BACKGROUND: AtlasGPT represents an innovative generative pretrained transformer, trained using neurosurgery literature. Its ability to construct its response according to the training level of the user is unique; however, whether its responses can be comprehended at each user's training level remains unknown. This study aimed to analyze the readability of responses provided by AtlasGPT. METHODS: Ten queries were presented to AtlasGPT across its 4 user profiles (i.e., surgeon, resident, medical student, patient). A readability analysis was performed using multiple instruments on Readability Studio. Readability scores of user-specific responses were compared using one-way analysis of variance testing and post hoc pairwise t-tests with Bonferroni correction. P value <0.05 was considered to be significant. RESULTS: Across the readability instruments that were leveraged, significant differences in reading ease were observed across all user profiles on comparisons to the patient (P < 0.005). Readability scores for the medical student profile tended to show greater reading ease than the surgeon and resident profiles; these differences, however, were not significant. The mean grade levels for patient responses across multiple instruments ranged from 8.8 to 11.51. Only one output via the New Dale-Chall assessment was written at the level of fifth-sixth grade. CONCLUSIONS: AtlasGPT-generated content demonstrates readability variations according to the user profile selected; however, the readability of patient content still exceeds recommendations set by United States departmental agencies, necessitating a call to action.

Study Design:Literature review. Objectives:Review prehabilitation techniques used for elective spine surgery to create a comprehensive list of recommendations. Methods:A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines by searching three electronic databases from 1997 to 2021. Pertinent literature reporting information on prehabilitation, applicable to spine surgery, was identified. Seventy studies were selected for further analysis. Findings from the literature were reinforced by practices employed by the authors. Results:Preoperative smoking cessation should be achieved 3-4 weeks before elective spine surgery. Preoperative weight loss programs to reach a goal BMI <35 kg/m2 may be a viable solution to minimize wound complications and surgical site infections. To minimize the negative impact of cardiopulmonary comorbidities, patients can enroll in an exercise program prior to surgery. Patients should abstain from alcohol before elective spine surgery. Patients with osteoporosis may benefit from supplementation with Vitamin D, calcium, and parathyroid hormone. Opioids should be weaned to complete cessation 6-8 weeks before surgery. Preoperative cognitive behavioral therapy (CBT) and education seem to be the most beneficial in reducing complications associated with psychiatric comorbidities. Patients should engage in a comprehensive prehabilitation regimen. Conclusion:Targeting patient risk factors with personalized interventions can improve postoperative outcomes in patients undergoing elective spine surgery.

BACKGROUND AND OBJECTIVES: The “July Effect” hypothesizes increased morbidity and mortality after the addition of inexperienced physicians at the beginning of an academic year. However, the impact of newer members on neurosurgical teams managing patients with traumatic brain injury (TBI) has yet to be examined. This study conducted a nationwide analysis to evaluate the existence of the “July Effect” in the setting of patients with TBI. METHODS: The Healthcare Cost and Utilization Project Central Distributor's National Inpatient Sample data set was queried for patients with TBI using International Classification of Diseases (ICD)-9 and ICD-10 codes. Discharges were included for diagnoses of traumatic epidural, subdural, or subarachnoid hemorrhages. Only patients treated at teaching hospitals were included to ensure resident involvement in care. Patients were grouped into July admission and non-July admission cohorts. A subgroup of patients with neurotrauma undergoing any form of cranial surgery was created. Perioperative variables were recorded. Rates of different complications were assayed. Groups were compared using χ2 tests (qualitative variables) and t-tests or Mann-Whitney U-tests (quantitative variables). Logistic regression was used for binary variables. Gamma log-linked regression was used for continuous variables. RESULTS: The National Inpatient Sample database yielded a weighted average of 3 160 452 patients, of which 312 863 (9.9%) underwent surgical management. Patients admitted to the hospital in July had a 5% decreased likelihood of death (P = .027), and a 5.83% decreased likelihood of developing a complication (P < .001) compared with other months of the year. July admittance to a hospital showed no significant impact on mean length of stay (P = .392) or routine discharge (P = .147). Among patients with TBI who received surgical intervention, July admittance did not significantly affect the likelihood of death (P = .053), developing a complication (P = .477), routine discharge (P = .986), or mean length of stay (P = .385). CONCLUSION: The findings suggested that there is no “July Effect” on patients with TBI treated at teaching hospitals in the United States.

Pregnancy-induced changes to spinal anatomy and physiology can increase the complexity of neurosurgical intervention in this population. There are numerous reports focused on the neurosurgical management of intracranial pathology for pregnant patients. However, less is known about the neurosurgical management of acute spinal pathology. This study aims to discuss the management of emergent spinal pathology during late-term pregnancy. This is a case series of acute spinal pathologies in pregnancy. Epidural spinal needle fracture, epidural abscess, disc herniation causing an acute neurological deficit, and potential spine trauma. An extensive literature search relevant to the operative cases was performed to highlight the relevant themes to management. (1) The epidural spinal needle fracture was managed by surgical exploration under local anesthesia. (2) The epidural abscess was managed with laminectomy and surgical evacuation of the infective mass under general anesthesia. (3) The acute disc herniation was managed with laminectomy and discectomy under general anesthesia. All three examples were managed with emergent surgeries with improvement of symptoms. (4) The potential spine trauma was managed nonoperatively. Relevant similar cases from the literature review were summarized and strategies for management were outlined. Several factors such as anesthesia type, positioning, and operation sequencing must be considered when managing acute spinal pathology in late-term pregnant patients, necessitating multi-disciplinary input. However, effective management can result in successful surgical intervention and improvement of symptoms.

BACKGROUND: The twisting motion associated with the golf swing puts the intervertebral discs and the paraspinal musculature under stress. The objective of this study was to characterize the spinal and paraspinal injuries associated with golf and their outcomes. METHODS: The National Electronic Injury Surveillance System was queried for emergency department visits between 2003 and 2023 for golf-related injuries with body part codes "neck," "upper trunk," and "lower trunk," which includes the cervical, thoracic, and lumbar spine, respectively. Narratives were screened for relevance and reports related to spinal and paraspinal injuries were included. Weighted survey analysis was used to construct national estimates. Injury and diagnosis trends were analyzed using binomial logistic regression, and time trends were analyzed with a linear model. P value of < 0.05 was considered significant. RESULTS: A total of 1441 relevant samples led to a national estimate of 69,153 emergency department visits for golf-related spinal/paraspinal injuries between 2003 and 2023. The weighted mean age of those injured was 52.8 years, and the majority were male (85%, 95% confidence interval [CI] 83-87). Strain was the most diagnosed injury (57.5%, 95% CI 54-61). Those aged >= 55 years constituted more injuries than any other age group (50.1%, 95% CI 47-53). Injuries in the lumbar region accounted for most cases (76.9%, 95% CI 74-80). Injury frequency did not change over the years (P [ 0.54), although the age of injury did increase over time (P< 0.001). CONCLUSIONS: Golf-associated paraspinal injuries are more common than neurological injuries, necessitating study into their mechanisms and onset.

There is a scarcity of literature exploring fluid-based biomarkers that have the potential to provide deeper insights into the cellular mechanisms underlying cervical spondylotic myelopathy (CSM) symptom presentation and postoperative recovery. This systematic review synthesized the literature on invasive, fluid-based biomarkers and their clinical significance with CSM. A comprehensive search strategy was developed for concepts of biomarkers and CSM. Retrieved results underwent title, abstract, and full-text screening with inclusion criteria being original research including animal or human subjects affected by CSM/compression myelopathy that investigated the relationship between a fluid-based biomarker and CSM. Risk-of-bias was reported using the OHAT Risk of Bias Rating Tool. The search strategy resulted in 191 unique manuscripts, with 20 meeting the predetermined inclusion/exclusion criteria, included in final analysis. Of these, 15 (75.0

Purpose Operative treatment of adult spinal deformity (ASD) has been shown to improve patient health-related quality of life (HRQOL). Selection of the uppermost instrumented vertebra (UIV) in either the upper thoracic (UT) or lower thoracic (LT) spine is a pivotal decision with effects on operative and postoperative outcomes. This review overviews the multifaceted decision-making process for UIV selection in ASD correction. Methods PubMed was queried for articles using the keywords “uppermost instrumented vertebra”, “upper thoracic”, “lower thoracic”, and “adult spinal deformity”. Results Optimization of UIV selection may lead to superior deformity correction, better patient-reported outcomes, and lower risk of proximal junctional kyphosis (PJK) and failure (PJF). Patient alignment characteristics, including preoperative thoracic kyphosis, coronal deformity, and the magnitude of sagittal correction influence surgical decision-making when selecting a UIV, while comorbidities such as poor body mass index, osteoporosis, and neuromuscular pathology should also be taken in to account. Additionally, surgeon experience and resources available to the hospital may also play a role in this decision. Currently, it is incompletely understood whether postoperative HRQOLs, functional and radiographic outcomes, and complications after surgery differ between selection of the UIV in either the UT or LT spine. Conclusion The correct selection of the UIV in surgical planning is a challenging task, which requires attention to preoperative alignment, patient comorbidities, clinical characteristics, available resources, and surgeon-specific factors such as experience.

Objective: The relationship between environmental contaminants and brain tumor incidence in adults has been thoroughly explored but research into how these contaminants affect pediatric brain tumor (PBT) incidence has not been explored. Children, typically having more limited geographical movement and thus more consistent environmental contaminant exposure, might offer more reliable insights into which environmental contaminants affect the incidence of brain tumors. The present study is the first to focus on exploring whether a possible association exists between the incidence of PBTs and exposure to environmental pollutants in New Jersey (NJ). Methods: Linear regressions were run between PBT incidence and the concentration of air quality pollutants such as Ozone (O 3 ), Particulate Matter 2.5 (PM2.5), Particulate Matter 10 (PM10), and Carbon Monoxide (CO). Similarly, linear regressions were run between PBT incidence and Elevated Blood Lead Levels (BLL). Results: The study observed a significant positive relationship between O 3 and PBT incidence (beta = 0.34, p = 0.028). However, the relationship between PBT incidence, and environmental pollutants such as CO (beta = 0.0047, p = 0.098), PM2.5 (beta = -0.2624, p = 0.74), and PM10 (beta = -0.7353, p = 0.073) were found to be nonsignificant. For elevated BLL, nonsignificant relationships with PBT incidence were observed at 10-14 mu g/dL (beta = -39.38, p = 0.30), 15-19 mu g/dL (beta = - 67.00, p = 0.21), and 20-44 mu g/dL (beta = -201.98, p = 0.12). Conclusions: The results indicate a possible impact of O 3 on the incidence of PBTs in NJ. In contrast to the significant links found in prior studies of adult brain tumors, the associations between PBT occurrence and particulate matter were not significant. These findings highlight the importance of further investigating how environmental factors, especially O 3 , relate to PBTs.

BACKGROUND:Proper documentation is essential for patient care. The popularity of artificial intelligence (AI) offers the potential for improvements in neurosurgical note-writing. This study aimed to assess how AI can optimize documentation in neurosurgical procedures. METHODS:Thirty-six operative notes were included. All identifiable data were removed. Essential information, such as perioperative data and diagnosis, was sourced from these notes. ChatGPT 4.0 was trained to draft notes from surgical vignettes using each surgeon's note template. One hundred forty-four surveys with a surgeon or AI note were shared with 3 surgeons to evaluate accuracy, content, and organization using a 5-point scale. Accuracy was defined as the factual correctness; content, as the comprehensiveness; and organization, as the arrangement of the note. Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) scores quantified each note's readability. RESULTS:The mean AI accuracy was not different from the mean surgeon accuracy (4.44 vs. 4.33; P = 0.512), the mean AI content was lower than the mean surgeon content (3.73 vs. 4.42; P < 0.001). The mean AI note FKGL was greater than the mean surgeon FKGL (13.13 vs. 9.99; P < 0.001) and the mean AI FRE was lower than the mean surgeon FRE (21.42 vs. 41.70; P < 0.001). CONCLUSIONS:AI notes were on par with surgeon notes in terms of accuracy and organization but lacked in content. Additionally, AI notes used language at an advanced reading level. These findings support the potential for ChatGPT to enhance the efficiency of neurosurgery documentation.

BACKGROUND AND OBJECTIVES:The Internet has become a primary source of health information, leading patients to seek answers online before consulting health care providers. This study aims to evaluate the implementation of Chat Generative Pre-Trained Transformer (ChatGPT) in neurosurgery by assessing the accuracy and helpfulness of artificial intelligence (AI)-generated responses to common postsurgical questions.METHODS:A list of 60 commonly asked questions regarding neurosurgical procedures was developed. ChatGPT-3.0, ChatGPT-3.5, and ChatGPT-4.0 responses to these questions were recorded and graded by numerous practitioners for accuracy and helpfulness. The understandability and actionability of the answers were assessed using the Patient Education Materials Assessment Tool. Readability analysis was conducted using established scales.RESULTS:A total of 1080 responses were evaluated, equally divided among ChatGPT-3.0, 3.5, and 4.0, each contributing 360 responses. The mean helpfulness score across the 3 subsections was 3.511 ± 0.647 while the accuracy score was 4.165 ± 0.567. The Patient Education Materials Assessment Tool analysis revealed that the AI-generated responses had higher actionability scores than understandability. This indicates that the answers provided practical guidance and recommendations that patients could apply effectively. On the other hand, the mean Flesch Reading Ease score was 33.5, suggesting that the readability level of the responses was relatively complex. The Raygor Readability Estimate scores ranged within the graduate level, with an average score of the 15th grade.CONCLUSION:The artificial intelligence chatbot's responses, although factually accurate, were not rated highly beneficial, with only marginal differences in perceived helpfulness and accuracy between ChatGPT-3.0 and ChatGPT-3.5 versions. Despite this, the responses from ChatGPT-4.0 showed a notable improvement in understandability, indicating enhanced readability over earlier versions.

Background: Magnetic resonance imaging-guided focused ultrasound (MRgFUS) thalamotomy offers incisionless treatment for essential tremor or tremor-dominant Parkinson’s disease, gaining acceptance as an alternative to deep brain stimulation. Compared to other methods, it offers real-time efficacy assessment without ionizing radiation. Case Description: A 63-year-old male underwent MRgFUS, initially yielding subtle results due to skull limitations. However, significant tremor relief emerged 6 hours post-procedure, sustained for 5 days. Imaging confirmed thalamotomy effect. A second treatment was delivered at day five for longevity. Conclusion: For patients with challenging skull characteristics and initial suboptimal outcomes, staged procedures may be considered, with potential delayed benefits and the need for lesion expansion for long-term relief.

Neurosurgical research is a rapidly evolving field, with numerous studies continuously published. As the body of research grows, upholding high-quality standards becomes increasingly essential. Open science practices offer tools to ensure quality and transparency. However, the prevalence of these practices remains unclear. This study investigated the extent to which neurosurgical publications have implemented open science practices. Five open science practices (preprint, equator guidelines, published peer review comments, preregistration, and open accessibility to data and methods) were measured from five top-ranked neurosurgical journals (Neurosurgery, Journal of Neurosurgery, World Neurosurgery, Neurosurgical Review, and Acta Neurochirurgica), according to Google Scholar. One hundred fifty articles were randomly sampled from January 1, 2022, to December 31, 2023. Two reviewers analyzed these articles for their utilization of open science practices. A third reviewer settled disagreements. One journal required (20

- OBJECTIVE: Coding for neurosurgical procedures is a complex process that is dynamically changing year to year, through the annual introduction and removal of codes and modifiers. The authors hoped to elucidate if publicly available artificial intelligence (AI) could offer solutions for neurosurgeons with regard to coding. METHODS: Multiple publicly available AI platforms were asked to provide Current Procedural Terminology (CPT) codes and Revenue Value Units (RVU) values for common neurosurgical procedures of the brain and spine with a given indication for the procedure. The responses of platforms were recorded and compared to the currently valid CPT codes used for the procedure and the amount of RVUs that would be gained. RESULTS: Six platforms and Google were asked for the appropriate CPT codes for 10 endovascular, spinal, and cranial procedures each. The highest performing platforms were as follows: Perplexity.AI identified 70% of endovascular, BingAI identified 55% of spinal, and ChatGPT 4.0 with Bing identified 75% of cranial CPT codes. With regard to RVUs, the top performer gained 78% of endovascular, 42% of spinal, and 70% of cranial possible RVUs. With regard to accuracy, AI platforms on average outperformed Google (45% vs. 25%, P [ 0.04236). CONCLUSIONS: The ability of publicly available AIs to successfully code for neurosurgical procedures holds great promise in the future. Future development of AI should focus on improving accuracy with regard to CPT codes and providing supporting documentation for its decisions. Improvement on the existing capabilities of AI platforms can allow for increased operational efficiency and cost savings for practices.

BACKGROUND CONTEXT Proximal junctional kyphosis (PJK) is a radiographic complication following adult spinal deformity (ASD) surgery. The decision-making process for PJK revision surgery is multi-faceted, involving the evaluation of clinical symptoms, radiographic findings, and patient-specific factors. PURPOSE To compare characteristics between ASD patients who received PJK revision at various time points and who did not receive PJK revision at all. STUDY DESIGN/SETTING Prospective, multicenter cohort of ASD patients with PJK. PATIENT SAMPLE A total of 113 ASD patients who underwent surgery for complex spinal correction and developed PJK postoperatively. OUTCOME MEASURES Spinopelvic parameters associated with the timing for revision surgery in patients who develop PJK following ASD surgery. METHODS Data was obtained from a multicenter database. Patients with ASD diagnosed with PJK were identified; those who had a revision within 6W were excluded due to the lack of postoperative films before 6W. The remaining patients were separated into groups: received revision surgery within two years, between two and four years, or no revision surgery within four years. Demographic variables were included. The SRS-22 questionnaire was used to assess health-related quality-of-life (HRQOL) at baseline. Spinopelvic parameters at 6W were collected, including C2-pelvic angle (C2PA), T4-pelvic angle (T4PA), L1-pelvic angle (L1PA), and T4PA-L1PA mismatch. Additionally, the incidence of preceding neurologic complications (within one year of PJK diagnosis) was determined. Hart-PJK severity score (PJKSS) was calculated without instrumentation or fracture components due to a lack of specific data. Bivariate analysis was performed with the Kruskal-Wallis and chi-squared tests. RESULTS A total of 113 patients diagnosed with PJK were included. Six patients who had revision before six weeks postoperatively were excluded. Forty-seven patients (41.6%) had a revision surgery between 6 weeks and 2 years, 18 had a revision between 2 and 4 years (15.9%), and 48 patients (42.5%) had no revision surgery within 4 years. There were no significant differences between C2PA (p = 0.719), T4PA (p = 0.701), L1PA (p = 0.934), and T4PA-L1PA mismatch (p = 0.613) at 6W between the three groups. Likewise, the incidence of neurologic complications was not significantly different (p = 0.797). CONCLUSIONS Early 6W postoperative spinopelvic parameters and the incidence of neurologic complications do not explain the timing of revision surgery. Additionally, demographics and HRQOL are similar among patients who received revision surgery for PJK and those who did not. Surgeons may be utilizing different variables for early risk stratification of PJK revision. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.

A historical overview of the evolution of anterolateral approaches to the lumber spine and associated patient outcomes is presented. In addition, the modern incorporation of new technologies is discussed, including interbody cages, intraoperative image guidance , robotics, augmented reality, and machine learning, which have significantly improved the spine surgery safety and efficacy profile. Current challenges and future directions are also covered, emphasizing the need for further research and development, particularly in robotic assistance and machine learning algorithms.

Art in neurosurgery has been a critical part of the discipline for centuries. Numerous cultures, such as ancient India, China, and Egypt, and more contemporary scientists, such as Leonardo da Vinci, Max Brödel, and Norman Dott, have significantly contributed to medical illustration. Today, advancements in three-dimensional technology have allowed for the creation of detailed neuroanatomy models for surgical planning and education. Medical illustrations are also used for research and outcome documentation as they help visualize anatomy and surgical procedures. Its use in education, surgical planning, and navigation remains integral to the advancement of neurosurgery. This review demonstrates the invaluable contribution of art in neurosurgery and how it has enabled continuous progress in the field.

BACKGROUND/OBJECTIVE:Neurosurgery emphasizes the criticality of accurate differential diagnoses, with diagnostic delays posing significant health and economic challenges. As large language models (LLMs) emerge as transformative tools in healthcare, this study seeks to elucidate their role in assisting neurosurgeons with the differential diagnosis process, especially during preliminary consultations. METHODS:This study employed 3 chat-based LLMs, ChatGPT (versions 3.5 and 4.0), Perplexity AI, and Bard AI, to evaluate their diagnostic accuracy. Each LLM was prompted using clinical vignettes, and their responses were recorded to generate differential diagnoses for 20 common and uncommon neurosurgical disorders. Disease-specific prompts were crafted using Dynamed, a clinical reference tool. The accuracy of the LLMs was determined based on their ability to identify the target disease within their top differential diagnoses correctly. RESULTS:For the initial differential, ChatGPT 3.5 achieved an accuracy of 52.63%, while ChatGPT 4.0 performed slightly better at 53.68%. Perplexity AI and Bard AI demonstrated 40.00% and 29.47% accuracy, respectively. As the number of considered differentials increased from 2 to 5, ChatGPT 3.5 reached its peak accuracy of 77.89% for the top 5 differentials. Bard AI and Perplexity AI had varied performances, with Bard AI improving in the top 5 differentials at 62.11%. On a disease-specific note, the LLMs excelled in diagnosing conditions like epilepsy and cervical spine stenosis but faced challenges with more complex diseases such as Moyamoya disease and amyotrophic lateral sclerosis. CONCLUSIONS:LLMs showcase the potential to enhance diagnostic accuracy and decrease the incidence of missed diagnoses in neurosurgery.

PURPOSE:The Rotterdam Scoring System (RSS) attempts to prognosticate early mortality and early functional outcome in patients with traumatic brain injury (TBI) based on non-contrast head computed tomography (CT) imaging findings. The purpose of this study was to identify the relationship between RSS scores and long-term outcomes in patients with severe TBI. METHODS:Consecutively treated patients with severe TBI enrolled between 2008 and 2011, in the prospective, observational, Brain Trauma Research Center database were included. The Glasgow Outcome Scale (GOS) was used to measure long-term functional outcomes at three, six, 12, and 24 months. GOS scores were categorized into favorable (GOS = 4-5) and unfavorable (GOS = 1-3) outcomes. RSS scores were calculated at the time of image acquisition. RESULTS:Of the 89 patients included, 74 (83.4%) were male, 81 (91.0%) were Caucasian, and the mean age of the cohort was 41.9 ± 18.5 years old. Patients with an RSS score of 3 and lower were more likely to have a favorable outcome with increased survival rates than patients with RSS scores greater than 3. CONCLUSIONS:The RSS score determined on the head CT scan acquired at admission in a cohort of patients with severe TBI correlated with long-term survival and functional outcomes up to two years following injury.

INTRODUCTION: Coding for Neurosurgical procedures is a complex process that is dynamically changing year to year, through the introduction and removal of codes and modifiers every year. It is an increasing challenge for Neurosurgeons to keep up with the changes and implement them in their practice to ensure accurate coding and maximize billing. The AANS reports only 43% of Neurosurgeons are estimated to have certified professional coders. METHODS: ChatGPT was asked to provide CPT codes for common neurosurgical procedures of the brain and spine with a given indication for the procedure. The responses of ChatGPT were recorded and compared to the accurate CPT codes used for the procedure. The total amount of RVUs provided by Chat GPT CPT codes were compared to the actual amount of RVUs for the given procedure. RESULTS: ChatGPT was asked for four cranial and spinal procedures each. In terms of accuracy, three responses were completely inaccurate, four responses were partially correct, and one response was completely correct. From the total 8 cases, ChatGPT provided CPT codes accounting for 132.88 of 227.33 expected RVUs (58.5%). For spinal procedures ChatGPT provided 81.7 of 107.8 expected RVUs (75.8%). For cranial procedures ChatGPT provided 51.2 of 119.5 expected RVUs (42.8%). CONCLUSIONS: The ability of ChatGPT to successfully code for neurosurgical procedures appears to be limited at this time, but it is not without promise. The information to successfully code for billing for medical procedures is not readily available on the internet. Using limited information ChatGPT is still able to successfully identify codes being used for procedures. Teaching artificial intelligence to use CPT codes for billing could offer neurosurgeons increased efficiency and efficacy in their billing in the future.

A historical overview of the evolution of anterolateral approaches to the lumber spine and associated patient outcomes is presented. In addition, the modern incorporation of new technologies is discussed, including interbody cages, intraoperative image guidance, robotics, augmented reality, and machine learning, which have significantly improved the spine surgery safety and efficacy profile. Current challenges and future directions are also covered, emphasizing the need for further research and development, particularly in robotic assistance and machine learning algorithms.