Robotic breast surgery encompasses oncologic resection and cancer-related reconstruction, but the development and structure of this literature remain incompletely characterized. This study mapped publication growth, citation relationships, thematic evolution, and collaboration patterns in the field. Web of Science Core Collection, Scopus, and PubMed were searched through 1 August 2026. After merging, deduplication, and metadata assessment, two reviewers independently screened 769 records; 210 publications from 2012 to 2026 were included. Bibliometric performance indicators, citation and co-citation analysis, bibliographic coupling, keyword mapping, thematic evolution, and collaboration networks were examined. The corpus comprised 755 authors and 81 sources, with an annual growth rate of 24.5
To evaluate the learning curve and perioperative outcomes of four-port assistant-independent robot-assisted total laparoscopic hysterectomy (RA-TLH) according to surgeon experience and retrieved tissue weight. Between July 2020 and October 2025, 486 RA-TLH procedures were performed. One case with a retrieved tissue weight of 7,141 g was excluded as the only case exceeding 3,000 g. The remaining 485 cases were classified into five groups according to retrieved tissue weight: <250 g, 250–<500 g, 500–<750 g, 750–<1,000 g, and 1,000–<3,000 g. Learning curves were evaluated using cumulative sum analysis of console time. Four novice surgeons demonstrated biphasic learning curves, with inflection points at the 15th, 17th, 18th, and 37th cases. For retrieved tissue weights < 500 g, console time was significantly longer during the first 20 cases than during cases 21–40, with no significant difference thereafter. For cases ≥ 500 g, console time did not differ significantly among experience groups. However, heavier cases were preferentially assigned to experienced surgeons. In this single-center experience, novice surgeons demonstrated learning-curve inflection points between 15 and 37 cases. For cases < 500 g, console time decreased significantly after approximately 20 cases. Four-port assistant-independent RA-TLH was feasible in selected patients with very large uteri, including those with retrieved tissue weights 1,000-<3000 g, when performed by experienced robotic surgeons. These findings should be interpreted in light of selective case allocation and the retrospective single-center design.
As robotic surgery expands beyond the da Vinci platform, the relevance of new-generation systems to pediatric patients remains uncertain. This review examined the technical characteristics, applications, and perioperative outcomes of alternative multiport robotic platforms in children. PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library were searched through 28 February 2026 in accordance with PRISMA 2020. Owing to clinical heterogeneity, findings were synthesized narratively, with Wilson 95
Robot-assisted abdominopelvic surgery often combines carbon dioxide pneumoperitoneum with steep Trendelenburg positioning. Together, these exposures can alter arterial inflow, venous outflow, intracranial downstream pressure, and systemic hemodynamics. We conducted a structured search of PubMed, Embase, Web of Science Core Collection, and the Cochrane Library from inception through 24 August 2026 and used narrative synthesis to integrate direct human evidence from robotic surgery with indirect evidence from other clinical settings. Fifty-five eligible full-text reports, representing 48 independent studies, were included. The direct evidence consisted mainly of small studies of robot-assisted laparoscopic radical prostatectomy. Pneumoperitoneum may increase systemic vascular resistance, so mean arterial pressure can remain stable or rise even while cardiac output and cerebral blood flow fall. Head-down tilt, higher thoracoabdominal pressure, and impaired jugular drainage may also increase central venous and intracranial pressure, reducing effective cerebral perfusion pressure. Near-infrared spectroscopy, optic nerve sheath diameter, mean velocity index, cerebral oximetry index, and direct flow measurements interrogate different parts of this physiology. When downstream pressure changes over time, a low or negative autoregulation index cannot exclude restricted cerebral perfusion. No evidence shows that raising mean arterial pressure alone or targeting a specific autoregulation threshold improves neurocognitive outcomes. Perioperative management should integrate brain-level arterial pressure, cardiac output, carbon dioxide, and venous drainage while addressing modifiable surgical factors. Future studies should standardize operative exposure, synchronize arterial and venous measurements, and use consistent neurocognitive outcomes.
To compare conversion to open surgery after intended robotic versus laparoscopic colorectal cancer resection in routine multicentre practice. This secondary post hoc analysis of the retrospective ATOCCS cohort included elective, curative-intent resections performed during 2022–2024 at Italian centres using both approaches. Propensity-score overlap weighting with centre indicators and multiple imputation addressed measured confounding and missing covariates. Centre-clustered models estimated adjusted risks, risk differences, and risk ratios. The primary cohort comprised 2,284 patients at 23 centres (1,408 laparoscopic; 876 robotic); conversion was evaluable in 2,278. Conversion occurred in 108/1,403 (7.7
Robot-assisted endoscopic submucosal dissection (ESD) represents a small but growing interdisciplinary field integrating gastrointestinal endoscopy and robotics. This study characterized publication patterns, collaboration networks, citation structures, research hotspots, and thematic evolution within a predefined bibliometric corpus. English-language Articles and Reviews published from January 1, 2000, to June 1, 2026, were retrieved from the Web of Science Core Collection (WoSCC) and screened according to predefined criteria. Flexible intraluminal robotic systems used for colorectal ESD were additionally verified. After standardized data cleaning and harmonization, bibliometric analyses and scientific knowledge mapping were performed using Bibliometrix/Biblioshiny, VOSviewer, and SCImago Graphica. Seventy-nine publications published between 2010 and 2026 were included, covering 50 journals, 344 authors, 93 institutions, and 15 countries or regions. Publication output increased after 2019. China showed the highest research participation and collaboration-network connectivity, whereas Singapore had the highest average citations per publication. Co-authorship analysis identified several closely connected author and institutional clusters, interpreted as network connectivity rather than evidence of sustained collaboration. Author keyword analysis, based on 62 publications with Author Keywords, showed temporal shifts toward traction, flexible endoscopy, continuum robots, flexible instruments, and motion and force control. Overall, these findings describe the bibliometric landscape of the WoSCC-derived literature. Further technical and clinical studies are needed to clarify the safety, effectiveness, and translational value of different robotic approaches.
Robot-assisted percutaneous vascular intervention (R-PVI) has expanded beyond coronary procedures, but previous reviews were largely coronary-focused and observational. Recent randomized controlled trials (RCTs) warrant broader reassessment of R-PVI versus manual percutaneous vascular intervention (M-PVI) across vascular territories. PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from database inception to January 31, 2026, following PRISMA guidelines. RCTs and observational studies including ≥10 adult patients in total were eligible. Comparative studies informed primary analyses, while single-arm studies provided supportive evidence. Primary outcomes were clinical success rate and major adverse cardiovascular/cerebrovascular events (MACE) rate. Secondary outcomes included mortality rate, technical success rate, procedural time metrics, contrast volume, and radiation exposure. Random-effects models were used. Forty studies were included: 3 RCTs, 10 comparative observational studies, and 27 single-arm observational studies, comprising 3,870 patients undergoing R-PVI and 1,142 undergoing M-PVI. Comparative analyses showed similar clinical success rates (RR 1.00, P = 0.46), MACE rates (RR 0.72, P = 0.43), and mortality. Single-arm pooled estimates for clinical and technical success were 98.76
The necessity of routine parenchymal renorrhaphy during off-clamp robot-assisted partial nephrectomy (RAPN) remains uncertain. This study aimed to compare perioperative, functional, safety, and oncological outcomes between sutureless and conventional renorrhaphy. We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Comparative studies evaluating sutureless versus conventional renorrhaphy during purely off-clamp RAPN were included. Trifecta achievement was the primary outcome. Random-effects models were used for pooled analyses, with subgroup analysis according to study design. Four studies involving 787 patients, including one randomized controlled trial (RCT) and three propensity score-matched (PSM) studies, were included. The overall pooled estimate showed no statistically significant difference in Trifecta achievement (RR 1.17, 95
Literature on learning and training in robotic transplantation spans multiple procedures, but its evidence base is strongly kidney-dominant and direct bibliometric findings need to be distinguished from clinical interpretation. We aimed to map the bibliometric development of literature explicitly addressing learning, proficiency, experience, and training in robotic transplantation and, secondarily, to interpret the clinical meaning of the mapped evidence across transplant procedures. The Web of Science Core Collection (WoSCC) was searched through August 11, 2026 using a predefined strategy that intersected robotic transplant or donor procedures with learning-related terms. English-language Articles and Review Articles were analyzed with R/Bibliometrix-Biblioshiny and CiteSpace 6.4.R1. Bibliometric findings were interpreted using an author-derived four-domain framework covering technical acquisition, procedural efficiency, clinical stabilization, and program-level implementation/transfer; this framework was not treated as a bibliometrically derived or validated proficiency model. Of 284 retrieved records, 167 publications were included after document-type and language screening. The corpus spanned 2002–2026, 61 sources, 908 authors, and 2,975 cited references; annual growth was 14.35
To characterize applications of artificial intelligence (AI) in robot-assisted surgery, summarize technical and clinical performance, and assess the quality of the available evidence. PubMed, Web of Science Core Collection, and Scopus were searched for English-language journal articles published from 1 January 2020 through 31 October 2025. Randomized, observational, model-development, validation, and feasibility studies evaluating AI in robot-assisted surgery or closely related image-guided minimally invasive workflows were eligible. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Owing to heterogeneity in surgical procedures, AI tasks, analytical units, validation strategies, and outcomes, findings were synthesized descriptively without statistical pooling. The review was registered in the International Prospective Register of Systematic Reviews (CRD420251175699). Seventeen studies were included: seven clinical prediction or decision-support studies, eight intraoperative recognition, segmentation, or image-guided studies, and two training or workflow studies. Five prediction studies reported area-under-the-curve values of 0.74–0.95. Technical studies reported F1 or Dice scores of 0.525–0.995 and task-specific accuracies of 0.840–0.998. Two randomized studies suggested benefits for personalized suturing feedback and automated camera control, but neither established improved patient outcomes. Only one study had low overall risk of bias; the remaining studies were at high or unclear risk or raised some concerns. AI applications in robot-assisted surgery show promise for prediction, intraoperative perception, training, and workflow support. Evidence primarily demonstrates technical feasibility rather than established clinical effectiveness. Independent multicenter validation and prospective evaluation of patient, educational, and workflow outcomes are required before widespread implementation.
Hybrid robotic transversus abdominis release (hrTAR) combines robotic posterior component separation with a planned limited open phase. Evidence supporting this strategy is sparse. Following PRISMA 2020, we searched PubMed, Embase, Scopus, and the Cochrane Library and registered the protocol in PROSPERO (CRD420261303285). Eligible studies reported hrTAR outcomes for ventral or incisional hernia repair. Findings were synthesized narratively; no pooled effect estimates were calculated. Three reports contained 85 hrTAR cohort entries. Because two reports came from the same institution and overlap could not be excluded, this total should not be interpreted as a unique-patient count. Surgical-site outcomes were heterogeneous: two reports used SSO endpoints (4
To evaluate the feasibility, safety, and stability of a novel remote multimodal surgical platform that integrates a dual-arm robotic system with an intraoperative swept-source OCT surgical microscope system for subretinal injection in porcine eyes. Subretinal injection was performed in vivo in Bama miniature pigs (one eye per animal), with six animals assigned to robotic manipulation (RM) and six to manual manipulation (MM). Successful injection was defined as localized subretinal bleb formation confirmed by intraoperative OCT. Outcome measures included procedure time, injection time, first-attempt success rate, bleb morphology, intraoperative complications, postoperative OCT findings, needle-tip tremor amplitude, and histological changes. Subretinal injection was successful in all 12 eyes (100
Osteophyte excision during total knee arthroplasty (TKA) influences gap balancing and deformity correction, but its effect on medial gap behavior remains poorly defined. This study evaluated the relationship between osteophyte burden, medial expected gap (mEG), and coronal correction in robotic assisted functional alignment TKA. This prospective study included 82 knees. Preoperative computed tomography images were used to measure medial tibial and femoral osteophytes. Following pilot development, mEG was calculated using an average osteophyte burden model with a non-linear physiological constraint capped at < 4 mm. Virtual gap balancing intentionally preserved the calculated mEG as medial tightness within predefined functional-alignment boundaries. Associations between osteophyte burden, mEG, coronal plane correction, and final knee balance were analyzed using correlation, regression, and group comparison statistics with bootstrap resampling for internal model validation. Raw medial osteophyte size demonstrated no significant association with lateral laxity severity (p = 0.357) or varus correctability (p = 0.302). Medial tibial (β = 0.12; p < 0.001) and medial femoral osteophytes (β = 0.16; p < 0.001) independently predicted mEG (R² = 0.47). Total osteophyte burden increased significantly across ascending mEG categories (p < 0.001), while final mEG values remained within a narrow physiological range. Mean coronal plane correction increased from 4.3° (mEG 1 mm) to 9.7° (mEG 4 mm) (p < 0.001). All knees achieved acceptable balance: 42 best balanced, 32 good, and 8 acceptable. Bootstrap internal validation supported the stability of the principal regression findings. The mEG provides a quantitative framework linking osteophyte burden to medial gap behavior, enabling preoperative planning of medial tightness and reproducible coronal correction during robotic assisted functional alignment TKA. Level of evidence: Level II, prospective cohort study.
Position-related transient neurological symptoms (PTNS) may occur after robot-assisted thoracic surgery (RATS) because of prolonged lateral positioning and upper-limb fixation. Evidence on effective nursing strategies for preventing PTNS in this setting remains limited. This single-center prospective observational cohort study was conducted from May 2022 to April 2023 within a registered cohort of patients undergoing RATS lobectomy. Consecutive eligible patients received conventional positioning care during the earlier study period and bundled positioning care during the later period. The bundled protocol included standardized positioning, post-docking readjustment, targeted pressure relief, and scheduled intraoperative inspection. The primary outcome was definite PTNS at 24 h. Among 289 patients, definite PTNS occurred in 28 of 144 patients (19.4
Robotic-assisted surgery demands a high level of bimanual dexterity, spatial awareness, and fine motor control. Training in musical instruments, athletics, and video games can allow for a similar skillset. Prior studies report improved baseline performance on robotic simulators among individuals with such training, but comparative effects of specific subtypes of training remain unexplored. This study evaluates how musical instrument, athletic, and gaming experience are associated with robotic simulator performance and short-term change in performance among medical students. 23 medical student volunteers with no prior robotic training completed two sessions using the da Vinci® Skills Simulator evaluating basic system control and suturing. The sessions were performed one week apart to assess short-term change in performance. Each student completed a questionnaire evaluating their prior fine motor skills training including experience with musical instruments, athletics, and video gaming. Baseline suturing scores were significantly higher in participants with video game experience (p = 0.015, d = 1.18, 95
Robotic-assisted arthroplasty is increasingly performed using technically distinct platforms. The types of device problems reported for different robotic arthroplasty platforms have not been characterised using Australian national surveillance data. The TGA Database of Adverse Event Notifications (DAEN) was searched for robotic arthroplasty adverse events reported between July 2012 and December 2025. Failure modes were extracted from the DAEN classification, and qualitative review of event narratives was performed independently by two authors. One hundred and forty reports were identified across five platforms: ROSA Recon (n = 46, 32.9
Robot-assisted surgery has been increasingly used in pediatric thoracic surgery. This study aimed to assess the safety and feasibility of robot-assisted thoracoscopic surgery (RATS) when applied to mediastinal tumor resection in pediatric patients. This retrospective study included pediatric individuals who underwent robot-assisted thoracoscopic resection of mediastinal lesions at our institution between April 2020 and December 2025, and their clinical records were fully analyzed. We analyzed key indicators, including operation duration, intraoperative hemorrhage, postoperative length of stay, chest tube drainage time, surgical complications and long-term follow-up results. The study cohort comprised 168 children (88 males, 80 females) with a median age of 74 (IQR 45–114) months, a weight of 21.0 (IQR 15.0–31.8) kg, and a median tumor diameter of 4.6 (IQR 3.1–6.3) cm. The median operative time was 94.5 (IQR 73.0–124.8) minutes, with an estimated blood loss of 5.0 (IQR 2.0–8.0) mL. Two patients (1.2
Core temperature is central to perioperative hypothermia (PH) prevention, but normothermia may not ensure thermal comfort. We examined temperature–comfort discordance, quantified PH burden, and developed an expert-informed management framework for robotic urologic surgery. This sequential multimethod study comprised three complementary stages. Stage I examined paired temperature–Cold Discomfort Scale states across four post-anesthesia care unit assessments in an 80-patient nonconcurrent controlled cohort. Stage II characterized PH burden and associated factors at 10 peri-anesthetic time points in an independent retrospective cohort of 1,214 patients. Stage III used two-round multidisciplinary consultation with 21 experts to develop the framework. Persistent normothermia–cold-discomfort discordance occurred in 38/40 control-period patients (95.0
Precise localization of the entry point is essential in unilateral biportal endoscopic (UBE) spine surgery. While the standard pedicle projection method (P-UBE) is simple, it depends substantially on surgeon experience and real-time fluoroscopy. Robot-assisted localization (r-UBE) has been developed to facilitate more reliable guidance in UBE. However, its clinical value in this context remains underexplored. This study assesses the trade-offs between the two techniques, focusing on fluoroscopy requirements, operative efficiency, and an exploratory learning-curve characterization for robotic localization. This retrospective, non-randomized, single-center cohort study included 86 consecutive patients who underwent single-level UBE for lumbar spinal stenosis or disc herniation. Group allocation was based on surgeon preference and availability of the robotic system, resulting in 32 patients in the r-UBE group (using the TiRobot system) and 54 in the P-UBE group (using conventional fluoroscopic landmarks). Primary outcomes were fluoroscopy frequency, number of localization adjustments, and localization confirmation time. Secondary outcomes included total operative time, clinical scores (VAS, ODI, MacNab), and an exploratory nonlinear learning-curve analysis for the r-UBE group. The r-UBE group was associated with a lower fluoroscopy frequency (2.1 ± 1.3 vs. 4.4 ± 1.8; mean difference − 2.3, 95
Robotic-assisted surgery (RAS) is increasingly used across surgical specialities. Despite global advancements, its integration in the Middle East remains limited. Patient awareness and perceptions may influence its acceptance and implementation. This study assessed awareness, perceptions, and acceptance of RAS among surgical patients at a tertiary hospital in Amman, Jordan, and assessed factors associated with preference for RAS and awareness of its availability. A cross-sectional study was conducted between November and December 2024 among patients attending outpatient surgical clinics at a tertiary hospital in Amman, Jordan. Participants completed a structured questionnaire assessing knowledge, attitudes, perceptions and future expectations toward RAS. Multinomial logistic regression was used to assess factors associated with preference for RAS and awareness of its availability in Jordan. Of 700 participants, 58.6
