Background:Anastomotic leak (AL) remains one of the most serious postoperative complications in colorectal surgery. Numerous predictive models have been proposed to identify patients at risk, yet their comparative validity, consistency and methodological rigor remain unclear. This review aimed to critically evaluate and summarize the performance of currently available AL prediction tools. Methods:A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials was performed in accordance with PRISMA 2020 guidelines. Eligible studies included those proposing or evaluating risk scores for AL using preoperative or intraoperative factors. Extracted data covered model characteristics and discrimination metrics, particularly the area under the curve (AUC). Risk of bias was assessed with the PROBAST tool. Where appropriate, random-effects meta-analysis of AUC values was planned. Results:Nine studies introducing nine distinct prediction models met the inclusion criteria. Commonly used predictors included sex, American Society of Anesthesiologists (ASA) classification and distance of the anastomosis from the anal verge. Only four models underwent validation and AUC values were reported in five studies. Considerable variation in model structure and inadequate reporting prevented a reliable pooled meta-analysis. Overall, methodological quality was suboptimal, with a high risk of bias observed in several domains. Conclusion:Current prediction scores for AL after colorectal surgery show substantial heterogeneity and insufficient external validation. The lack of standardized development approaches and inconsistent reporting of performance measures limit their clinical utility. Future research should prioritize transparent methodology, large prospective datasets and comprehensive validation to improve predictive reliability.

Obesity remains a major public health challenge in Italy, and robotic-assisted metabolic bariatric surgery (MBS) is gaining increasing attention for its potential advantages in precision and recovery. However, data on short-term outcomes from Italian centres are still limited. This study aimed to evaluate six-month postoperative outcomes of robotic gastric bypass in Italian adults, focusing on weight and BMI reduction, and exploring subgroup differences by gender and comorbidity status. This retrospective observational study was conducted at a primary care hospital in Italy and included 60 consecutive adult patients who underwent robotic gastric bypass with complete six-month follow-up. Demographic data, surgical details, and anthropometric measures (weight and BMI) were collected at baseline, two months, and six months postoperatively. Subgroup analyses were performed according to gender and comorbidity status. Repeated-measures ANOVA and appropriate comparative analyses were used to assess statistical significance. The cohort was predominantly female (68.33

This systematic review synthesizes current evidence on robotic transanal minimally invasive surgery (TAMIS) for rectal neoplasms, analyzing data from 26 clinical studies (2011–2024) involving 1,284 patients. The findings demonstrate robust short-term oncologic outcomes, including an 89.1

Background: The rapid adoption of robotic abdominal surgery has necessitated structured training programs to ensure surgeon competence and patient safety. The da Vinci TR 100-200-300-400-500 training system represents a comprehensive pathway for developing robotic surgical skills, yet its effectiveness on learning curves remains incompletely characterized. Methods: A systematic review was conducted following PRISMA guidelines, searching PubMed, Embase, and Cochrane databases from inception to October 2025. Studies evaluating learning curves associated with the TR training system in robotic abdominal surgery were included. Data extraction focused on training methodologies, assessment parameters, learning curve patterns, and clinical outcomes. Results: The search identified 1,591 records, with 17 studies meeting inclusion criteria. The TR training system demonstrates a progressive learning curve across its modules: TR 100 (technical skills foundation), TR 200 (technical-clinical integration), TR 300 (procedure application), TR 400 (procedure refinement), and TR 500 (mastery). Significant learning occurs within 5–10 repetitions for basic skills, with 90

Background:Androgen-secreting adrenal tumors are rare causes of virilization in adult women and often raise concerns regarding malignancy, particularly when tumor size exceeds 6 cm. Current guidelines recommend surgical resection in hormonally active adrenal masses, with minimally invasive surgery increasingly adopted in selected cases. Case report:We report the case of a 50-year-old woman presenting with progressive virilization due to a right adrenal mass measuring 10 cm. Hormonal evaluation revealed marked androgen excess, with elevated serum testosterone, androstenedione and dehydroepiandrosterone sulfate levels. Imaging studies showed a well-defined adrenal lesion without radiological signs of local invasion. The patient underwent robot-assisted laparoscopic adrenalectomy (RALA). The postoperative course was uneventful, with complete resolution of virilizing symptoms and normalization of androgen levels. Histopathological examination confirmed a benign androgen-secreting adrenal adenoma. Conclusion:This case demonstrates that robot-assisted laparoscopic adrenalectomy is a safe and effective treatment option for large, hormonally active adrenal tumors in carefully selected patients. Robotic surgery offers the benefits of minimally invasive approaches while maintaining oncological safety, supporting its role in guideline-concordant management of complex adrenal lesions.

For over 3 decades, laparoscopic cholecystectomy (LC) has been established as the standard surgical treatment for gallstone disease. Robotic cholecystectomy (RC) has emerged as an innovative alternative designed to overcome technical limitations of LC, offering enhanced visualization, improved instrument articulation, and superior ergonomics. Despite increasing global adoption, robust comparative evidence regarding operative outcomes, complication rates, patient-centered metrics, and economic impact remains limited. This systematic review and meta-analysis synthesizes the most recent evidence through 2025 to provide a comprehensive comparison of the safety, efficacy, and cost-effectiveness of LC versus RC. A comprehensive systematic search was conducted in PubMed, Embase, and the Cochrane Library from inception through December 2024, supplemented by manual searches through January 2025. Randomized controlled trials, prospective cohort studies, and retrospective cohort studies comparing LC and RC in adults were included. Two independent reviewers extracted data on patient demographics, operative outcomes, complications, length of hospital stay, patient-reported outcomes, and cost metrics. Methodological quality was assessed using the Cochrane Risk of Bias 2.0 tool for randomized trials and the Newcastle–Ottawa Scale for observational studies. Meta-analyses were performed for key outcomes, including operative time, blood loss, complications, conversion rates, and hospital stay duration. Heterogeneity was addressed using random-effects models, and subgroup analysis was performed based on study design and geographic region. Population-level context was provided using national databases, including the U.S. National Inpatient Sample (NIS), ACS NSQIP, and Medicare claims. A potential limitation is the exclusion of non-English language studies. 38 studies including over 412,000 patients were analyzed. LC accounted for approximately 85–95

Background:Robotic-assisted D2 gastrectomy combines minimally invasive benefits with enhanced precision, though its technical complexity creates a significant learning curve. This study evaluates the learning process and its impact on surgical outcomes. Methods:We conducted a PRISMA-compliant meta-analysis of studies from major databases (2010-2023) including ≥10 robotic D2 gastrectomies. Outcomes assessed operative metrics, complications and oncological results using random-effects models. Results:Analysis of 30 studies (4,589 patients) revealed that proficiency required 25-50 cases. Significant improvements after achieving proficiency included 35% reduction in operative time (94.6 minutes), 50% less blood loss (89.2 mL), 18% increased lymph node yield (5.3 nodes) and 62% fewer major complications. High-volume centers achieved proficiency 12 cases sooner than low-volume counterparts. Conclusion:Robotic D2 gastrectomy demands 25-50 cases for mastery, with outcomes improving substantially post-learning curve. Centralized training and standardized protocols are crucial for optimal implementation.

Resection of tumors located in the posterosuperior liver segments (I, IVa, VII, VIII) presents significant technical challenges during laparoscopic liver resection (LLR) due to restricted instrument maneuverability and suboptimal surgical ergonomics. Robotic liver resection (RLR) may overcome these limitations through enhanced dexterity and superior visualization. This systematic review and meta-analysis of propensity score-matched (PSM) studies aimed to compare intraoperative safety, postoperative outcomes, and oncological adequacy between RLR and LLR for tumors in these challenging anatomical locations. Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through March 2024. Studies employing propensity score matching to compare RLR and LLR for posterosuperior segment tumors were included. Primary endpoints were intraoperative blood loss and conversion rates; secondary outcomes included operative time, transfusion requirements, perioperative morbidity and mortality, R0 resection rates, and hospital stay duration. Random-effects models were used to calculate pooled odds ratios (OR) and weighted mean differences (WMD). Eight PSM studies including 11,364 patients (RLR: 2,289; LLR: 9,075) were included. RLR demonstrated significantly reduced blood loss (WMD: -121.8 mL; 95

Introduction:Esophagectomy is a complex surgical procedure primarily used for the treatment of esophageal malignancies and other esophageal disorders. In recent years, minimally invasive techniques, such as laparoscopic and robotic-assisted esophagectomy, have gained popularity due to their potential to reduce postoperative morbidity and enhance recovery. However, the comparative effectiveness, safety, and long-term outcomes of laparoscopic versus robotic esophagectomy remain unclear. Aim:This study aims to conduct a systematic review and meta-analysis comparing the perioperative and long-term outcomes of laparoscopic and robotic esophagectomy, with a focus on operative time, estimated blood loss, postoperative complications, length of hospital stay, lymph node yield, R0 resection rate, and oncological outcomes. Methods:A comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to January 2023. Randomized controlled trials (RCTs) and observational studies comparing laparoscopic and robotic esophagectomy were included. The primary outcomes were operative time, estimated blood loss, and postoperative complications. Secondary outcomes included length of hospital stay, lymph node yield, R0 resection rate, and long-term oncological outcomes. Meta-analyses were performed using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale (NOS) for observational studies. Publication bias was evaluated using Egger's test. Statistical analyses were conducted using Stata version 16.0, with a p-value < 0.05 considered statistically significant. Results:A total of 24 studies (6 RCTs and 18 observational studies) involving 6,972 patients (3,433 robotic and 3,539 laparoscopic esophagectomy cases) were included. Robotic esophagectomy was associated with a longer operative time (mean difference [MD] = 55.52 minutes, 95% CI: 27.55 to 83.49, p < 0.001) but lower estimated blood loss (MD = -103.67 ml, 95% CI: -162.78 to -44.57, p = 0.001) compared to laparoscopic esophagectomy. Postoperative complications (odds ratio [OR] = 0.78, 95% CI: 0.59 to 1.04, p = 0.091) and length of hospital stay (MD = -0.74 days, 95% CI: -1.82 to 0.34, p = 0.181) were comparable between the two techniques. Robotic esophagectomy demonstrated a higher lymph node yield (MD = 2.38, 95% CI: 0.89 to 3.87, p = 0.002) and a higher R0 resection rate (OR = 1.70, 95% CI: 1.26 to 2.30, p < 0.001). Long-term oncological outcomes, including overall survival and disease-free survival, were similar between the two approaches. Egger's test indicated no significant publication bias. Conclusions:This meta-analysis demonstrates that robotic esophagectomy, despite longer operative times, offers advantages in terms of reduced blood loss, higher lymph node yield, and improved R0 resection rates compared to laparoscopic esophagectomy. Both techniques exhibit comparable postoperative complication rates, length of hospital stay, and long-term oncological outcomes. The choice between laparoscopic and robotic esophagectomy should be guided by surgeon expertise, patient-specific factors, and institutional resources.

Background:Robotic pancreatic surgery has emerged as a minimally invasive alternative to open procedures, offering potential benefits in precision and recovery. This study evaluates the feasibility, safety and learning curve of robotic duodenopancreatectomy (RDP) and robotic distal splenopancreatectomy (RDSP) during the initial phase of implementation at a single institution. Methods:A retrospective analysis of 20 consecutive patients, who underwent RDP (n=12) or RDSP (n=8) between January 2020 and December 2022, was performed. Data on operative time, intraoperative blood loss, conversion rates, postoperative complications (classified by Clavien-Dindo and ISGPS criteria) and length of hospital stay (LOS) were collected. Early (first six RDPs and four RDSPs) and late cases were compared to assess progression along the learning curve. Statistical analysis included Mann-Whitney U and Fisher's exact tests. Results:The median operative time for RDP decreased from 480 minutes [interquartile range (IQR) 420-540] in early cases to 390 minutes (IQR 360-420) in later cases (p=0.03). The operative time for RDSP remained stable at 300 minutes (IQR 240-360; p=0.12). Intraoperative blood loss was 200 mL (IQR 100-400) for RDP and 150 mL (IQR 50-300) for RDSP. Two RDP cases (16.7%) required conversion to open surgery due to vascular adhesions. Postoperative complications included pancreatic fistula in 20% of cases, delayed gastric emptying in 15% of cases and major complications (Clavien-Dindo ≥III) in 25% of cases. The median LOS was 10 days (IQR 8-18) for RDP and seven days (IQR 5-10) for RDSP. No 90-day mortality was observed. Conclusions:Robotic pancreatic resections are feasible and safe during the early learning curve, with morbidity comparable to open surgery. Operative efficiency improved significantly for RDP, highlighting the importance of structured training and case volume. These findings support the adoption of robotic techniques in pancreatic surgery, though further studies are needed to validate long-term outcomes.

Robotic-assisted thoracic surgery (RATS) lobectomy has diffused rapidly as an alternative to video-assisted thoracoscopic surgery (VATS) for resectable non-small cell lung cancer (NSCLC). A growing but heterogeneous evidence base—including prospective cohorts, meta-analyses, economic models, learning-curve studies and one large randomized trial—permits an updated synthesis to guide clinicians and policy makers. We conducted a focused, reproducible literature search of Cochrane CENTRAL, PubMed/MEDLINE and Embase through 15 August 2025 using terms that included “robotic lobectomy,” “RATS,” “VATS,” “non-small cell lung cancer,” “randomized,” “meta-analysis,” “cost” and “learning curve.” We prioritized randomized evidence, prospective comparative cohorts, high-quality meta-analyses, multicenter registries, and full economic evaluations published 2020–2025. Primary outcomes were perioperative (operative time, blood loss, conversion, complications, length of stay), nodal harvest and pathologic upstaging, disease-free and overall survival, quality of life (QOL), cost and learning-curve metrics. We present a transparent search strategy, selection criteria, and synthesized quantitative findings drawn from high-impact sources. The RVlob randomized controlled trial (n = 320) showed non-inferiority of robotic to VATS lobectomy for 3-year overall survival (RAL 3-yr OS 94.6

Robotic-assisted minimally invasive esophagectomy (RAMIE) has been increasingly adopted, yet the comparative outcomes of its three principal approaches—Ivor Lewis, McKeown, and transhiatal—remain inadequately defined. This study aims to provide a comprehensive comparison to guide surgical decision-making. A systematic review and meta-analysis were conducted following PRISMA guidelines. Databases were searched from January 2010 to December 2023 for studies comparing robotic Ivor Lewis, McKeown, and transhiatal esophagectomy. Primary outcomes included perioperative parameters, complication rates, and oncologic efficacy. Sixteen studies (7,339 patients) were included in the systematic review, with eight studies (3,015 patients) eligible for meta-analysis. Robotic Ivor Lewis esophagectomy demonstrated superior outcomes compared to robotic McKeown, including significantly lower rates of recurrent laryngeal nerve palsy (OR = 0.13, 95

The von Hippel-Lindau (VHL) syndrome is a rare autosomal dominant disorder caused by mutations in the VHL tumor suppressor gene, leading to the development of benign and malignant tumors in multiple organs, including the kidneys, brain, spine, retina, and pancreas. Since its initial description in the early 20th century, significant progress has been made in understanding its pathogenesis, genetic basis, and clinical management. This narrative review provides a comprehensive overview of VHL syndrome, from its discovery to the latest medical and surgical therapies. A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, incorporating the Egger test to assess publication bias. The review highlights the evolution of diagnostic criteria, the role of genetic testing, and the development of targeted therapies such as hypoxia-inducible factor 2-alpha (HIF-2α) inhibitors. Surgical interventions, including nephron-sparing surgery and minimally invasive techniques, are also discussed. This review emphasizes the importance of a multidisciplinary approach to managing VHL syndrome and explores emerging therapies that hold promise for improving patient outcomes.

This investigation systematically evaluates the skill acquisition process in robotic colectomy procedures, determining the case volume required for surgical competency and assessing the effectiveness of various training methodologies. A comprehensive evidence synthesis was performed according to PRISMA standards. Multiple medical databases (PubMed, Embase, Cochrane Library) were systematically interrogated for relevant publications from January 2000 to January 2024. Eligible studies documented proficiency development in robotic colectomy, providing metrics on procedure duration, adverse events, and educational approaches. Analytical methods incorporated random-effects modeling with heterogeneity evaluation through I2 indices.Methods:From an initial pool of 1,800 potential studies, 35 met rigorous inclusion criteria, collectively representing 7500 surgical cases. Results: Proficiency development required between 20 and 70 procedures, with a weighted mean of 45 cases (95

Pheochromocytoma, a rare neuroendocrine tumor of the adrenal glands, drives excessive catecholamine production, precipitating hypertension, cardiovascular crises, and systemic symptoms. Laparoscopic adrenalectomy has long been the surgical gold standard, but robotic adrenalectomy is increasingly recognized as a precise, minimally invasive alternative with potential advantages in recovery and operative precision. This narrative review critically evaluates the efficacy, safety, and cost-effectiveness of robotic adrenalectomy for pheochromocytoma, synthesizing evidence from clinical studies to compare perioperative outcomes, complications, and economic impacts against laparoscopic approaches. While robotic techniques demonstrate promising short-term results, including reduced blood loss and shorter hospital stays, the analysis identifies gaps in long-term outcome data and potential publication bias favoring newer technologies. This review underscores the necessity for rigorous prospective studies to validate these findings and refine patient selection criteria. By contextualizing robotic adrenalectomy within the evolving landscape of minimally invasive surgery, this work aims to guide clinical practice, optimize resource allocation, and improve patient-centered care.

The aim of this comprehensive review is to describe the normal anatomy and anatomical variations of the inferior mesenteric artery (IMA), to identify various classification systems cited in the literature for IMA vascularization, and to correlate these findings with their clinical significance. A systematic review was conducted using articles from Google Scholar, Embase, Medline, and PubMed, applying the search terms: lower anatomy of the mesenteric artery and variation of the inferior mesenteric artery. The anatomy of the inferior mesenteric system is highly variable, with limited anatomical studies providing detailed support. Variations are more commonly observed in the branching patterns of the left colic, sigmoid, and superior rectal arteries rather than in the origin of the IMA itself. Regarding classification systems, we identified multiple schemes without a universally accepted guideline. Understanding the variable anatomy of the IMA and its branches is essential in left colic resection for both benign conditions and oncological surgery.

Anastomotic leakage (AL) remains a critical complication following left-sided colectomy, with severe leaks (Grade C) significantly increasing mortality and healthcare costs. Robotic surgery offers technical advantages, but large-scale comparative data on AL severity, survival, and cost-effectiveness are limited. Using a national registry (2014–2025), 2916 robotic and laparoscopic left colectomy cases were 1:1 propensity-matched for age, sex, BMI, ASA class, tumor location, and operative year. Outcomes included AL severity (Colorectal Leakage Score), conversion rates, lymph node yield, survival, and cost-effectiveness. Robotic procedures increased from 8

Background: The increasing prevalence of obesity, with associated health risks such as type 2 diabetes and cardiovascular disease, has led to the rise of bariatric surgery as a critical intervention. Roux-en-Y gastric bypass (RYGB) remains one of the most commonly performed bariatric procedures. The advent of robotic-assisted surgical techniques has raised questions regarding their comparative effectiveness and safety versus traditional laparoscopic approaches. Aim: This meta-analysis aims to systematically compare the clinical outcomes, complication rates, operative times, and overall effectiveness of laparoscopic versus robotic-assisted RYGB, expanding our understanding of their respective advantages and drawbacks. Methods: A thorough systematic review was conducted following PRISMA guidelines. A comprehensive search was performed across databases including PubMed, Cochrane Library, and Scopus up to October 2023. Selected studies were subjected to stringent inclusion and exclusion criteria. Statistical analysis employed both fixed-effects and random-effects models as appropriate. Results: A total of 30 studies, including randomized controlled trials (RCTs) and cohort studies, involving over 6,000 patients, were included. Robotic RYGB was associated with a significantly lower overall complication rate (OR 0.65; 95% CI 0.45–0.94; p = 0.02) but longer operative times (MD 30 minutes; 95% CI 20–40 minutes; p < 0.001) when compared to laparoscopic RYGB. Conclusions: Both laparoscopic and robotic methods are effective in achieving weight loss, but robotic RYGB may result in lower complication rates despite a longer operative time. The surgical approach should be tailored to individual patient needs and available resources.

The adrenal glands are small but vital endocrine organs responsible for hormone production, which is essential for stress response, fluid balance, and blood pressure regulation. Adrenalectomy, the surgical removal of one or both adrenal glands, is indicated in various benign and malignant conditions such as pheochromocytomas, aldosterone-producing adenomas, and adrenocortical carcinoma. Historically performed via open surgery, adrenalectomy has evolved significantly with the introduction of laparoscopic adrenalectomy in the 1990s and more recently, robotic adrenalectomy. Robotic adrenalectomy enhances surgical precision through 3D visualization, articulated instruments, and improved ergonomics, thereby addressing the limitations inherent to laparoscopic adrenalectomy. This narrative review synthesises the findings from pivotal studies that compare the perioperative outcomes of robotic adrenalectomy and laparoscopic adrenalectomy. Robotic adrenalectomy demonstrates favourable outcomes in terms of operative precision, reduced estimated blood loss, and comparable or shorter hospital stay, especially in complex scenarios involving obesity, large tumours, or altered anatomy. Complication rates remain low, and R0 resection rates exceed 95

The integration of indocyanine green (ICG) fluorescence imaging into robotic liver segmentectomies has improved intraoperative visualization for parenchymal-sparing hepatic resections. This systematic review and meta-analysis of 15 prospective and retrospective studies (n = 612 patients) found that ICG navigation was associated with higher rates of R0 resection, with a pooled odds ratio of 2.34 (95