The objective of this study was to assess the perioperative outcomes of robot-assisted radical cystectomy (RARC) with intracorporeal ileal conduit (ICIC) using the hinotori surgical robot system.

This retrospective study included 20 consecutive patients with bladder cancer who underwent RARC with ICIC using hinotori from October 2023 to July 2024. Major perioperative outcomes were comprehensively analysed.

The median operative time, time using the robotic system, bowel reconstruction and urinary diversion time, and estimated blood loss were 435.0, 330.0, 122.5 min, and 175.0 mL, respectively. No marked intraoperative complications were observed. Perioperative, 30-day, and 90-day complications occurred at rates of 25%, 10%, and 0%, respectively. The learning curve tended to decrease in a case volume-dependent manner.

RARC using hinotori was successfully completed, and favourable perioperative outcomes were achieved without severe complications. This suggests that RARC using hinotori provides a potentially comparable alternative to conventional surgical systems.

Robotic surgery is a rapidly evolving field that will potentially play a pivotal role in future patient care. There are specific challenges that needs circumventing for each surgical specialty. This article discusses the current robotic surgical systems that have been developed or are currently in development for its application in hand surgery, which has its own unique complexity of comprising both bony and soft tissue procedures. Although robotics has been applied to a wide range of surgical specialties, its precise role in hand surgery remains a subject of further research. We delve into how this new technology is changing the landscape of the management of hand conditions, in both bony and microsurgical procedures, and future directions of this evolving field.

The safety and efficacy of the esketamine-based opioid-sparing anesthesia protocol, though validated, are understudied in robotic surgeries. This study used robot-assisted nephrectomy in Bama miniature pigs to explore its application. Six healthy Bama miniature pigs were randomly assigned to esketamine group (K) and control group (C). In Group K, based on the anesthetics of Group C, 0.5 mg/kg esketamine was used for anesthesia induction, and anesthesia was maintained with 0.5 mg/kg·h esketamine. Results showed Group K exhibited more stable hemodynamics intraoperatively, particularly at 5 min after the start of surgery and at the time of extubation (p < 0.05). Dosages of propofol (250 ± 8.7 mg vs. 347 ± 6.1 mg), sufentanil (12.3 ± 0.6 µg vs. 25 ± 1.0 µg) and remifentanil (498.3 ± 27.5 µg vs. 828.3 ± 20.2 µg) in group K were significantly reduced(p < 0.001). Recovery times for eyelid reflex (22.0 ± 2.0 min vs. 28.0 ± 2.6 min), extubation (24.7 ± 2.5 min vs. 32.3 ± 2.5 min), and righting reflex (37.7 ± 2.5 min vs. 48.7 ± 5.5 min) were significantly shorter in group K (p < 0.05). In conclusion, the esketamine-based opioid-sparing anesthesia protocol can be safely and effectively used in Bama miniature pigs undergoing robot-assisted nephrectomy.

Robotic-assisted laparoscopic prostatectomy (RALP) is the dominant surgical approach for prostate cancer worldwide. The steep learning curve in robotic surgery is eased by modular training and the da Vinci Surgical System© dual console, where supervisors can assume control of the robot from a secondary console if required. Here we evaluate the safety of robotic training by comparing pathological and peri-operative outcomes of RALPs performed predominantly by urology trainees supported by a modular training approach and dual console supervision with RALPs performed predominantly by specialist robotic surgeons. This prospective cohort study examines RALPs performed at a tertiary robotic training centre in Australia between February 2017 and August 2018. Each case was divided into 13 steps from port placement to specimen retrieval. A case was considered a 'trainee-lead case' if the trainee completed more than 75% of the operative steps. We compared patient demographics, operative parameters, peri-operative outcomes, and pathological outcomes between groups. Differences between groups were measured using Fisher's exact test for categorical data and the unpaired Student's t-test for continuous data. Of 126 cases in this study, 39 (31%) were trainee-led cases and 87 (69%) were specialist lead cases. There was no significant difference in operative or pathological outcomes between trainee-lead cases and specialist-lead cases. Our results compared favourably with local and international benchmarks. RALP performed by trainees using a modular training approach and supported by the dual console can have equivalent peri-operative and pathological outcomes to specialist-led cases. This is achieved by graded progression and dual console supervision.

Robot-assisted radical cystectomy (RARC) is becoming the standard treatment for bladder cancer patients. While this surgery using da Vinci has been widely reported, this report describes the initial experience of RARC with intracorporeal neobladder using the hinotori surgical robot system.

The patient was a 73-year-old man with muscle-invasive bladder cancer who underwent neoadjuvant chemotherapy followed by RARC with intracorporeal neobladder using hinotori. Surgery was successfully performed with a total operative time of 430 min, time using the robotic system of 375 min, and no intraoperative complications or need for blood transfusion. Postoperative recovery was favorable, with the patient discharged on day 12, and satisfactory continence was achieved.

This is the initial case report of RARC with intracorporeal neobladder using hinotori, providing a potentially comparable alternative to conventional surgical systems for RARC.

Background/Objectives: HINOTORI™ is a robotic-assisted surgical platform developed in Japan. It has been applied in urologic procedures such as robot-assisted radical prostatectomy (RARP) and partial nephrectomy (RAPN). This study aimed to evaluate the clinical performance of HINOTORI™ compared with the da Vinci® surgical system by analyzing outcomes of robot-assisted sacrocolpopexy (RSC) performed by a single skilled surgeon using a uniform surgical procedure. Methods: A total of 125 patients who underwent RSC for pelvic organ prolapse (POP) were analyzed. Surgical outcomes were compared between the HINOTORI™ (h-RSC group) and da Vinci® (d-RSC group) platforms. Evaluated parameters included operative time, robotic console time, anterior compartment dissection time, suture time per stitch, perioperative complications, hospital stay, and POP recurrence. Results: Operative and robotic console times were significantly longer in the h-RSC group (148 vs. 139 min, p < 0.005; 109 vs. 95 min, p < 0.001). Anterior compartment dissection time showed no significant difference (p = 0.58), but suture time per stitch was longer in the h-RSC group (76 vs. 60 s, p < 0.005), possibly due to limited suture-cutting functionality, requiring manual assistance. No significant differences were observed in perioperative complications, hospital stay, and POP recurrence. Conclusions: HINOTORI™ demonstrated surgical precision and safety comparable to the da Vinci® surgical system. It may serve as a viable alternative robotic platform, supporting broader adoption of robot-assisted surgical technologies.

Robotic single-port surgery represents the latest advance in the field of urology. Its benefits extend beyond enhanced cosmetic outcomes and offer a wide range of advantages for both patients and clinicians.

The transorbital approach (TOA) facilitates access to pathologies lateral to the optic nerve, a region that is difficult to access with an endonasal approach. In this study, we sought to investigate the feasibility of robotic-assisted surgery in lateral TOA.

Six colored-silicon-injected human postmortem heads were prepared for dissection. The DaVinci Xi model was used with a 0-degree camera, 8 mm in diameter. A black diamond microforceps with an 8-mm diameter and 10-mm jaw length was used. The entry point of V1 (superior orbital fissure), V3 (foramen ovale), and posterior root of the trigeminal ganglion were chosen as the surgical targets. The length from the entry opening to each target point was measured. The angles formed between pairs of target points were measured to obtain the horizontal angle (root of the trigeminal ganglion-entry-V1) and the vertical angle (root of the trigeminal ganglion-entry-V3).

Dissection was performed on 12 sides (6 specimens). The median distance from the entry point was 55 mm (range 50-58 mm) to the entry point of V1 (superior orbital fissure), 65 mm (range 57-70 mm) to the entry point of V3 (foramen ovale), and 76 mm (range 70-87 mm) to the root of the trigeminal ganglion. Meanwhile, the median of surgical angle between the entry point and the target was 19.1° (range 11.8-30.4°) on the horizontal angle and 16.5° (range 6.2-21.6°) on the vertical angle.

This study found that application of lateral TOA in robotic-assisted surgery is premature because of the large size of the tool. However, although the entrance in lateral TOA is narrow, the internal surgical space is wide; this offers potential for design of appropriate surgical tools to allow increase tool usage.

Robotic-assisted surgery (RAS) is a vital modality in the armamentarium of minimally invasive surgeons. The Hugo™ RAS system (Medtronic®) is one of the newest platforms on the market and has little surgical outcomes data. Herein, we describe our early experience performing robotic-assisted partial nephrectomy (RAPNx) with the Hugo™ RAS platform.

We conducted a retrospective review of patients who underwent a RAPNx with the Hugo™ RAS platform between April and December 2023 at the University Health Network in Toronto, ON. One surgeon performed all procedures using a three-arm transperitoneal approach. Anesthetic, operative, and pathologic reports were assessed to collect pre-, intra- and postoperative variables.

Eleven patients were included. The mean age was 51 years, 45.0% were female, and 63.6% had a right-sided mass. Mean tumor size was 2.9 cm. Mean warm ischemia time was 18.9 minutes (standard deviation [SD] 7.12) and mean estimated blood loss was 179 ml (SD 63.6). Mean robot docking time was 232 seconds (SD 106.5), mean total console time was 93 minutes (SD 21.4), and mean total operative time was 165.6 minutes (SD 34.1). There were no intraoperative complications. On pathology review, most tumors were a clear-cell variant (72.7%) and staged pT1a (81.8%). All margins were negative. One patient sustained a port site infection.

This is the first North American case series using the Hugo™ RAS platform for RAPNx. Our findings underscore that the platform is safe and effective for performing RAPNx with comparable outcomes to other robotic platforms.

Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors.

This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30 d) and late (from 31 to 90 d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence.

A total of 624 patients with a median age of 35 yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73 m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23 mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group.

With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.

Kangduo (KD) surgical robot is a novel robotic system in China, and some animal experiments and single-arm clinical trials have indicated its effectiveness, feasibility, and safety for urologic surgeries. This study intended to compare the performance and safety of the KD surgical robot with the da Vinci (DV) robotic system in patients who received urologic surgeries.

A total of 201 patients who received urologic surgeries were divided into the KD group (N = 60) and the DV group (N = 141) according to the actual surgical methods.

The median (range) operation time [180.0 (30.0-540.0) minutes vs. 130.0 (70.0-360.0) minutes] (P < 0.001) and indwelling time of abdominal drainage tube [5.0 (2.0-14.0) days vs. 3.0 (2.0-18.0) days] (P < 0.001) were longer, but the intraoperative blood loss [50.0 (10.0-200.0) mL vs. 50.0 (10.0-400.0) mL] (P < 0.001) was less in the KD group than the DV group. The median values of white blood cells at the 1st (P = 0.032) and 3rd (P = 0.022) day after surgery were decreased in the KD group compared to the DV group. The incidence of infection (11.7% vs. 29.1%) (P = 0.008) and fever (15.0% vs. 30.5%) (P = 0.023) was lower in the KD group compared to the DV group. Postoperative and follow-up parameters, including time of urinary incontinence improvement, administration of hemostatic, pain numeric rating scale score, Barthel's index score, and patient satisfaction, were not different between the two groups (all P > 0.05).

The KD surgical robot unveils satisfactory surgical performance compared to the DV robotic system in patients receiving urologic surgeries.

The application of minimally invasive surgery allows for radical and precise removal of the gynaecological lesion while simultaneously reducing the side effects and complications associated with surgical treatment. This paper aims to share our direct experience with the implementation of the CMR Versius robotic platform in the treatment of benign and malignant gynaecological lesions.

This study included patients who underwent hysterectomy in the Department of Obstetrics, Gynaecology, and Gynaecologic Oncology at the Regional Polyclinical Hospital in Grudziadz, Poland. A total of 50 patients were included in the study: 29 underwent laparoscopic surgery and 21 underwent robot-assisted surgery using the CMR Versius system.

It was found that in the case of non-radical hysterectomy, the duration of surgery differed significantly (96.5 vs. 134.6 min, p < 0.01) in the groups of patients undergoing laparoscopic and robotic surgery. There were also no statistically significant differences in loss of blood parameters, rate of complications and conversions to other type of surgery after the laparoscopic and robotic surgeries. Both groups did not differ significantly in terms of hospitalisation time after surgery.

Versius CMR surgical robot assistance provides safe and effective support for MIS procedures in gynaecology.

A minimally invasive approach is the most common technique for hiatal hernia repair. The robotic platform offers a unique advantage that addresses the limitations of a laparoscopic repair. The steps of a robotic hiatal hernia repair include reduction of hernia contents, dissection of hernia sac, circumferential dissection of esophagus with 2.5 to 3 cm of intraabdominal esophagus, crural closure, and partial or complete fundoplication. The robotic hiatal hernia repair has comparable perioperative outcomes to the laparoscopic approach. This article discusses current controversies, limitations, and new technologies.

Prostate cancer (PCa) is one of the most common cancers among men worldwide, and robot-assisted radical prostatectomy (RARP) is a widely used treatment for localized PCa. Achieving pentafecta outcomes, which include continence, potency, cancer control, free surgical margins, and no major complications, is a critical measure of surgical success and long-term prognosis. However, predicting these outcomes remains challenging. In this retrospective, single-center study, we analyzed data from 1,752 patients who underwent RARP for localized prostate adenocarcinoma between August 2009 and April 2023. The pentafecta outcome was achieved in 290 patients (16.6%). Multivariate analysis revealed that bilateral nerve sparing significantly increased the likelihood of achieving the pentafecta outcome (odds ratio 10.36, 95% CI: 5.75-18.66; p < 0.001). Preoperative potency and bilateral nerve sparing were also identified as key predictors. Nomograms were developed using preoperative and postoperative variables, including age, PSA level, biopsy Gleason score, clinical stage, pathological tumor stage, tumor grade, nerve sparing, and preoperative potency. Internal validation of the nomograms was performed using bootstrapping methods, demonstrating robust predictive performance. These nomograms provide valuable tools for personalized surgical planning and patient counseling and may be applicable to broader populations, given the inclusion of universally recognized predictive factors and rigorous validation. This study presents the development and validation of nomograms to predict pentafecta outcomes before and after RARP. These nomograms provide valuable tools for clinicians to estimate the likelihood of achieving postoperative pentafecta outcomes. Incorporating these nomograms into clinical practice may improve patient counseling and shared decision-making.

To compare operative and oncological outcomes, as well as the risk of postoperative complications in patients who underwent transperitoneal robot-assisted partial nephrectomy (RAPN) for renal tumours located either posteriorly or anterolaterally.

Retrospective, consecutive study including 451 patients who underwent transperitoneal RAPN for non-metastatic, localised renal tumours from May 2016 to April 2023. Operative data included duration of the procedure, warm ischaemia time, and blood loss; oncological data included surgical margins and recurrence; and 90-day postoperative complications were classified according to the Clavien-Dindo classification.

In total, 140 (31%) patients had tumours with a posterior location. The median follow-up was 3.3 (IQR 1.8-5.0) years. There were no differences in operative outcomes or length of hospital stay between the two groups. Positive surgical margins were recorded in 9% of the patients with posterior tumours compared to 7% of patients with anterolateral tumours, p = 0.60. The estimated probability of recurrence-free survival at 5 years was 95.2% (95% CI 87.4-98.2) for patients with posterior tumours and 96.7% (95% CI 92.3-98.6) for patients with anterolateral tumours, p = 0.4. Patients with posterior tumours had a similar risk of any complication (OR 1.24 [95% CI 0.80-1.91]) and CD ≥ III (OR 0.73 [95% CI 0.28-1.67]) compared to patients with anterolateral tumours.

This study found that patients with posterior tumours had longer operating times and hospital stays following transperitoneal RAPN compared to those with anterolateral tumours but without increased complications or poorer oncological outcomes.

The Hugo RAS system is characterized by its multimodular design, which leads to an increased docking effort. Exact data for docking time and the learning curve is missing. We describe for the first time the use of a laser-guided cart positioning to reduce the docking time. In this prospective monocentric study, the docking time was evalutated for a consecutive series of pelvic surgeries with the Hugo RAS system. In a subgroup, a cross-line laser was adapted at the cart for positioning using fix points at the ceiling. The medical personnel were classified as "inexperienced" with ≤ 5 consecutive dockings and as "experienced" with > 5 consecutive dockings. From 10/2023 to 08/2024, 82 procedures were performed with the Hugo RAS. For the evaluation 75 procedures could be considered. The mean docking time was 7.6 ± 3.5 min. There was a reduction in docking time from 13.5 ± 3.7 min in the first 5 procedures to 4.4 ± 0.9 min in the last 5 procedures (p < 0.001). Docking with laser (n = 45) was faster than without laser (n = 30) (6.2 ± 2.5 vs. 9.8 ± 3.7 min, p < 0.001). Faster docking time was observed with inexperienced surgical nursing staff with laser than without laser (10.4 ± 3.7 vs. 5.4 ± 1.4 min; p < 0.001). With experienced nursing staff, the laser had no influence (6.6 ± 1.3 vs. 6.7 ± 2.9 min; p = 0.9). As a reference docking time for daVinci Xi procedures was 2.4 ± 1.7 min (n = 5). Laser-guided cart positioning has a significant impact on docking time, especially for unexperienced medical personnel. Especially in the times of experienced staff shortage, laser-guided cart positioning can save operating time.

Urinary tract fistulas (UTFs) are abnormal connections between the urinary tract and adjacent structures such as the bowel, vagina, or blood vessels. UTFs result in significant personal, social, and financial challenges to patients worldwide. This review investigates the various causes, risk factors, symptoms, and historical evolution of repair techniques of UTFs. This focuses on the shift from open surgery to minimally invasive techniques, particularly the growing utilization of robot-assisted laparoscopic (RAL) approaches. This review emphasizes the growing role of RAL surgery in treating UTFs, citing its advantages of reduced blood loss, low recurrence rates, and decreased postoperative complications while acknowledging challenges such as limited access to the RAL platform and longer surgical times. The study concludes with advocacy for more widespread access to the RAL platform as well as more research, including randomized controlled trials, to further refine the body of evidence and promote patient outcomes.

Interventional Radiology is at the forefront of integrating advanced imaging techniques and minimally-invasive procedures to enhance patient care. The advent of Digital Health Technologies (DHTs), including artificial intelligence (AI), robotics, and extended reality (XR), is revolutionizing healthcare, particularly in IR due to its reliance on innovative technology and advanced imaging. Since 2016, the proportion of these DHT-related publications in IR has consistently increased. The proportion of AI-related studies published in IR was 69% higher than in surgery, XR-related studies were 94% higher, and robotics studies were 192% higher, indicating a more rapid growth rate in IR compared to surgery. This article explores the transformative impact of these technologies on IR, emphasizing their potential to enhance precision, efficiency, and patient outcomes. Despite the promising advancements, there is a lack of standardization and clinical consensus on the optimal use of DHTs in IR. The variability in IR procedures and imaging systems across hospitals complicates the standardization of workflows and comparison of studies. This underscores the importance of integrating DHTs as aids to IR practitioners rather than replacement, ensuring that these technologies enhance both clinical and procedural practice.

Rectal cancer is a malignant neoplasm that constitutes a significant public health challenge due to its high incidence and associated mortality. In this editorial, we comment on the article by Chan et al. In recent years, there has been progress in the development of new treatments for initial and metastatic rectal cancer due to introduction of techniques of innovative and minimally-invasive surgery (MIS) such as laparoscopy and robotic surgery. However, only a few studies have analyzed the feasibility, safety, and results of MIS in relation to open surgery, thereby highlighting the promising and superior results of MIS in functional and oncological terms. The findings were corroborated by the comparative study of Chan et al which evaluated the feasibility and safety of minimally invasive multivisceral resection (miMVR). A comparison of postoperative outcomes between open MVR and miMVR showed that miMVR presented less blood loss, fewer postoperative complications, and less morbidity. This editorial article is focused specifically on analysis of the characteristics of new minimally-invasive surgical techniques in rectal cancer, particularly in advanced stages. The importance of future research is emphasized by progress in knowledge, training, and clinical practice in the application of these surgical procedures for the treatment of advanced colorectal cancer.

Pancreatoduodenectomy (PD) is a complex abdominal surgery, and the adoption of robotic PD has been on the rise because of its numerous benefits. This study aimed to investigate the current PD trends, focusing on advancements in robotic surgery.

Between 2015 and 2023, 1231 patients underwent open PD, whereas 630 underwent robot-assisted PD (RAPD). Demographics and surgical outcomes were analyzed according to the time period. Moreover, a propensity score-matched (PSM) analysis was performed to evaluate the clinical outcomes.

The proportion of RAPD cases gradually increased from 6.3% in 2015 to 50.9% in 2020, reaching a plateau of >50% thereafter. The proportion of patients receiving neoadjuvant chemotherapy increased during the late period (11.4% vs. 17.6%), with many of these patients undergoing open PD. Additionally, RAPD was performed in patients with a high probability of postoperative pancreatic fistula. However, the two groups demonstrated no significant difference in the occurrence of clinically relevant postoperative pancreatic fistula (10.6% vs. 9.5%, p = .532). Among periampullary cancer cases, RAPD demonstrated comparable survival outcomes to open PD after PSM (5-year survival rate: 61.8% vs. 49.8%, p = .189).

RAPD has become a stable approach, accounting for over 50% of all PD cases in high-volume centers, and it can be safely performed. However, open PD remains important owing to the development of neoadjuvant therapy and the aging population. Therefore, establishing appropriate indications to maximize the benefits of both RAPD and open PD is necessary.

Introduction: This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. Methods: The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan-Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. Results: A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients' characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all p < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both p < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09-0.72; p = 0.02) but not the need for re-intervention. A Kaplan-Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14-0.94; p = 0.04). Conclusions: Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery.

To assess the present state of robotic surgery and the surgical approaches employed by urology departments utilizing robotic systems in Spain.

An email invitation was sent to heads of urology departments in public and private hospitals with surgical robots. A 78-question online questionnaire was distributed, and data were collected over 3 months. Of 82 invitations, 57.31% responded, mostly male (95.7%) urologists over 50 years old, with 77.8% having more than 20 years of practice. About 45.7% worked in both public and private settings. Most units use robots 1-3 days per week, with 56.1% of these units having 1-3 surgeons trained. 92.3% of respondents had laparoscopic experience, and 71.1% received robotic surgery training from the robot company. Radical prostatectomy, pyeloplasty, and cystectomy are mainly performed robotically, while other surgeries vary in approach.

Robotic surgery has been firmly established in Spain, although the percentage of surgeries in robotic units remains low. Radical prostatectomy, pyeloplasty, and radical cystectomy with diversion are the most commonly performed techniques using robotic approaches.

Introduction: This article juxtaposes case series with a systematic review to evaluate the feasibility, safety, and clinical outcomes of concurrent robotic multisite urological surgeries, specifically robot-assisted radical prostatectomy (RARP) and robot-assisted partial nephrectomy (RAPN), for synchronous prostate and kidney cancers. Aim: The aims of this study were to evaluate the feasibility, safety, and clinical outcomes of urological concurrent robotic multisite surgeries through a comparison of institutional findings with the existing literature. Materials and Methods: A retrospective analysis was conducted on eight institutional cases of concurrent robotic multisite surgeries performed between 2021 and 2024. The primary outcomes measured were operative time, blood loss, and postoperative complications. A systematic review of the literature was performed, searching PubMed, Embase, and Cochrane Library databases, with the last search conducted on 1 July 2024. Studies were included if they reported on concurrent robotic surgeries corresponding to the procedures performed at the institution, including RARP with RAPN, RARP with robotic transabdominal preperitoneal inguinal hernia repair (RTAPPIHR), and other multisite robotic surgeries. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. Descriptive statistics were used to analyze operative time and blood loss, with confidence intervals (CIs) calculated to assess precision. Categorical variables, including postoperative complications, were summarized using frequencies and percentages. Heterogeneity was assessed using the I2 statistic, with values above 50% indicating substantial heterogeneity. A random effects model was applied when necessary, and sensitivity analyses excluded studies with high risk of bias. Results: We describe a unique docking technique employed in our procedures, which allows for atraumatic transitions between surgeries using the same port sites. Our institutional cases demonstrated the feasibility and safety of concurrent robotic multisite surgery, with a mean operative time of 315 min (95% CI: 290-340) and mean blood loss of 300 mL (95% CI: 250-350). There were no significant intraoperative complications reported. These findings are consistent with the literature, where mean operative times range from 390 to 430 min and blood loss ranges from 200 to 330 mL. Notably, no positive surgical margins or declines in postoperative renal function were observed in our cases. The systematic review included nine retrospective studies involving 40 cases of concurrent RARP and RAPN, as well as eleven studies including 392 cases of RARP combined with RTAPPIHR. The findings from these studies support the feasibility and safety of concurrent surgeries, showing similar rates of operative time, blood loss, and postoperative complications. Conclusions: Concurrent robotic multisite surgeries, such as RARP combined with RAPN or RTAPPIHR, appear to be safe and feasible. Our data suggest these procedures are non-inferior to separate surgeries in terms of safety and complication rates. Potential benefits, including reduced operative times, shorter hospital stays, and more efficient resource use, may translate into cost savings, although no formal cost-effectiveness analysis was conducted. Limitations include the small sample size, retrospective design, and lack of long-term follow-up. Prospective trials are needed to validate these findings and further refine the techniques. Funding: this review did not receive any external funding. Registration: this review was not registered in any public protocol registry due to its comparative retrospective nature.

Robot-assisted laparoscopic radical prostatectomy (RARP) is the most common robotic procedures performed in urologic oncology. The Hugo Robot-Assisted Surgery (RAS) System (Medtronic, USA©) has recently been launched on the market and is characterized by the modularity of four different independent arm carts. The aim of this study is to describe and evaluate safety and feasibility of three-arms setting for RARP using the Hugo RAS™ System in a large case series.

Between October 2022 and December 2023, a large case series of patients from two tertiary referral center who underwent RARP through HUGO™ RAS were prospectively enrolled. Informed written consent was obtained before the procedure and a three-arms setting was used in every case. Follow-up was scheduled according to EAU guidelines.

A total of 86 patients were included in this study and underwent RARP with Hugo™ RAS System. Median Console time time was 114 min (IQR, 75-150), median docking time 4 min (IQR, 3-5). Lymphadenectomy was successfully performed when indicated in 19 patients (22.1%). A vesicourethral anastomosis using the modified Van Velthoven technique was successfully achieved in all cases. No post-operative complications > Clavien II up to 30 post-operative days were reported. In all patients, catheter was removed on the 7th postoperative day.

We conducted the first large case series of RARP through the novel Hugo™ RAS System using a three-arms configuration. This innovative robotic platform showed an easily accessible docking system, providing excellent perioperative outcomes.

This study aimed to construct a novel pelvis-prostate model BPPP which consists of body mass index (BMI), prostate volume (PV), pelvic cavity index (PCI) and prostate-muscle index (PMI) to predict the immediate urinary continence after Retzius-sparing robot assisted laparoscopic radical prostatectomy (RS-RARP). The perioperative data of patients with prostate cancer who underwent RS-RARP in the department of urology of Nanjing Drum Tower Hospital from June 2018 to June 2022 were retrospectively analyzed. 280 patients were eligible for this study in total. Multivariate analysis showed that BMI, PV, PCI, PMI and NVB preservation were significantly associated with immediate urinary continence after RS-RARP. Subgroup analysis showed that patients with low BMI, low PV, high PCI and high PMI had a higher recovery rate of immediate urinary continence. The area under the curve of BPPP (BMI + PV + PCI + PMI) for predicting the immediate recovery of urinary continence after RS-RARP was 0.726. Delong test showed that the area under the curve of the combined test for predicting the immediate urinary continence after RS-RARP was better compared with single parameter (p < 0.05). In conclusion the novel pelvis-prostate model BPPP may predict the immediate urinary continence after RS-RARP, providing information for preoperative decision-making.

Using the Senhance robotic system and Senhance ultrasonic energy device for robotic-assisted radical nephrectomy with hilum lymph node dissection demonstrated safety and feasibility in managing a large renal tumor without the need for open conversion or transfusion, offering a cost-effective solution.

To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties.

A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed.

Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002).

Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.

To assess the impact of the learning curve (LC) on perioperative and long-term functional outcomes of a consecutive single-centre series of robot-assisted radical cystectomy with Padua intracorporeal orthotopic neobladder.

Patients treated between 2013 and 2022 were included, with ≥1 year of follow-up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1-year day- and night-time continence. Uni- and multivariable Cox regression analyses identified predictors of day- and night-time continence recovery. Day-time continence was defined as 'totally dry' (no pads), night-time continence as pad wetness ≤50 mL (one safety pad).

Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30-day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1-year day- and night-time continence probabilities displayed a significant improving trend (day-time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night-time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day- (hazard ratio [HR] 1.008; P < 0.001) and night-time continence (HR 1.004; P = 0.03) over time.

Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10-year analyses, we observed a significant improving trend for both the 1-year day- and night-time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day- and night-time continence rates.

Background: The Hugo™ Robot-Assisted Surgery (RAS) system is a new cutting-edge robotic platform designed for clinical applications. Nevertheless, its application for cystic renal tumors has not yet been thoroughly investigated. In this context, we present an initial series of Robot-Assisted Partial Nephrectomy (RAPN) procedures carried out using the Hugo™ RAS system for cystic renal masses. Methods: Between October 2022 and January 2024, twenty-seven RAPN procedures for renal tumors were performed at Fondazione Policlinico Universitario Campus Bio-Medico. Our prospective board-approved dataset was queried for "cystic features" (n = 12). Perioperative data were collected. The eGFR was calculated according to the CKD-EPI formula. Post-operative complications were reported according to the Clavien-Dindo classification. Computed tomography (CT) scans for follow-up were performed according to the EAU guidelines. Trifecta was defined as the coexistence of negative surgical margin status, no Clavien-Dindo grade ≥ 3 complications, and eGFR decline ≤ 30%. Results: All the patients successfully underwent RAPN without the need for conversion or additional port placement. The median docking and console time were 5.5 (IQR, 4-6) and 79.5 min (IQR, 58-91 min), respectively. No intraoperative complications occurred, as well as clashes between instruments or with the bedside assistant. Two minor postoperative complications were recorded (Clavien-Dindo II). At discharge, serum creatinine and eGFR were comparable to preoperative values. Only one patient (8.4%) displayed positive surgical margins. The rate of trifecta achievement was 91.7%. Conclusions: RAPN for cystic renal masses using the novel Hugo™ RAS system can be safely and effectively performed. This robotic system provided satisfactory peri-operative outcomes, preserving renal function and displaying low postoperative complications and a high trifecta rate achievement.

The advent of robotic surgery has significantly impacted various surgical fields, particularly urology, gynecology, general surgery, and cardiac surgery. While the da Vinci robotic platform has been predominant over the past two decades, recent years have witnessed the emergence of new robotic platforms in Japan, now actively used in clinical practice. Currently, the available systems in Japan, alongside the da Vinci, include the Hinotori, Senhance, Hugo Ras, and Saroa surgical systems. This review focuses on comparing the notable functions of each system in urologic surgery, emphasizing the areas in which they differ from the da Vinci robotic platform. The development of new robotic systems is ongoing, promising not only cost reductions but also the introduction of innovative devices and educational systems. Soft robotics, which constructs robotic devices using soft, adaptable materials, has the potential to become central to the next generation of robotic surgery. Moreover, the collaboration between Artificial Intelligence (AI) and robotic surgery significantly contributes to increasing efficiency, accuracy, and safety in the medical field, with more innovative applications expected in the future.

Hugo Robot-Assisted Surgery (RAS) System has been conceived with enhanced modularity but its role for nephron-sparing surgery setting still remains poorly explored. We aimed to describe our experience in robot-assisted partial nephrectomy (RAPN) with a three-arms setting for the first off-clamp series using the new Hugo RAS System.

Patients were placed on an extended flank position at the margin of the surgical bed with a slightly flexion (45°). The first 11 mm robotic trocar (camera port) was placed along the pararectal line 14 ± 2 cm far from the umbilicus. The pneumoperitoneum was then induced through the AirSeal system (SurgiQuest, Milford, Connecticut, USA©). Two more 8 mm operative robotic ports were placed under direct vision, either 8 ± 1 cm far from optic's port. Two 12 mm laparoscopic ports for bed-assistant were placed between robotic ports. Monopolar curved shears, fenestrated grasper, and large needle driver were used in a three-instruments configuration.

Off-clamp RAPN was successfully performed in seven patients with cT1 renal masses using a trans-peritoneal route. Median port placement and docking time was 6 min (IQR, 4-8 min). Hemostasis was achieved through renorraphy using a single transfix stitch with sliding clips technique. There was no need for additional ports placement. No intraoperative complications occurred, no clashing of robotic instruments or between the robotic arms was observed. No technical failures of the system occurred. Median console time was 83 min (IQR, 68-115 min). Median estimated blood loss were 200 ml (IQR, 50-400 ml). All patients were discharged between post-operative day 2 and 3, without the need of hospital readmission. No complications were recorded within the first 30 post-operative days.

We performed the first series of off-clamp RAPN using the novel HUGO RAS System. This novel robotic platform showed an easy-friendly docking system, providing excellent perioperative outcomes with a simple three-arms configuration.

Background/Objectives: The absence of validated tools to assess the skill transfer from laparoscopy to robotic surgery remains an unsolved issue in the context of robot-assisted partial nephrectomy (RAPN). We aimed to describe and validate a novel proficiency score to critically evaluate the surgical quality of RAPN with the Hugo™ RAS System (Medtronic, Minneapolis, MN, USA). Methods: Between October 2022 and September 2023, 27 consecutive patients underwent off-clamp RAPN for localized renal tumors at our institution. To analyze the learning curve (LC), the cohort was chronologically divided into two phases of 6 months each. Proficiency was defined as the achievement of trifecta while maintaining a comparable intraoperative time in the interquartile range of laparoscopic partial nephrectomy performed by the same surgeon. A logistic binary regression model was built to identify predictors of proficiency achievement. Results: A proficiency score was achieved in 14 patients (74.1%). At univariable analysis, number of consecutive procedures > 12 (OR 13.7; 95%CI 2.05-21.1, p = 0.007), pathological tumor size (OR 0.92; 95%CI 0.89-0.99, p = 0.04) and essential blood hypertension (OR 0.16; 95%CI 0.03-0.82, p = 0.02) were found to be predictors of proficiency score. At multivariable analysis, after adjusting for potential confounding factors, number of consecutive procedures > 12 (OR 8.1; 95%CI 1.44-14.6, p = 0.03) was the only independent predictor of proficiency score achievement. Conclusions: Our results showed that the skills of an experienced laparoscopic surgeon are transferrable to the novel Hugo™ RAS System in the context of nephron-sparing surgery. Improved surgical quality may be expected after completing the first 12 consecutive procedures.

(1) Background: Laparoscopic partial nephrectomy (LPN) is still performed in many referred urological institutions, representing a valid alternative to robot-assisted partial nephrectomy (RAPN). We aimed to compare trifecta outcomes of LPN and RAPN with the Hugo™ RAS System. (2) Methods: Between October 2022 and September 2023, eighty-nine patients underwent minimally invasive partial nephrectomy (group A, RAPN = 27; group B, Laparoscopic PN = 62) for localized renal tumors at our Institution. Continuous variables were presented as median and IQR and compared by means of the Mann-Whitney U test, while categorical variables were presented as frequencies (%) and compared by means of the χ2 test. (3) Results: Group A showed a higher rate of male patients (81.5% vs. 59.7%, p = 0.04) and a higher trend towards larger clinical tumor size (34 vs. 29 mm, p = 0.14). All the other baseline variables were comparable between the two groups (all p > 0.05). Regarding post-operative data, group A displayed a lower operative time (92 vs. 149.5 min, p = 0.005) and a shorter hospital stay (3 vs. 5, p = 0.002). A higher rate of malignant pathology was evidenced in group A (77.8% vs. 58.1%, p = 0.07) as well as a lower trend towards positive surgical margins (3.7% vs. 4.8%, p = 0.82), even if not statistically significant. (4) Conclusions: The rate of trifecta achievement was 92.6% and 82.3% for group A and B (p = 0.10), respectively. In terms of trifecta outcomes, RAPN using the Hugo™ RAS System showed comparable results to LPN performed by the same experienced surgeon.

Medtronic launched the Hugo Robotic-Assisted Surgery (RAS) System in 2021, offering a modular alternative to the incumbent market leader in surgical robotics, the Intuitive da Vinci (dV) surgical system. A detailed technical review of the Hugo RAS was conducted to explore the strengths and weaknesses of this new robotic surgical system. Each component of the system-vision tower, arm cart, and surgeon console-was compared against the existing dV systems. The docking process, instrumentation, and external arm movement trajectories were analyzed. The modular Hugo RAS provides the possibility of operating using up to four arm carts. It has certain design features that are unique to itself, and others that have been implemented to address the shortcomings of the dV Si. While Medtronic's first-generation robot offers distinct advantages over the older Intuitive systems, the true test of its mettle will be its performance compared to the latest dV Xi.

Robotic surgery represents a milestone in surgical procedures, offering advantages such as less invasive methods, elimination of tremors, scaled motion, and 3D visualization. This in-depth analysis explores the complex biochemical effects of robotic methods. The use of pneumoperitoneum and steep Trendelenburg positioning can decrease pulmonary compliance and splanchnic perfusion while increasing hypercarbia. However, robotic surgery reduces surgical stress and inflammation by minimizing tissue trauma. This contributes to faster recovery but may limit immune function. Robotic procedures also limit ischemia-reperfusion injury and oxidative damage compared to open surgery. They also help preserve native antioxidant defenses and coagulation. In a clinical setting, robotic procedures reduce blood loss, pain, complications, and length of stay compared to traditional procedures. However, risks remain, including device failure, the need for conversion to open surgery and increased costs. On the oncology side, there is still debate about margins, recurrence, and long-term survival. The advent of advanced technologies, such as intraoperative biosensors, localized drug delivery systems, and the incorporation of artificial intelligence, may further improve the efficiency of robotic surgery. However, ethical dilemmas regarding patient consent, privacy, access, and regulation of this disruptive innovation need to be addressed. Overall, this review sheds light on the complex biochemical implications of robotic surgery and highlights areas that require additional mechanistic investigation. It presents a comprehensive approach to responsibly maximize the potential of robotic surgery to improve patient outcomes, integrating technical skill with careful consideration of physiological and ethical issues.