The portal vein (PV), the main vessel that supplies up to 75%–80% of liver blood flow, has long been considered a structure with relatively constant anatomy. Anatomical variants of the PV should be considered important parameters critical to the success of any surgical intervention in the hepatobiliary system. The “standard” anatomy is not present in all patients, with the variant frequency reaching 37%. The most clinically significant variants include main trunk trifurcation, early origin of the right posterior branch, absence of main trunk bifurcation, and origin of right segmental branches from the left PV branch. Anatomical variants not recognized at the preoperative stage increase the risk of massive bleeding, ischemic damage to remaining segments, and iatrogenic bile duct injury. The use of three-dimensional modeling and artificial intelligence allows the minimization of these risks and the transition to personalized surgery. Precise preoperative knowledge of the individual structure of the portal venous system has become an integral component of ensuring surgical safety. Careful consideration of PV anatomy features allows the development of personalized surgical approaches, which are key to successful treatment outcomes in modern high-tech medicine.
Objective The safety and efficacy of robot-assisted colorectal surgery following self-expandable metal stent (SEMS) placement for obstructive colorectal cancer with double-stapling anastomosis remain unclear. This study aimed to compare the short-term outcomes of robot-assisted and laparoscopic surgery in this setting. Methods This single-center retrospective study included patients who underwent minimally invasive surgery with double-stapling anastomosis for obstructive colorectal cancer between June 2018 and July 2025 at Ehime Prefectural Central Hospital, Japan. Patients were divided into robot-assisted surgery (RS) and laparoscopic surgery (LS) groups on the basis of the surgical approach. Short-term outcomes were compared using 1:1 propensity score matching. Results A total of 118 patients (RS, n = 31; LS, n = 87) were included in the study. After matching, 25 patients were included in each group. The operative time was significantly longer in the RS group before matching (246 min [IQR, 201–275 min] vs. 214 min [IQR, 170–255 min], p = 0.003) but was not significantly different after matching (245 min [IQR, 200–270 min] vs. 237 min [IQR, 173–271 min], p = 0.357). After matching, blood loss tended to be lower in the RS group (20 g [IQR, 0–20 g] vs. 50 g [IQR, 0–60 g], p = 0.057), while no significant differences were observed in conversion to laparotomy (0.0% vs. 4.0%, p = 1.000), postoperative length of stay (7 d vs. 8 d, p = 0.910), postoperative complications (12.0% vs. 12.0%, p = 1.000), anastomotic leakage (4.0% vs. 0.0%, p = 1.000), radial margin positivity (4.0% vs. 0.0%, p = 1.000), or 90-day mortality (0.0% vs. 0.0%, p = 1.000). The severity of Clavien–Dindo complications was similar between the groups after matching. Conclusion After propensity score matching, no statistically significant differences in short-term outcomes were observed between the RS and LS in patients with obstructive colorectal cancer who underwent double-stapling anastomosis after SEMS placement. These findings suggest that RS may be a feasible option after SEMS placement, although further studies with larger cohorts are needed.
Objective Pancreatic resection remains one of the most technically demanding abdominal surgery procedures and is associated with substantial perioperative morbidity and long-term mortality. Although minimally invasive pancreatic surgery has been increasingly adopted, its association with longer-term outcomes remains uncertain. This study aimed to develop and internally validate a machine learning model for predicting 1-year mortality after pancreatic resection and to use SHapley Additive exPlanations (SHAP) to explore the contribution of key clinical predictors. Methods This retrospective cohort study was based on the publicly available INSPIRE database. Adult patients who underwent pancreatic resection were included, and the primary outcome was all-cause mortality within 1 year after surgery. After preprocessing, least absolute shrinkage and selection operator (LASSO) regression with class balancing was used to select the most informative predictors. Nine machine learning algorithms were evaluated within a 5-fold cross-validation framework with a synthetic minority over-sampling technique (SMOTE) applied only to the training folds. Model discrimination was primarily assessed using the area under the receiver operating characteristic curve (AUC), while calibration was evaluated by the Brier score and calibration curve. Decision curve analysis (DCA) was used to assess potential clinical utility. The best-performing model was further interpreted using SHAP. Results A total of 414 patients were included, of whom 46 (11.1%) died within 1 year after surgery. LASSO identified 10 core predictors. Among the nine evaluated algorithms, the random forest model achieved the best overall discrimination, with an AUC of 0.722 (95% CI: 0.662–0.777). The model showed acceptable calibration with a Brier score of 0.120 and demonstrated favorable net benefit across a broad range of threshold probabilities in the DCA. SHAP analysis revealed surgical approach, lymphocyte count, and age as the most influential predictors. In the interpretation of the SHAP-based model, the laparoscopic approach appeared to be associated with lower predicted 1-year mortality, and this pattern seemed more pronounced among elderly patients (aged > 65 years). Conclusions This model showed acceptable performance for predicting 1-year mortality after pancreatic resection in the internal validation cohort, and an association between the laparoscopic approach and lower predicted mortality was detected, particularly among elderly patients. These findings may support individualized postoperative risk stratification and generate hypotheses for future prospective studies.
Objective More than 60,000 laparoscopic cholecystectomies are performed annually in the United Kingdom. Classically, on-table cholangiogram (OTC) has been used to visualise the biliary tree and assess common bile duct (CBD) stones. Increasingly, hospitals are adopting intraoperative ultrasound (IOUS) to assess the CBD for stones. This service evaluation aimed to compare the use of IOUS and OTC in the detection of gallstones in the CBD during cholecystectomy in a high-volume centre. Methods An observational cohort evaluation was performed at Portsmouth Hospitals University NHS Trust, United Kingdom, including all consecutive patients who underwent a cholecystectomy with intraoperative imaging of the CBD in 2023. Patients were assigned to the OTC or IOUS groups on the basis of the type of imaging technique used. Baseline characteristics and procedural data were collected. Whether retained stones were identified during follow-up, with at least 12 months of follow-up. Results A total of 1016 patients underwent a cholecystectomy at our centre. And 511 of these patients (50.3%) had intraoperative bile duct imaging with either OTC (n = 333) or IOUS (n = 178). Overall, the duration of surgery was longer in the OTC group than in the IOUS group (87.3 ± 43.0 min vs. 74.7 ± 33.0 min, p < 0.001). The complication rates were similar in both groups (3.9% vs. 7.3%, p = 0.146). Following OTC, 255 (76.6%) patients were deemed to have a clear CBD, and 6 patients presented with retained stones. Another 3 patients presented with retained stones after undergoing CBD exploration in the same procedure, where the CBD was deemed clear at the end of the procedure. OTC demonstrated an estimated sensitivity of 96.2% and a specificity of 97.6%. Following the IOUS, 149 (83.7%) patients were deemed to have a clear CBD, and 5 patients presented with retained stones. IOUS demonstrated an estimated sensitivity of 100% and a specificity of 96.6%. Conclusion No differences were detected between OTC and IOUS with regards to complications, sensitivity, or specificity in the assessment of the CBD. IOUS was generally faster to apply and requires fewer resources. In cases of unclear biliary anatomy or equivocal intraoperative findings, the IOUS and OTC may be used as complementary imaging modalities to aid in intraoperative decision-making.
Objective Postoperative risk stratification in esophageal squamous cell carcinoma (ESCC) remains largely dependent on clinicopathologic stage. Biologically interpretable models derived from public transcriptomic data may refine postoperative surveillance and risk communication after esophagectomy. This study aims to develop and internally validate a biologically interpretable Hallmark pathway-derived risk score for overall survival stratification in patients with ESCC. Methods This retrospective computational study analyzed publicly available cases from the Cancer Genome Atlas esophageal carcinoma project (TCGA-ESCA) restricted to ESCC. Data retrieval for the analytic files was completed on April 29, 2026. Primary tumor messenger RNA (mRNA) expression data and clinical survival information were integrated. Gene-level expression values were transformed into Hallmark pathway scores using within-cohort standardized gene expression. Survival-associated pathways were screened by univariable Cox regression. The three pathways with the strongest univariable survival signals were entered into a penalized Cox model to generate a continuous pathway-derived risk score. Internal validation was performed using 5-fold cross-validation. Prognostic value was evaluated by Kaplan–Meier analysis, Cox regression, clinical-model comparison, and prespecified subgroup analyses. Results Ninety-five TCGA-ESCC patients with available survival data were included. The final model included the reactive oxygen species pathway, UV response up, and p53 pathway. The 5-fold cross-validated concordance index was 0.687 (95% CI, 0.516–0.833). Using the median risk score as an exploratory visualization threshold, 48 patients were classified as high risk and 47 as low risk, with significant survival separation (log-rank p < 0.001). Univariable analysis revealed that the pathway-derived risk score was associated with overall survival (HR, 3.29; 95% CI, 1.53–7.04; p = 0.002) and remained an independent prognostic factor after adjustment for age, sex, pathological T stage, and nodal status (HR, 3.80; 95% CI, 1.46–9.90; p = 0.006). Adding the risk score to a clinicopathologic model improved the concordance from 0.710 to 0.762 and reduced the partial Akaike information criterion from 209.40 to 203.94. Conclusion A three-pathway Hallmark-based score provided internally validated and biologically interpretable prognostic stratification in the TCGA-ESCC. The score remains exploratory, and external validation is necessary before clinical translation or threshold-based use.
Objective Revisional bariatric surgery (RBS) constitutes up to 15% of all bariatric procedures, with Roux-en-Y gastric bypass (RYGB) being commonly performed as a conversion procedure after adjustable gastric banding (AGB), vertical sleeve gastrectomy (VSG), or vertical banded gastroplasty (VBG), and VSG being frequently performed as a conversion procedure after AGB or VBG. The optimal surgical approach—laparoscopic versus robotic—remains debated. This study aimed to compare laparoscopic and robotic conversion approaches for RBS. Methods A retrospective case–control study was conducted that included patients who underwent conversion procedures between January 2013 and December 2023 at two centers in Switzerland. Patients were matched on the basis of their index (AGB or stapled procedures) and revisional surgery (RYGB or VSG). The outcomes included early postoperative complications, intensive care unit admissions, operative times, and lengths of hospital stay. Results A total of 59 conversion procedures were performed, with 46 patients included after matching for revisional and index procedures: 23 in the robotic group and 23 in the laparoscopic group. The baseline characteristics of the patients in both groups were not significantly different. The operative time was significantly shorter in the laparoscopic group (160.7 ± 55.1 min vs. 234.9 ± 61.4 min, p = 0.001). The overall early postoperative complication rates were similar between the groups (13.0% in the laparoscopic group vs. 17.4% in the robotic group, p = 0.681). Although numerically greater in the laparoscopic group, no statistically significant difference was observed between groups regarding major postoperative complications (13.0% vs. 0.0%, p = 0.073). All three patients with complications in the laparoscopic group required multiple reoperations, but none of the patients in the robotic surgery group required reoperation (13.0% vs. 0.0%, p = 0.073). Conclusion Although major complications and reoperations were numerically less frequent in the robotic group, this potential benefit must be balanced against the significantly longer operative time associated with the robotic approach. Larger studies are needed to clarify whether the numerical differences observed reflect a true clinical effect.
Objective Minimally invasive liver resection (MILR) is a common surgical treatment for hepatocellular carcinoma (HCC). However, the current difficulty scoring system for MILR is limited to small samples or a single center, and a scoring system to assess surgery only for HCC is rare. Thus, we developed and validated a novel difficulty prediction system based on data from multiple centers to assess the surgical difficulty of MILR for treating HCC. Methods This retrospective multicenter cohort study included patients who underwent MILR for resectable HCC between June 2011 and November 2022 at eight minimally invasive surgical centers in China. The cohort was randomly divided into a training dataset and a validation dataset at a 3:1 ratio. Univerable and multivariable logistic regression analyses were performed on the training dataset to identify independent risk factors for surgical difficulty and construct a prediction model. The performance of the model was validated by the validation dataset, and its discriminative ability, calibration, and clinical effectiveness were assessed using receiver operating characteristic curves and decision curve analysis. Results This study included 776 patients, with 582 patients in the training cohort and 194 patients in the validation cohort. Cirrhosis (OR, 1.91; 95% CI, 1.12–2.64), maximum tumor diameter (OR, 1.4; 95% CI, 1.26–1.56), and surgical resection extent (grade B: OR, 11.92; 95% CI, 3.53–38.32; grade C: OR, 46.97; 95% CI, 9.31–228.18; grade D: OR, 32.85; 95% CI, 9.25–111.29) were identified as independent risk factors influencing the challenge of MILR for HCC. The AUC was 0.783 (95% CI, 0.746–0.820) for the training cohort and 0.717 (95% CI, 0.643–0.791) for the validation cohort. Decision curve analysis revealed that this clinical model has strong practicality. Conclusions This novel nomogram performed well in predicting the difficulty of MILR in treating HCC on the basis of Eastern data.
Objective Prostate cancer is a leading malignancy among men worldwide. Surgical management, including open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robot-assisted radical prostatectomy (RARP), remains a cornerstone for treating localized disease. This meta-analysis aimed to evaluate the clinical efficacy and cost-effectiveness of RARP compared with those of ORP and LRP. Methods A systematic search of the PubMed/MEDLINE, Embase, Cochrane, and Scopus databases was conducted up to March 2025. Random effects meta-analysis was used to calculate odds ratios (ORs) and mean differences with 95% confidence intervals (CIs). Meta-regression was used to explore the sources of heterogeneity. An expanded 20-year Markov model with probabilistic sensitivity analysis was used to assess cost-effectiveness using averaged multi-study inputs and meta-derived transition probabilities. Future costs and health outcomes (quality-adjusted life years, QALYs) were discounted at an annual rate of 3%. Results Forty studies were included (33 on clinical outcomes and 7 on cost-effectiveness). RARP was associated with significantly lower odds of urinary incontinence (vs. LRP: OR = 0.58, 95% CI: 0.53 to 0.63, p < 0.01; vs. ORP: OR = 0.68, 95% CI: 0.55 to 0.84, p < 0.01) and erectile dysfunction (vs. LRP: OR = 0.43, 95% CI: 0.33 to 0.55, p < 0.01; vs. ORP: OR = 0.74, 95% CI: 0.60 to 0.90, p < 0.01). In addition, RARP was associated with lower overall complications (OR = 0.70, 95% CI: 0.52 to 0.93, p = 0.01) than LRP, and lower biochemical recurrence (OR = 0.72, 95% CI: 0.57 to 0.92, p = 0.008) and lower all-cause mortality (OR = 0.52, 95% CI: 0.34 to 0.78, p = 0.002) than ORP. The 20-year Markov model yielded incremental cost-effectiveness ratios (ICERs) of US $16,547/QALY for RARP versus LRP and US $27,610/QALY versus ORP. Conclusion Compared with LRP and ORP, RARP clearly demonstrates clinical superiority in terms of functional recovery and oncologic control. With ICERs below commonly accepted high-income thresholds over a 20-year horizon, RARP may offer good value in resource-rich settings. However, ICERs exceed the willingness-to-pay thresholds of typical low- and middle-income countries, highlighting the need for cost-reduction strategies, targeted adoption in high-benefit subgroups, or the integration of emerging lower-cost robotic platforms to improve accessibility in low- and middle-income countries.
Objective To evaluate the overall and step-specific learning curves of extraperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) using the da Vinci SP system during the initial adoption phase. Methods This retrospective observational study included consecutive patients with localized prostate cancer who underwent extraperitoneal SP-RARP at Saitama Medical University International Medical Center between April 2025 and March 2026. All procedures were performed by a single surgeon. The operation was subdivided into nine predefined surgical steps. Learning curves were constructed using console time, step-specific operative time, and estimated blood loss. Cumulative sum analysis and segmented regression were used to identify breakpoints. Results A total of 31 consecutive patients were included. The median age was 72.8 y (IQR, 68.5–75.6 y), the median body mass index was 23.5 kg/m2 (IQR, 21.3–24.9 kg/m2), and the median prostate-specific antigen level was 10.6 ng/mL (IQR, 6.5–16.2 ng/mL). According to National Comprehensive Cancer Network criteria, 19 patients (61.3%) had biopsy grade group 4 or 5, and 19 (61.3%) had high- or very-high-risk disease. The median console time was 162 min (IQR, 153–184 min), with a breakpoint at approximately cases 16–17, whereas the estimated blood loss stabilized earlier at approximately cases 3–4. Step-specific analyses demonstrated heterogeneous maturation. Early stabilization was observed in the endopelvic fascia incision, dorsal venous complex control, and posterior reconstruction; intermediate stabilization in the vesicourethral anastomosis, anterior reconstruction, rectum-prostate dissection, and vas deferens/seminal vesicle dissection; and delayed stabilization in the development of the Retzius space. Bladder neck dissection showed no clear breakpoint. Conclusion Extraperitoneal SP-RARP improved progressively during the initial adoption phase, but technical maturation was not uniform across surgical steps. Step-specific analysis provided a more detailed understanding of procedural learning than overall operative metrics alone did.
Objective Robotic surgery offers distinct advantages for patients but introduces unique ergonomic demands that may contribute to musculoskeletal strain among surgeons. The purpose of this study was to evaluate the impact of ergonomic adjustments on postoperative musculoskeletal discomfort among robotic surgeons. Methods This quality improvement evaluation was conducted at Griffin Hospital, a medium-sized community hospital from May 2024 to January 2025. Participants completed a baseline ergonomics survey and subsequently participated in four control and four experimental observations. In the control condition, surgeons operated using their usual console setup. In the experimental condition, a standardized ergonomic intervention was applied. Postoperative discomfort across body regions was compared between control and ergonomic conditions using linear mixed-effects models, adjusting for preoperative discomfort and operative duration. Results Seven surgeons participated in this study. Robotic experience varied, with most surgeons (6, 85.7%) reporting 1–10 years of practice. In the routine console use, many reported musculoskeletal symptoms, particularly involving the neck (57.1%), shoulders (71.4%), and back (57.1%). Following ergonomic adjustments, surgeons reported significantly lower postoperative discomfort scores, including reductions in the shoulders (MD, 0.488; p < 0.001), back (MD, 0.862; p < 0.001), and hands/wrists (MD, 0.334; p = 0.014). Overall discomfort was significantly lower in the ergonomic condition than in the control condition (MD, 0.668; p < 0.001). Conclusion Musculoskeletal discomfort is prevalent among robotic surgeons and may be linked to modifiable ergonomic factors. These findings highlight the need for standardized ergonomic guidelines and the incorporation of ergonomic education into robotic surgery training.
Stump cholecystitis is an uncommon but clinically significant cause of post-cholecystectomy syndrome resulting from inflammation of a residual gallbladder remnant or cystic duct stump. Patients may present months to years after the initial operation with symptoms mimicking acute cholecystitis or biliary colic. Diagnosis is often delayed because of low clinical suspicion and variable imaging findings. This narrative review indicates that magnetic resonance cholangiopancreatography is considered the most useful modality for diagnosis, whereas endoscopic ultrasound and endoscopic retrograde cholangiopancreatography may assist in both diagnosis and treatment. Completion cholecystectomy remains the definitive treatment, although it can be technically challenging because of adhesions and distorted anatomy. Recent advances in laparoscopic/robotic techniques have facilitated minimally invasive completion cholecystectomy with favorable outcomes. Endoscopic approaches, such as cholangioscopy-guided lithotripsy or endoscopic ultrasound-guided drainage, have emerged as alternatives in selected high-risk patients. Early recognition and appropriate management are essential for preventing recurrent biliary complications.
Digital twin technology, which creates virtual replicas of physical entities that are continuously updated with real-time data, has emerged as a transformative innovation in healthcare. In surgical practice, digital twins offer unprecedented opportunities to enhance precision, personalisation, and patient outcomes through simulation, planning, and predictive analytics. This narrative review aims to examine the current applications of digital twin technology in surgical practice, evaluate its potential benefits and limitations, critically assess the maturity level of reported applications, and identify future directions for research and implementation. A comprehensive narrative review was conducted using the PubMed, Scopus, Web of Science, and IEEE Xplore databases. Publications from 2015 to 2025 were included, focusing on peer-reviewed articles, clinical trials, case studies, and technical reports describing digital twin applications in surgical contexts. Digital twin technology has demonstrated significant potential across multiple surgical domains, including preoperative planning, intraoperative guidance, postoperative monitoring, and surgical training. Its applications span cardiovascular, orthopaedic, neurological, and oncological surgeries. Evidence quality varies considerably across specialties, ranging from proof-of-concept to early clinical deployment, with orthopaedic surgery demonstrating the strongest current evidence base. Implementation faces challenges, including data integration, computational complexity, validation requirements, and regulatory considerations. Potential pathways forward include interoperability standards, reduced-order modelling, federated learning, and proactive regulatory engagement. Digital twin technology represents a paradigm shift in surgical practice, enabling personalised, data-driven approaches to patient care. While promising results have been reported, further research is needed to establish standardised protocols, validate clinical outcomes, and address technical and ethical challenges before widespread adoption.
Objective C-reactive protein (CRP) is a well-established biomarker of surgical stress and postoperative inflammation. This study aimed to compare the postoperative inflammatory response and recovery after colorectal cancer surgery via open, laparoscopic, or robotic approaches and to assess the predictive value of early CRP levels for complications and prolonged hospital stays. Methods A retrospective analysis was conducted on 291 patients who underwent elective colorectal cancer resection between January 2021 and July 2025 at Policlinico Umberto I, Italy. CRP values were measured on postoperative days (PODs) 1, 3, and 5. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to assess the accuracy of the CRP level in predicting postoperative complications and prolonged length of stay (LOS ≥7 days). Results Overall, 46 patients (15.8%) experienced complications. The complication rates were 21.1% after open surgery, 13.5% after laparoscopic surgery, and 15.2% after robotic surgery (p = 0.42). CRP levels decreased from POD 1 to POD 5 in open surgery and laparoscopic surgery groups, whereas in the robotic surgery group they increased from POD 1 to POD 3 and then decreased by POD 5; CRP levels differed among the approaches at POD 1, POD 3, and POD 5 (p < 0.05). The POD 1 CRP showed the best (yet modest) discrimination for complications (AUC 0.687), with high sensitivity (0.92) and low specificity (0.47), supporting its use primarily to rule out complications. The CRP values and dynamic indices (ΔCRP5-3 and ΔCRP5-1) showed limited accuracy, particularly for prolonged LOS (AUC ≤ 0.60). Conclusions Early postoperative CRP (POD1) may help identify patients at increased risk of postoperative complications after colorectal resection, although its discriminatory ability is modest. The high sensitivity and low specificity suggest a role in ruling out, rather than confirming, complications. Although the CRP level differed significantly among surgical approaches at PODs 1, 3, and 5, postoperative outcomes were comparable among the groups.
Objective Conventional total hip arthroplasty (cTHA) may be technically challenging in some scenarios. Robotic-assisted THA (rTHA) was introduced in the 1980s with an active ROBODOC system. Considering the miscellaneous drawbacks of this early system, more recent semi-active systems were subsequently introduced. The present meta-analysis aimed to compare the operative and clinical outcomes of rTHA assisted by semi-active systems with those of cTHA in randomized controlled trials (RCTs). Methods The present study was conducted in line with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 expanded statement. Three databases were searched for relevant studies (July 2025) in English, including PubMed, Web of Science Core Collection and Scopus. The outcome data included the operative time, amount of intraoperative and total blood loss, duration of hospital stay, number of patients in the Lewinnek or Callanan safe zones, postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, postoperative Harris hip score and leg length discrepancy (LLD). The risk of bias in the included studies was assessed via the risk of bias assessment tool. Results Eleven RCTs with 834 patients were included in this study. No significant differences were found between rTHA and cTHA regarding blood loss, hospital stay, WOMAC score or Harris hip score. While cTHA had a significantly shorter operative duration (MD: 22.12; 95% CI: 9.75, 34.48), rTHA was associated with a significantly greater frequency of patients in the Lewinnek (OR: 4.11; 95% CI: 2.04, 8.31) and Callanan (OR: 3.93; 95% CI: 1.15, 13.57) safe zones and a significantly lower LLD (SMD: -0.45; 95% CI: -0.60, -0.30). Conclusion Compared with cTHA, rTHA is a more accurate surgical technique with comparable blood loss, hospital stay and clinical scores.
Objective A “hostile male pelvis” describes unfavorable pelvic anatomy that impairs surgical access during robot-assisted radical prostatectomy (RARP). Key factors include narrow pelvic diameters and increased dorsal venous complex (DVC) volume. This research aims to define the “hostile male pelvis” with the aforementioned variables to identify individuals who would have an increased risk of positive surgical margins (PSMs) after RARP. Methods The population tested consisted of males who were diagnosed with organ-confined prostate cancer, irrespective of their Gleason score, who were eligible for radical surgical treatment, who underwent RARP at a single tertiary high-volume center (Ludwik Rydygier Collegium Medicum, Poland), and who were operated on by an experieced surgeon between March 2023 and March 2025. MRI-derived pelvic diameters—anatomic, robotic (RC), and diagonal conjugates—and DVC volume were assessed. The associations of these genes with PSM at the prostatic apex were analyzed. Results The study included 117 adult males. PSM occurred in 19.2% of the patients. RC provided high sensitivity (0.87), whereas DVC volume offered high specificity (0.76) for predicting PSM. At the estimated optimal cutoff point (RC: 9.95 cm, DVC: 15.65 cm3), the baseline PSM probability was 25.9%. A DVC volume >15.65 cm3 significantly increased the PSM risk (OR = 1.24, 95% CI: 1.05–1.52; p = 0.028), with each 1 cm3 increment increasing the OR by 24%. Conclusion RC and DVC volume may predict apical PSM, supporting their role in defining the “hostile male pelvis”.
