operator's situational awareness, decreasing the risk of iatrogenic trauma during the operation.
BACKGROUND:Robotic systems may facilitate the double-flap technique (DFT) after proximal gastrectomy (PG), yet the superiority of robotic DFT following PG (RPG-DFT) over laparoscopic PG with DFT (LPG-DFT) remains unclear. METHODS:Seventy-three gastric cancer patients (28 RPG-DFT, 45 LPG-DFT) were compared for baseline characteristics, perioperative outcomes, and 3-month postoperative data. Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and weight loss are postoperative primary endpoints. RESULTS:RPG-DFT had significantly longer operative time (308.3 vs. 204.5 min, p < 0.0001) but shorter postoperative hospital stay (6.21 vs. 8.13 days, p < 0.0001). By postoperative day 3, RPG-DFT showed faster decline in inflammatory markers (NLR, PLR, MLR, SII). No significant differences were observed in reflux symptoms or anastomotic stenosis rates. CONCLUSION:Compared to LPG-DFT, RPG-DFT facilitates accelerated patient recovery, as evidenced by a rapid decline in inflammatory markers and reduced length of hospital stay.
BACKGROUND:Soft robots utilised for intestinal diagnosis and therapy use, compliant materials and novel actuation were employed to address the limitations of rigid endoscopic tools. METHODS:This paper systematically reviewed the literature (2000-present) on robotic systems explicitly developed for intestinal applications, organising findings across actuation, materials, fabrication and clinical use. Ethical approval: Not applicable because this study is a literature review and involved no human participants or animal experiments. RESULTS:Fluidic, shape-memory alloy, electroactive polymer and magnetic actuation strategies were classified and compared by operating principles, advantages and limitations. Common material platforms (e.g., silicones and hydrogels) were analysed for flexibility, biocompatibility, responsiveness and fabrication methods (casting, 3D printing and shape deposition manufacturing) and were assessed for producing functional, complex structures. Applications clustered around examination, targeted drug delivery and minimally invasive interventions, with designs grouped by function and morphology. CONCLUSIONS:Intestinal constraints (peristalsis, variable lumen geometry and biosafety) remain key barriers; interdisciplinary integration is central to clinical translation.
OBJECTIVE:To evaluate the feasibility of hyperaccuracy three-dimensional (HA3D) virtual models with augmented reality (AR) in robot-assisted retroperitoneal lymph node dissection (R-RPLND) for testicular cancer. METHODS:A 35-year-old male with 4 cm interaortocaval seminoma recurrence underwent unilateral template R-RPLND. A patient-specific HA3D model was generated from contrast-enhanced CT using Avatar Medical software and integrated into preoperative planning and intraoperative AR navigation. RESULTS:HA3D modeling enabled precise preoperative identification of a critical renal arterial branch adjacent to the tumor, facilitating safe dissection. R-RPLND was completed in 76 min with minimal blood loss (30 mL) and no complications. Pathology confirmed 4.5 cm viable seminoma metastasis. Nine-month follow-up showed no recurrence. CONCLUSION:This proof-of-concept case demonstrates successful integration of HA3D virtual models and AR into R-RPLND workflow, potentially enhancing anatomical visualization, surgical planning, and procedural safety. Multicenter prospective studies are needed to validate reproducibility and clinical benefit.
