BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital c...As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.展开更多
The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and ma...The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.展开更多
Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic varian...Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performance.Materials and methods:A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures:ventral hernia repairs,hysterectomies,lung lobectomies,pancreatectomies,gastric bypass,and prostatectomies.The criteria analyzed to compare these procedures included morbidity rate,readmission rate,mortality rate,cost,length of hospitalization and operative time.These criteria were scaled based on their significance when considering a surgery,such that more important criteria,those that directly impact patient health,are more heavily weighted than less important criteria.Results:The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies.Laparoscopy was preferred for all other procedures.In the case of gastric bypass,laparoscopy was heavily preferred,and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs.Conclusion:The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries.With new technologies,preferences are likely to change in favor of robotic surgery,and this model can be employed to predict the impact of those advancements.展开更多
BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,...BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.展开更多
Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital wer...Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.展开更多
Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,whi...Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.展开更多
There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among thes...There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.展开更多
BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar...BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.展开更多
Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer(LARC);however,it poses significant technical challenges,which account for the high...Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer(LARC);however,it poses significant technical challenges,which account for the high risk of morbidity and mortality associated with the procedure.As complete histopathologic resection is the most important determinant of patient outcomes,LARC often requires an extended resection beyond the total mesorectal excision plane to obtain clear re-section margins.In an era when laparoscopic surgery and robot-assisted surgery are becoming commonplace,the optimal approach to extensive pelvic inter-ventions remains controversial.However,acceptance of the suitability of mini-mally invasive surgery is slowly gaining traction.Nonetheless,there is still a lack of evidence in the literature about minimally invasive approaches in multiple and extensive surgical resections,highlighting the need for research studies to explore,validate,and develop this issue.This editorial aims to provide a critical overview of the currently available applications and challenges of minimally invasive abdo-minopelvic surgery for LARC.Furthermore,we discuss recent developments in the field of robotic surgery for LARC,with a specific focus on new innovations and emerging frontiers.展开更多
The management of locally advanced rectal cancer involving adjacent organs and extending beyond the surgical planes of total mesorectal excision has evolved over the past few decades both in terms of the effectiveness...The management of locally advanced rectal cancer involving adjacent organs and extending beyond the surgical planes of total mesorectal excision has evolved over the past few decades both in terms of the effectiveness of preoperative treatments and surgical innovation.The use of a robotic platform is increasing,even in complex surgery such as pelvic exenteration together with the advantages of minimally invasive procedures.However,satisfactory surgical,oncological,and functional outcomes are achieved not only minimizing the impact of a demolitive surgery but also when a multidisciplinary specialized team focuses on experienced surgeons,mandatory rules of surgical oncology,appropriate medical treatments,accurate preoperative planning,and an acceptable quality of life.展开更多
Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and es...Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.展开更多
Artificial intelligence(AI)and machine learning(ML)are transforming spine care by addressing diagnostics,treatment planning,and rehabilitation challenges.This study highlights advancements in precision medicine for sp...Artificial intelligence(AI)and machine learning(ML)are transforming spine care by addressing diagnostics,treatment planning,and rehabilitation challenges.This study highlights advancements in precision medicine for spinal pathologies,leveraging AI and ML to enhance diagnostic accuracy through deep learning algorithms,enabling faster and more accurate detection of abnormalities.AIpowered robotics and surgical navigation systems improve implant placement precision and reduce complications in complex spine surgeries.Wearable devices and virtual platforms,designed with AI,offer personalized,adaptive therapies that improve treatment adherence and recovery outcomes.AI also enables preventive interventions by assessing spine condition risks early.Despite progress,challenges remain,including limited healthcare datasets,algorithmic biases,ethical concerns,and integration into existing systems.Interdisciplinary collaboration and explainable AI frameworks are essential to unlock AI’s full potential in spine care.Future developments include multimodal AI systems integrating imaging,clinical,and genetic data for holistic treatment approaches.AI and ML promise significant improvements in diagnostic accuracy,treatment personalization,service accessibility,and cost efficiency,paving the way for more streamlined and effective spine care,ultimately enhancing patient outcomes.展开更多
Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we exa...Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.展开更多
Deep learning now underpins many state-of-the-art systems for biomedical image and signal processing,enabling automated lesion detection,physiological monitoring,and therapy planning with accuracy that rivals expert p...Deep learning now underpins many state-of-the-art systems for biomedical image and signal processing,enabling automated lesion detection,physiological monitoring,and therapy planning with accuracy that rivals expert performance.This survey reviews the principal model families as convolutional,recurrent,generative,reinforcement,autoencoder,and transfer-learning approaches as emphasising how their architectural choices map to tasks such as segmentation,classification,reconstruction,and anomaly detection.A dedicated treatment of multimodal fusion networks shows how imaging features can be integrated with genomic profiles and clinical records to yield more robust,context-aware predictions.To support clinical adoption,we outline post-hoc explainability techniques(Grad-CAM,SHAP,LIME)and describe emerging intrinsically interpretable designs that expose decision logic to end users.Regulatory guidance from the U.S.FDA,the European Medicines Agency,and the EU AI Act is summarised,linking transparency and lifecycle-monitoring requirements to concrete development practices.Remaining challenges as data imbalance,computational cost,privacy constraints,and cross-domain generalization are discussed alongside promising solutions such as federated learning,uncertainty quantification,and lightweight 3-D architectures.The article therefore offers researchers,clinicians,and policymakers a concise,practice-oriented roadmap for deploying trustworthy deep-learning systems in healthcare.展开更多
ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as As...ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.展开更多
BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0...BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.展开更多
Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various...Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.展开更多
The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and...The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.展开更多
Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive ...Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.展开更多
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘As robotic surgery provides clinical benefits and increases on a global scale,it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation.The digital coupling between human control inputs and surgical motion replaces the previous physical link.Robotic surgery is therefore in effect‘surgery-by-wire’,the term capturing the engineering phenomenon that has also occurred in the‘fly-by-wire’of aviation and‘drive-by-wire’of cars.This paper reviews the fundamental commonality across domains.Intrinsic to‘by-wire’control is digital processing,which generates the control signal to the effector.This processing enables a progressive spectrum of motion modulation,from precision and stability of motion,through assistance and envelope protection,to automation.Precision now manifests in all three domains.In modern aircraft and cars,higher-order assistance is commonplace,such as flight envelope protection,with analogous support in driving,as well as significant automation.In robotic surgery,such assistance and automation have not yet entered wider clinical practice,with concepts such as envelope protection requiring further definition.The digital interface combined with telecommunication has also enabled teleoperation in all domains.Therefore,motion‘by-wire’has enhanced performance across industries.A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery.As the pan-industry digital transformation evolves,important principles can be derived for application in robotic surgery.
文摘The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.
文摘Aim:The goal of this research was to create a mathematical model to evaluate the short-term effectiveness of laparoscopic and robotic surgeries and to apply this model to surgeries with laparoscopic and robotic variants to evaluate their performance.Materials and methods:A mathematical model was developed in this study to compare the short-term effectiveness of six different surgical procedures:ventral hernia repairs,hysterectomies,lung lobectomies,pancreatectomies,gastric bypass,and prostatectomies.The criteria analyzed to compare these procedures included morbidity rate,readmission rate,mortality rate,cost,length of hospitalization and operative time.These criteria were scaled based on their significance when considering a surgery,such that more important criteria,those that directly impact patient health,are more heavily weighted than less important criteria.Results:The mathematical model indicated that robotic surgery was the preferred option for lung lobectomies and prostatectomies.Laparoscopy was preferred for all other procedures.In the case of gastric bypass,laparoscopy was heavily preferred,and there was only a marginal preference in laparoscopy for hysterectomies and ventral hernia repairs.Conclusion:The mathematical model developed in this research serves as a robust definitive standard that can continue to be utilized to compare robotic and laparoscopic surgeries.With new technologies,preferences are likely to change in favor of robotic surgery,and this model can be employed to predict the impact of those advancements.
基金Supported by Tianjin Key Medical Discipline(Specialty)Construction Project,No.TJYXZDXK-015A and No.TJYXZDXK-058B.
文摘BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.
文摘Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.
基金The authors are the awardees of the Indian Council of Social Science Research(ICSSR)Research Program(F.No.G-11/2021-22/ICSSR/RP)This paper is largely an outcome of the research program sponsored by the ICSSR.However,the responsibility for the facts stated,opinions expressed,and conclusions drawn is entirely that of the authors.
文摘Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.
文摘There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.
基金National Natural Science Foundation of China,NO.82174466.
文摘BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.
文摘Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer(LARC);however,it poses significant technical challenges,which account for the high risk of morbidity and mortality associated with the procedure.As complete histopathologic resection is the most important determinant of patient outcomes,LARC often requires an extended resection beyond the total mesorectal excision plane to obtain clear re-section margins.In an era when laparoscopic surgery and robot-assisted surgery are becoming commonplace,the optimal approach to extensive pelvic inter-ventions remains controversial.However,acceptance of the suitability of mini-mally invasive surgery is slowly gaining traction.Nonetheless,there is still a lack of evidence in the literature about minimally invasive approaches in multiple and extensive surgical resections,highlighting the need for research studies to explore,validate,and develop this issue.This editorial aims to provide a critical overview of the currently available applications and challenges of minimally invasive abdo-minopelvic surgery for LARC.Furthermore,we discuss recent developments in the field of robotic surgery for LARC,with a specific focus on new innovations and emerging frontiers.
文摘The management of locally advanced rectal cancer involving adjacent organs and extending beyond the surgical planes of total mesorectal excision has evolved over the past few decades both in terms of the effectiveness of preoperative treatments and surgical innovation.The use of a robotic platform is increasing,even in complex surgery such as pelvic exenteration together with the advantages of minimally invasive procedures.However,satisfactory surgical,oncological,and functional outcomes are achieved not only minimizing the impact of a demolitive surgery but also when a multidisciplinary specialized team focuses on experienced surgeons,mandatory rules of surgical oncology,appropriate medical treatments,accurate preoperative planning,and an acceptable quality of life.
文摘Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.
文摘Artificial intelligence(AI)and machine learning(ML)are transforming spine care by addressing diagnostics,treatment planning,and rehabilitation challenges.This study highlights advancements in precision medicine for spinal pathologies,leveraging AI and ML to enhance diagnostic accuracy through deep learning algorithms,enabling faster and more accurate detection of abnormalities.AIpowered robotics and surgical navigation systems improve implant placement precision and reduce complications in complex spine surgeries.Wearable devices and virtual platforms,designed with AI,offer personalized,adaptive therapies that improve treatment adherence and recovery outcomes.AI also enables preventive interventions by assessing spine condition risks early.Despite progress,challenges remain,including limited healthcare datasets,algorithmic biases,ethical concerns,and integration into existing systems.Interdisciplinary collaboration and explainable AI frameworks are essential to unlock AI’s full potential in spine care.Future developments include multimodal AI systems integrating imaging,clinical,and genetic data for holistic treatment approaches.AI and ML promise significant improvements in diagnostic accuracy,treatment personalization,service accessibility,and cost efficiency,paving the way for more streamlined and effective spine care,ultimately enhancing patient outcomes.
基金funded by the National Key Research and Development Program of China(Grant No.2022YFB4700904 to Wang L)the Shanghai Shenkang Hospital Development Center's project for the Promotion of Clinical Skills and Clinical Innovation Three-Year Action Plan(Project No.SHDC2022CRT006 to Wang L and SHDC2022CRS010B to Tang S).
文摘Objective:This study aimed to assess the feasibility and safety of the SHURUI single-port robotic surgical system for a range of major urological surgeries.Methods:In this prospective,multicenter clinical trial,we examined the effectiveness of the SHURUI single-port robotic surgical system in urological interventions.The first 50 patients from four centers in China underwent single-port surgeries including partial nephrectomy,radical prostatectomy,partial adrenalectomy,and pyeloureteroplasty,exclusively by the SHURUI single-port robotic surgical system.The study's primary endpoints focused on the success of surgeries,defined as no deviations from planned procedures,no need for more than one port,and no re-operations within 24 h after surgery.Secondary endpoints encompassed a range of surgical metrics,functional outcomes,and patient demographic data.Clinical assessments were conducted before surgery,before discharge,and 1 month after discharge.Results:The surgical procedures were executed successfully without requiring intraoperative conversions or transfusions.Both estimated blood loss and operation durations were maintained within satisfactory limits.For each type of surgery,the mean console times and estimated blood loss were 179.8(standard deviation[SD]39.4)min and 125.6(SD 126.0)mL for radical prostatectomy,126.7(SD 47.8)min and 39.2(SD 54.4)mL for partial nephrectomy,112.6(SD 37.4)min and 20.0(SD 13.2)mL for partial adrenalectomy,and 148.0(SD 18.2)min and 18.0(SD 17.9)mL for pyeloureteroplasty,respectively.Across the cohort,17 patients experienced a total of 25 adverse events,while 10 postoperative complications,all rated as Clavien-Dindo grade I,were encountered by eight patients.All patients had shown recovery or improvement from these events before the end of this trial.Conclusion:The SHURUI single-port robotic surgical system demonstrated feasibility and safety in the performance of major urological surgeries.These initial findings highlight the system's potential,though further research and longer follow-up are required to assess long-term outcomes.
基金supported by the Science Committee of the Ministry of Higher Education and Science of the Republic of Kazakhstan within the framework of grant AP23489899“Applying Deep Learning and Neuroimaging Methods for Brain Stroke Diagnosis”.
文摘Deep learning now underpins many state-of-the-art systems for biomedical image and signal processing,enabling automated lesion detection,physiological monitoring,and therapy planning with accuracy that rivals expert performance.This survey reviews the principal model families as convolutional,recurrent,generative,reinforcement,autoencoder,and transfer-learning approaches as emphasising how their architectural choices map to tasks such as segmentation,classification,reconstruction,and anomaly detection.A dedicated treatment of multimodal fusion networks shows how imaging features can be integrated with genomic profiles and clinical records to yield more robust,context-aware predictions.To support clinical adoption,we outline post-hoc explainability techniques(Grad-CAM,SHAP,LIME)and describe emerging intrinsically interpretable designs that expose decision logic to end users.Regulatory guidance from the U.S.FDA,the European Medicines Agency,and the EU AI Act is summarised,linking transparency and lifecycle-monitoring requirements to concrete development practices.Remaining challenges as data imbalance,computational cost,privacy constraints,and cross-domain generalization are discussed alongside promising solutions such as federated learning,uncertainty quantification,and lightweight 3-D architectures.The article therefore offers researchers,clinicians,and policymakers a concise,practice-oriented roadmap for deploying trustworthy deep-learning systems in healthcare.
文摘ECharles Osterberg。Dr.Osterberg is a board-certified urologist with fellowship training in male genitourinary reconstruction.He moved to Austin(TX,USA)in 2016 to join the University of Texas-Dell Medical School as Associate Professor of Surgery.Dr.Osterberg specializes in reconstructive urology,genitourinary trauma,prosthetics,and robotic surgery.After serving as the Chief of Urology at Dell-Seton Medical Center-the main teaching hospital for Dell Medical School for 7 years,Dr.Osterberg transitioned his practice to Urology Austin,an affiliate of Urology America.At his new practice,he and his team have performed hundreds of complex urologic reconstructions and urethral stricture surgeries.
基金Supported by Jiangsu Provincial Administration of Traditional Chinese Medicine,No.MS2023017 and No.SLJ0311the Jiangsu Provincial Health Commission,No.ZDXK202251.
文摘BACKGROUND Gastroesophageal junction(GEJ)or gastrointestinal stromal tumor(GIST)are located in unfavorable parts of the stomach,due to the anatomical complexity of these regions,protecting the cardia while ensuring R0 resection is a major challenge for surgeons.CASE SUMMARY Two cases of GEJ stromal tumors were reported.Abdominal computed tomography scans revealed that both tumors were located at the GEJ,close to the posterior wall,with one tumor measuring greater than 5 cm.Both patients successfully underwent robot-assisted laparoscopic wedge resection of the stomach.The surgeries achieved R0 resection while preserving the cardia sphincter and maximizing gastric tissue preservation.Postoperatively,no symptoms such as gastroesophageal reflux or cardia stenosis were observed.Case 1:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD34,CD117,and DOG1,and negative for SMA,desmin,S-100,and SDHB(normal expression).The Ki-67 proliferation index was approximately 5%.Case 2:Postoperative pathology:GIST.Immunohistochemical results:Tumor cells were positive for CD117(++),CD34(++),DOG1(+++),and focal positivity for SMA.Negative for desmin,S-100(few cells positive),and SDHB(preserved expression).The Ki-67 proliferation index was approximately 10%.CONCLUSION The gastric tube-guided robotic-assisted laparoscopic resection is a safe and effective method for tumor resection while preserving the cardia,and it is worth further promotion in clinical practice.
文摘Objective To report our preliminary clinical experience and outcomes of uro-oncology procedures conducted utilizing the SSI Mantra^(TM)surgical robotic system.Methods Data of consecutive patients who underwent various robot-assisted uro-oncology procedures using the SSI Mantra^(TM)surgical robotic system at our institution between July 2022 and September 2023 were recorded.The specific surgical configurations employed with the SSI Mantra^(TM)for these procedures were duly noted.We assessed the feasibility of these procedures with this novel surgical robotic system and report the outcomes.Results A total of 156 patients were operated with the SSI Mantra^(TM)surgical robotic system.The spectrum of procedures performed comprised robot-assisted laparoscopic radical prostatectomy with bilateral extended pelvic lymph node dissection(n=77),robot-assisted radical cystectomy with bilateral extended pelvic lymph node dissection with extracorporeal urinary diversion(n=39),robot-assisted radical nephrectomy(n=32),robot-assisted partial nephrectomy(n=6),robot-assisted radical nephroureterectomy with bladder cuff excision(n=1),and bilateral robot-assisted video endoscopic inguinal lymph node dissection(n=1).One robot-assisted laparoscopic radical prostatectomy had to be converted to open in view of system malfunction.However,no system-related intraoperative complications or injuries were encountered.Conclusion The SSI Mantra^(TM)surgical robotic system demonstrates significant promise as an innovative robotic platform.In this single-center experience,we have demonstrated the feasibility of a diverse array of surgical procedures using this platform.Further research,involving a larger cohort of patients,is imperative to refine the operative techniques and comprehensively understand the perioperative outcomes of the SSI Mantra^(TM)surgical robotic system,particularly in comparison to other robotic surgical platforms.
文摘The increasing use of robotic surgery has seen a wave of technology ripple through global healthcare.Similar changes occurred in aviation several decades ago.New robot types have increased access for both patients and surgeons.The modern robotic curriculum therefore needs to train surgeons of varying experience,gaining access to several robot types,and based in centres around the world.Drawing on this analogy with aviation helps to derive principles for curriculum design,and considers humanemachine interface,non-technical skills,team training,and simulation.The components of the curriculum could be core(cross-platform),platform-specific,specialty-specific,and platform-transitional.Analogous concepts also emerge,including type rating,control as surgery-by-wire,spatio-haptic envelope,and virtual operations.The fourth industrial revolution sets anticipation for progress.
文摘Objective:To present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy(RLESS-RNU)with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma(UTUC).Methods:Fifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed at our medical institution(The Second Affiliated Hospital of Nanjing Medical University,Nanjing,China),from our prospectively maintained institutional database.The da Vinci^(®)Xi system(Intuitive Surgical,Sunnyvale,CA,USA)was utilized for surgical procedures in all patients.An in-depth analysis was conducted on their baseline demographic characteristics,pathological factors,and perioperative details.The complete surgical process and details are elaborated.Results:The median age of 15 patients was 67 years.The final pathology demonstrated 47%(7/15)patients with pT1 or lower and 47%(7/15)with pT3;one patient could not undergo pathological staging because of preoperative chemotherapy.The perioperative outcomes revealed that the mean operative time was 185(standard deviation[SD]23.05)min.The mean times of the trocar placement for primary and second docking were 15.00(SD 0.85)min and 8.00(SD 0.52)min,respectively.The median estimated blood loss was 55 mL.The mean drainage tube duration and postoperative hospital stay were 7.50 days and 11.00 days,respectively.After a mean follow-up period of 24.20 months,the relapse-free survival rate was 87%.Two patients experienced disease progression:one patient exhibited multifocal evidence of non-muscle invasive bladder cancer,and the other patient developed systemic recurrence.Conclusion:This study demonstrates that the modified technique for RLESS-RNU is safe and satisfactory for UTUC.
