As a landmark technological breakthrough in 21st-century minimally invasive surgery, robotic surgical systems have been widely adopted for all types of hepatectomy. Difficult liver segments, including Couinaud segments I, IVa, VII and VIII, occupy deep anatomical spaces in immediate proximity to the hepatic veins and inferior vena cava. Conventional laparoscopic techniques suffer from limited working space and suboptimal surgical visualization, thereby substantially raising technical challenges and perioperative risks. Equipped with exclusive merits such as high-definition three-dimensional stereoscopic vision, multi-articulated bionic manipulators and sustained stable field retraction, robotic platforms effectively overcome the inherent limitations of conventional laparoscopy and deliver an innovative technical paradigm for minimally invasive resection of anatomically demanding hepatic segments. In the present study, we summarize the overall application status of robotic hepatectomy. Focusing on the definition and surgical hurdles of difficult hepatic segments, it integrates our institutional clinical experience with data from domestic and international comparative studies to objectively elaborate the core strengths and intrinsic limitations of robotic resection for these lesions. Furthermore, we delineate cutting-edge advances including robotic-specific difficulty scoring metrics, single-port robotic systems, remote robotic surgery and AI-assisted intraoperative navigation, in order to provide theoretical support and clinical references for standardized minimally invasive resection of anatomically intricate complex hepatic segments.
Robotic liver resection (RLR) has progressed beyond technical feasibility and now requires a clearer definition of its clinical value, appropriate indications, and pathway for wider adoption. Conventional laparoscopy remains efficient and reproducible for many low-complexity liver resections; however, robotics may provide added value in anatomically demanding settings, including posterosuperior lesions, deep parenchymal tumors, major vascular-adjacent resections, and selected major hepatectomies. In this Expert Perspective, we argue that the future development of RLR should be guided by procedural complexity, measurable value, and standardized implementation rather than by technological availability alone. The evaluation of RLR should extend beyond conventional perioperative outcomes to include economic value, manpower efficiency, surgeon sustainability, and integration with enhanced recovery after surgery pathways. Broader adoption requires structured training, stable robotic teams, standardized workflows, and auditable outcomes. Looking ahead, image-guided surgery, artificial intelligence-assisted decision-making, and surgeon-supervised autonomy may further support the transition toward robotic-centered minimally invasive liver surgery.
Robotic surgery has become an important component of minimally invasive colorectal cancer surgery. Compared with conventional laparoscopy, robotic platforms offer potential advantages in three-dimensional stable visualization, articulated instruments, precise manipulation, and surgeon ergonomics, and may be particularly useful in selected scenarios such as mid-low rectal cancer, narrow pelvis, obesity, post-neoadjuvant fibrosis, and complex pelvic procedures. However, robotic surgery should not be simply regarded as a universal replacement for laparoscopy. Its clinical value should be evaluated comprehensively in terms of patient benefit, indication selection, long-term oncological outcomes, functional recovery, learning curve, and cost-effectiveness. With the development of artificial intelligence, fluorescence imaging, three-dimensional reconstruction, and surgical data science, robotic platforms may evolve from minimally invasive surgical tools into digital interfaces for preoperative planning, intraoperative decision support, and postoperative quality assessment. This review article discusses the clinical positioning, ongoing controversies, intelligent development, and future application strategies of robotic-assisted colorectal cancer surgery, aiming to provide a reference for its standardized, precise, and sustainable use.
Postoperative hypoparathyroidism remains a common concern after thyroid surgery, with transient and permanent forms reported in approximately 19%–38% and 0%–3% of patients, respectively. Parathyroid protection therefore requires not only gland identification but also preservation of blood supply and postoperative function. Although near-infrared autofluorescence and indocyanine green angiography improve intraoperative visualization, their interpretation remains influenced by surgical exposure, device settings, background signals, and surgeon experience.With the growing availability of intraoperative images and surgical videos, deep learning and computer vision have been introduced into this field. Most available studies focus on structural tasks, including localization on autofluorescence images, detection or segmentation on white-light images, and video-based prompting during endoscopic surgery. These studies show that AI can improve the consistency and timing of parathyroid recognition in selected datasets. A smaller number of studies have attempted ICG-based perfusion analysis or ischemia-related warning. These applications are clinically attractive, but they should not yet be interpreted as validated functional preservation. In many studies, the reference standards are still based on expert annotation, ICG scoring, intraoperative visual assessment, or autotransplantation decisions rather than independent perfusion measurements or postoperative endocrine outcomes.This review summarizes current evidence on AI-assisted parathyroid protection in thyroid surgery, with particular attention to the gap between image-based recognition and preservation of postoperative function. At present, the strongest evidence remains at the level of structural recognition. Future work needs to test whether AI-assisted outputs can actually guide surgical decisions and whether they are associated with postoperative PTH recovery, serum calcium stability, calcium or vitamin D supplementation, and temporary or permanent hypoparathyroidism.
Benign biliary strictures (BBS) are ductal narrowings resulting from non-malignant causes, most commonly iatrogenic injuries during cholecystectomy, chronic pancreatitis, and other post-operative complications. While endoscopic and percutaneous interventions are the primary management strategy, surgical reconstruction remains the definitive treatment for refractory cases. This review synthesizes the current understanding of the etiology, diagnosis, and classification of BBS and evaluates the evolving landscape of its management, with a specific focus on the application of robotic surgery for complex biliary reconstruction.
Remote-controlled robot-assisted gynecological surgery is an innovative medical model integrating advanced communication technologies with robotic surgery systems. It promotes the equitable distribution of high-quality medical resources and responds to public health emergencies. This article, authored by domestic experts, aims to standardize clinical applications and enhance surgical quality and safety. It reviews the development of remote surgery, details the construction and technical requirements of remote-controlled robot-assisted gynecological surgery systems supported by 5G and other communication technologies, and emphasizes the importance of quality management. This includes equipment access, personnel qualifications, team collaboration, network communication and security, and health economics indicators. The article also offers recommendations for the access and training assessment of remote surgery. Additionally, it elaborates on the operating procedures of remote-controlled robot-assisted gynecological surgery, covering preoperative preparation, surgical steps, postoperative management, and the prevention and treatment of complications and fault response. Finally, it discusses the challenges in the development of this technology, including the iterative upgrading of robotic surgery systems, network security assurance, the realization of full-process remote medical services, and the implementation of remote surgery in special environments. These discussions aim to provide references for the promotion of remote-controlled robot-assisted gynecological surgery in China.
Objective To investigate the feasibility and technical points of a novel reconstruction technique following robotic-assisted proximal gastrectomy for gastric cancer, robotic-assisted proximal gastrectomy with anterior esophagogastrostomy combined with stent-supported Toupet fundoplication (RAFT Technique). Methods A patient diagnosed with esophagogastric junction (EGJ) adenocarcinoma (cT2N0M0) underwent da Vinci robot-assisted proximal gastrectomy. The reconstruction involved an anterior esophagogastric anastomosis combined with a Toupet fundoplication. Postoperative complications and quality of life were monitored and recorded. Results The procedure was completed successfully. The anastomosis was patent and tension-free, with an estimated intraoperative blood loss of 50 mL. To date, follow-up has revealed no complications such as anastomotic leakage, bleeding, stenosis, or reflux esophagitis, and no tumor recurrence has been observed. Conclusion The RAFT technique integrates the physiological advantages of anterior esophagogastrostomy with the antireflux efficacy of Toupet fundoplication, while maintaining procedural simplicity by requiring only a single primary anastomosis. Our initial experience confirms its safety and technical feasibility. Further clinical research is warranted to validate these findings.
Objective To investigate the clinical feasibility and safety of the domestic Jingfeng single-port robotic surgical systems in robot-assisted radical prostatectomy. Methods A retrospective analysis was conducted on the clinical data of 18 patients who underwent single-port robotic-assisted surgeries at the First Affiliated Hospital of Anhui Medical University from March 1 to May 31, 2025. The procedures included single-port robotic-assisted radical prostatectomy (SP-RARP) (n = 18). The preoperative patient's age, body mass index (BMI), prostate volume, preoperative prostate-specific antigen (PSA), Gleason score, operative time (OT), estimated blood loss (EBL), length of stay (LOS), and duration of catheterization were collected. Results All 18 patients with SP-RARP successfully completed the operations. The mean age was 67.6 ± 7.9 years, and the mean BMI was 22.76 ± 2.37 kg/m2. The median (interquartile range, IQR) preoperative PSA was 8.2 (6.6, 11.4) ng/mL, and the median (IQR) preoperative prostate volume on MRI was 31.3 (22.6, 37.5) cm3. Among the perioperative indicators, the mean OT was 136.83 ± 43.77 min; the median (IQR) EBL was 35.0 (15.0, 77.5) mL; the median (IQR) LOS was 4 (3, 4) days; and the median (IQR) duration of catheterization was 3 (3, 3) days. Only 4 of them used NSAIDs during hospitalization, accounting for 22.2%. The Clavien-Dindo grades of all patients were Grade Ⅰ. No positive postoperative pathologic margins were found in any patients. No conversion to open surgery or serious complications occurred during the perioperative period. Conclusion Domestic Jingfeng single-port robotic surgical system demonstrate good safety and efficacy in urology, but larger sample size, multicenter, randomized controlled clinical studies are still needed to further validate their effects.
Objective We evaluated the safety and feasibility of robot-assisted hepatectomy (RAH) by comparing its early outcomes at our institution with those of laparoscopic hepatectomy (LH). Methods Among minimally invasive hepatectomies performed at our institution between 2013 and 2025, 29 cases of RAH (January–September 2025) and 52 cases of LH (January 2013–September 2025) were retrospectively compared in terms of operative time, blood loss, postoperative hospital stay, and complications of Clavien–Dindo grade III or higher. Technical details and procedural innovations were described with representative cases. Results There were no significant differences in patient background characteristics between the two groups, except for the Iwate difficulty score, which was significantly higher in the RAH group. Blood loss, postoperative hospital stay, and the incidence of complications of grade III or higher were comparable between the groups. Operative time was significantly longer in the RAH group. Four representative cases were presented to illustrate the surgical techniques. In addition, a risk-adjusted CUSUM analysis of console time suggested an initial improvement in console efficiency, with transient upward shifts in selected cases. Conclusions Even in the early phase of RAH introduction, short-term outcomes equivalent to those of LH were achieved.
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) for the treatment of gynecologic diseases offers advantages such minimal invasiveness, low surgical complication rates, and faster postoperative recovery. It also achieves a true “scarless” cosmetic outcome and represents a key direction in the development of modern surgery. The latest generation of single-port (SP) surgical robots deploy one electronic endoscope and three robotic surgical instruments through a single mechanical port, allowing high-definition visualization, a wide range of motion and restoration of the surgical triangulation. These characteristics reduce surgical difficulty and improve precision. Single-port robotic-assisted vNOTES (RSP-vNOTES) allows surgeons to perform intricate surgical procedures within confined anatomical spaces, expands surgical indications, enhances surgical precision and outcomes, and instates a new era of minimally invasive gynecologic surgery.
Objective To standardize and promote the clinical application of pancreatic duct (repair) surgery for benign and borderline/low-grade malignant pancreatic tumors, improve surgical outcomes and reduce complications, the expert consensus was formulated. Methods Organized by the Minimally Invasive Surgery Committee and Intelligent Medicine Committee of the Chinese Research Hospital Association, domestic pancreatic surgery experts, based on literature evidence and clinical experience, discussed key topics including pancreatic duct anatomy, the concepts of pancreatic duct (repair) surgery, surgical indications, preoperative evaluation, intraoperative techniques, and postoperative management. Results The consensus describes the core techniques of pancreatic duct (repair) surgery, such as main pancreatic duct repair, end-to-end pancreatic anastomosis, main pancreatic duct replacement, and local resection of branch-duct intraductal papillary mucinous neoplasm (BD-IPMN). It emphasizes preoperative multimodal imaging assessment, intraoperative ultrasound guidance and minimally invasive approaches. Recommendations include the selection of repair strategies based on the severity of duct injury, the standardized use of pancreatic stents, and the prevention protocols for postoperative pancreatic fistula. Conclusion Pancreatic duct (repair) surgery restores the continuity of the pancreatic duct, avoids gastrointestinal reconstruction, and reduces postoperative complications. It represents a significant advancement in organ preservation pancreatic surgery. Further studies are needed to verify the long-term efficacy and refine the technical procedures.
Background: The integration of 5G technology into telerobotic surgery is expanding minimally invasive options in gynecologic oncology by enabling high-definition 3D visualization, precise articulation of instruments, and low-latency remote collaboration. This case report describes the use of a domestically developed Chinese surgical robotic system (Edge) to perform comprehensive endometrial cancer staging and shares insights regarding its technical implementation. Objective: To evaluate the feasibility and safety of 5G-supported, robot-assisted endometrial cancer staging surgery using a domestically developed robotic platform. Methods: On August 22, 2025, a remote robotic-assisted endometrial cancer staging procedure was successfully performed on a 63-year-old female patient through collaboration between Zhongnan Hospital of Wuhan University and Chinese PLA General Hospital, utilizing the domestically produced Edge surgical robot. Operative time, technical details, intraoperative blood loss, and postoperative recovery metrics were systematically documented and analyzed. Results: The procedure was completed successfully in 126 min with an estimated blood loss of 30 mL. No severe intraoperative or postoperative complications occurred. The 5G network supported real-time operation seamlessly, with a measured video latency of 19 ms and no subjective lag reported. Intraoperative frozen section analysis of four sentinel lymph nodes showed no evidence of metastasis. The patient followed an Enhanced Recovery After Surgery (ERAS) protocol, recovered favorably, and was discharged without incident. Final pathology confirmed G1 endometrial adenocarcinoma. The final pathological staging was FIGO Stage IA. Conclusion: This case demonstrates that a 5G-supported, domestically developed robotic system can safely and effectively facilitate precise pelvic dissection and lymph node evaluation during endometrial cancer staging surgery. The successful execution under real-time remote collaboration highlights the clinical feasibility of this approach. These results support the broader clinical adoption, while also underscoring the importance of optimizing 5G infrastructure, ensuring cybersecurity, and enhancing specialized team training to maximize the potential of telerobotic surgery in gynecologic oncology.
The integration of artificial intelligence (AI) into minimally invasive surgery (MIS) for endometriosis represents a transformative advancement in clinical practice, with the potential to improve preoperative diagnosis, intraoperative guidance, and postoperative outcomes. This review synthesizes recent literature to evaluate the applications of AI across various domains including imaging modalities, biomarker interpretation, and surgical navigation etc. The performance of machine learning (ML) and deep learning (DL) algorithms has been assessed. Notably, AI-augmented imaging techniques, in particular, significantly improved the detection of ovarian endometriomas, achieving an area under the curve (AUC) of up to 0.997, while deep endometriosis detection yielded AUC values of 0.800–0.878. Beyond diagnosis, AI demonstrates promise in enhancing surgical precision through real-time lesion recognition and identification of critical anatomical structures. Nevertheless, the development of fully or semi-automated surgical procedures is still in the conceptual validation stage and remains a long-term goal for future investigations. Current findings suggest that AI could substantially enhance both diagnostic and therapeutic outcomes in MIS for endometriosis, although most studies remain at proof-of-concept stages and challenges exist. Future research should prioritize multicenter prospective trials with external validation to ensure reproducibility and generalizability across diverse populations and clinical settings.
Objective To review the latest advancements in artificial intelligence (AI) applications for neurosurgery, focusing on innovations in diagnostic imaging, intraoperative assistance, predictive analytics, and postoperative care, while addressing challenges and future directions for clinical integration. Methods A comprehensive analysis of recent studies and technologies was conducted, including convolutional neural networks (CNNs), robotic-assisted systems, and AI-driven tools for imaging, surgical navigation, and predictive modeling. Key platforms such as Aidoc, Qure.ai, ROSA, and da Vinci were evaluated, alongside emerging approaches like federated learning and explainable AI (XAI). Results AI demonstrates transformative potential in neurosurgery, achieving up to 97.5% accuracy in tumor detection, 30% reduction in resection errors, and real-time molecular classification (e.g., DeepGlioma with >90% accuracy). Predictive analytics optimize personalized treatments, improving glioblastoma survival rates (24.3 vs. 17.5 months). AI-enhanced rehabilitation tools (e.g., VR/wearables) and simulation-based training further elevate outcomes. However, challenges persist, including data bias, algorithmic transparency, and ethical concerns. Discussion While AI significantly enhances precision, efficiency, and accessibility in neurosurgery, its "black box" nature and reliance on high-quality datasets limit widespread adoption. Collaborative efforts among clinicians, engineers, and policymakers are critical to address ethical, regulatory, and technical barriers. Conclusion AI is redefining neurosurgical practice through innovations in diagnostics, robotics, and personalized medicine. Future success hinges on overcoming data and interpretability challenges while ensuring equitable, responsible implementation.
Objective To examine the historical development of robotic pancreaticoduodenectomy (RPD) and evaluate its clinical applicability and future directions. Methods This review article synthesizes the evolution of robotic pancreaticoduodenectomy by reviewing key clinical studies and advancements in robotic technology, with a focus on the da Vinci system. Results Robotic pancreaticoduodenectomy has demonstrated clear advantages in precision, lymph node dissection, and postoperative recovery, although it remains associated with longer operative time and higher costs compared to open pancreaticoduodenectomy. Discussion The rapid technological advances in robotic surgery have transformed the landscape of pancreatic surgery, but challenges such as high costs, longer operation time, and the lack of haptic feedback remain significant. Emerging trends like AI integration and single-port surgery hold promise for future developments. Conclusion While RPD provides immediate clinical benefits in terms of recovery and complication rates, further studies on long-term oncologic outcomes and cost-effectiveness are necessary for a comprehensive understanding of its role in pancreatic surgery.
Objective To report a case of FIGO 2018 stage IVB PD-L1-positive cervical squamous cell carcinoma successfully managed with neoadjuvant immunochemotherapy followed by conversion surgery and maintenance systemic therapy, highlighting the feasibility and potential benefit of a multimodal approach in selected patients. Methods A 61-year-old postmenopausal woman with cervical cancer and distant lymph node metastases (pelvic, para-aortic, and left supraclavicular) was treated with six cycles of neoadjuvant therapy comprising a PD-1 inhibitor, paclitaxel, cisplatin, and bevacizumab. This was followed by two additional cycles of PD-1 inhibitor and bevacizumab alone. Radiologic evaluation identified significant regression of metastatic lesions and shrinkage of the primary cervical tumor. However, mild re-enlargement of the cervical lesion was noted on follow-up imaging. Robotic-assisted radical hysterectomy, pelvic and para-aortic lymphadenectomy, and partial vaginectomy were performed based on multidisciplinary consensus and patient preference. Postoperative adjuvant therapy and maintenance treatment ensued. Results Neoadjuvant treatment resulted in partial response with significant reduction in both target and non-target lesions. Despite mild re-enlargement of the primary cervical lesion after chemotherapy de-escalation, surgery was pursued. Pathology revealed minimal residual disease confined to the cervical stroma without nodal metastasis. The patient completed four cycles of adjuvant therapy and achieved complete response. She has since remained disease-free on maintenance therapy with bevacizumab and a PD-1 inhibitor, with a follow-up duration of 16 months from the initial diagnosis. Conclusion This case illustrates that, in selected PD-L1-positive FIGO stage IVB cervical cancer patients with resectable distant metastases and no parametrial invasion, a multimodal approach combining systemic immunochemotherapy with anti-angiogenic agents, followed by robotic-assisted conversion surgery and personalized postoperative management, can achieve complete response and potentially curative outcomes. Robotic surgery also facilitates complex procedures in anatomically constrained spaces, supporting its role in advanced-stage cervical cancer management. This treatment model may offer a viable strategy to prolong progression-free and overall survival in carefully selected patients.
Objective To evaluate the feasibility and effectiveness of fully robotic-assisted synchronous resection for gastric and ascending colon malignancies. Methods An 83-year-old patient underwent robotic-assisted radical distal gastrectomy with Roux-en-Y gastrojejunostomy and right hemicolectomy using the Da Vinci Xi system with intracorporeal anastomosis. Results The patient had a rapid postoperative recovery with early mobilization, flatus on postoperative day two, resumed full enteral nutrition on day five, and discharged on day eight without complications. Conclusions Fully robotic surgery provided precise dissection, effective reconstruction, and minimal trauma, demonstrating safety and efficacy in elderly patients with synchronous gastrointestinal malignancies.
Objective: To describe the surgical technique of robot-assisted single-port laparoscopic redo pyeloplasty (RSLRP) in children and to confirm the feasibility of this technique. Methods: A 12-year-3-month-old boy with recurrent ureteropelvic junction obstruction after robot-assisted laparoscopic surgery underwent RSLRP with da Vinci Xi surgical system. The general clinical characteristics, perioperative variables and follow-up outcomes were summarized. Results: The child was allowed to drink water up to 2 h before surgery. The operation was successfully performed without conversion to open surgery or intraoperative complications. The total operative time was 215 min, including 170 min of console time, with an estimated blood loss of 10 mL. Oral intake was initiated postoperatively upon awakening from anesthesia, starting with clear fluids and advancing to a regular diet as tolerated, with no signs of aspiration. The postoperative complication was gross hematuria (Clavien-Dindo grade Ⅱ), which was improved after conservative treatment. The postoperative hospital stay was 7 days, with total hospitalization duration of 11 days. The ureteral stent was removed 35 days after surgery. Follow-up ultrasound showed improvement of hydronephrosis compared with the preoperative assessment. Conclusion: The application of the da Vinci Xi surgical system for pediatric RSLRP is safe and feasible. Further studies with larger cohorts and long-term follow-up are warranted to validate the safety and efficacy of RSLRP in the pediatric population.
Robotic surgery has been introduced in all fields of general surgery including pancreatic resections in the last decade. While there is growing evidence that this type of minimally-invasive surgery can be used safely for standard procedures including distal pancreatectomy as well as pancreatico-duodenectomy, there is little data on the use of robotic approaches in the indication of chronic pancreatitis (CP) and it's specific drainage or resection procedures such as lateral pancreatico-jejunostomy or duodenum-preserving pancreatic head resection as these procedures may be challenging – especially due to the inflammatory changes. Therefore, patients suffering from CP are rarely chosen for robotic procedures although it may offer similar advantages in this specific patient collective as in other indications.This update gives an overview on the current status of robotics in CP surgery with a focus on proper patient selection, technical topics as well as the standards in the authors’ institution and reviews the available literature.
