ABSTRACT Background Autosomal dominant polycystic kidney disease (ADPKD) often prompts pre‐transplantation or simultaneous native nephrectomy. Methods We reviewed adult patients with ADPKD who underwent RKT without native nephrectomy at one transplant centre. Native kidney volume (NKV) and estimated abdominopelvic cavity volume (EACV) were estimated using ellipsoid approximations from cross‐sectional imaging, and a Spatial Occupancy Ratio (SOR = combined NKV/EACV) was derived to quantify anatomical crowding. Results Sixteen patients underwent RKT for ADPKD without preemptive native nephrectomy, with a median SOR of 24.7%. Median warm ischaemia and operative times were 37 and 267 minutes, respectively, with an estimated blood loss of 50 mL. Increasing SOR demonstrated a moderate but significant inverse correlation with graft volume ( r = −0.52, p = 0.038) and a weak positive correlation with operative time ( r = 0.07, p = 0.80). Conclusions RKT without native nephrectomy appears feasible across a broad spectrum of anatomical abdominopelvic occupancy, supporting a selective rather than routine approach to nephrectomy.
ABSTRACT Background Accurate path planning for minimally invasive neurosurgery is necessary to navigate complex anatomy that contains critical structures, such as blood vessels, ventricles and white‐matter tracts. Planning with nonholonomic kinematics is difficult, and typical planners fail to generate kinematically feasible paths. Methods AutoPlan is a deep reinforcement learning (DRL) framework that generates a needle trajectory on a magnetic resonance imaging (MRI) patient dataset. AutoPlan implements kinematic control strategies, variable curvature with fixed insertion (VCFI) and variable insertion with fixed curvature (VIFC), with random and selective start‐point initialisation. Path planning was performed on 55 volumes using PPO, SAC, DDPG and RRT. Results PPO (VIFC, selective start): 90.9% success, path length 45.96 14.76 mm, computation time 0.02 0.02 s. RRT: 65.5% success, path length 102.07 126.15 mm, computation time 9.72 20.29 s. Conclusions AutoPlan provides consistent planning while avoiding critical structures, resulting in fast, kinematically safe trajectories.
ABSTRACT Background Advanced rectal and anal malignancies often require dissections beyond total mesorectal planes for improved oncological outcomes. While minimally invasive techniques facilitate this approach, they result in larger perineal defects, creating reconstructive challenges. Robotic‐assisted surgery enhances precision, visualisation, and ergonomics, potentially optimising outcomes. However, data on robotics beyond total mesorectal excision (bTME) remain limited. This study evaluated robotic bTME and synchronous gracilis or PAP (profunda artery perforator) flap reconstruction. Methods This retrospective case series reviewed 10 patients with locally advanced or recurrent anorectal cancer who underwent elective robotic bTME with synchronous perineal gracilis or PAP flap reconstruction. Results Median operative time was 465 minutes. Gracilis flap harvest was concurrent. No major flap‐related complications or reoperations. R0 resection was achieved in 80%. At 1‐year, local recurrence was 0%, distant metastases 30%, and disease‐free survival 70%. Conclusion Robotics bTME with synchronous gracilis or PAP flap reconstruction is feasible, efficient, and oncologically safe.
ABSTRACT Background During surgical robotic tool development, teleoperation can provide a valuable means of evaluating tool performance and informing iterative design improvements. Methods We propose a compact framework for establishing real2sim bimanual teleoperation systems. Using this framework, an Omni‐to‐Unity system was established to enable bimanual teleoperation of simulated robotic tools using two portable haptic devices. A dVRK‐to‐Unity system was also implemented to evaluate the framework with a different leader robot. An application scenario was presented to illustrate its use in robotic tool design. Results Both systems were integrated with simulated surgical tasks and operated without observed system failures during the reported experiments. The experiments showed the applicability of the framework to different leader robots and simulated robotic tools with different kinematic configurations. Conclusions The proposed framework provides a compact approach to establishing bimanual real2sim teleoperation systems and facilitates the evaluation of different robotic tool designs through simulated surgical tasks.
OBJECTIVE:To evaluate the feasibility and preliminary perioperative outcomes of a traction pre-bladder suturing technique for managing the intramural ureter during single-position robot-assisted laparoscopic nephroureterectomy (RALNU) in patients with early-stage upper tract urothelial carcinoma (UTUC). METHODS:10 consecutive patients with early-stage UTUC underwent RALNU (Oct 2022-Aug 2023). The technique involves four steps: mucosal tenting, a purse-string suture for containment, en bloc resection of the protruding mucosa and ureter, and reinforced double-layer bladder closure. RESULTS:All procedures were successful. Mean operative time was 145 min, with 38 min dedicated to the intramural segment. Mean blood loss was 35 mL, with no conversions or major complications. Pathology confirmed R0 resection of low-grade noninvasive carcinoma. Two metachronous bladder recurrences occurred during a median 12-month follow-up. CONCLUSION:This technique appears to be a feasible approach in patients with early-stage UTUC, with the potential to minimise urine spillage and facilitate secure bladder closure during RALNU.
