Although robotic radical resection for hilar cholangiocarcinoma (HCCA) has been reported in some large hepatobiliary centers, biliary-enteric reconstruction (BER) remains a critical step that hampers the operation\'s success. This study aimed to evaluate the feasibility and quality of BER in robotic radical resection of HCCA and propose technical recommendations. A retrospective study was conducted on patients with HCCA who underwent minimally invasive radical resection at Zhejiang Provincial People\'s Hospital between January 2016 and July 2023. A 1:2 propensity score matching (PSM), widely used to reduce selection bias, was performed to evaluate the outcomes, especially BER-related data, between the robotic and laparoscopic surgery. Forty-six patients with HCCA were enrolled; ten underwent robotic-assisted resection, while the others underwent laparoscopic surgery. After PSM at a ratio of 1:2, 10 and 20 patients were assigned to the robot-assisted and laparoscopic groups, respectively. The baseline characteristics of both groups were generally well-balanced. The average liver resection time was longer in the robotic group than in the laparoscopic group (139.5 ± 38.8 vs 108.1 ± 35.8 min, P = 0.036). However, the former had less intraoperative blood loss [200 (50-500) vs 310 (100-850) ml], despite no statistical difference (P = 0.109). The number of residual bile ducts was 2.6 ± 1.3 and 2.7 ± 1.2 (P = 0.795), and anastomoses were both 1.6 ± 0.7 in the two groups (P = 0.965). The time of BER was 38.4 ± 13.6 and 59.1 ± 25.5 min (P = 0.024), accounting for 9.9 ± 2.8% and 15.4 ± 4.8% of the total operation time (P = 0.001). Although postoperative bile leakage incidence in laparoscopic group (40%) was higher than that in robotic group (10%), there was no significant difference between the two groups (P = 0.204); 6.7 ± 4.4 and 12.1 ± 11.7 days were observed for tube drawing (P = 0.019); anastomosis stenosis and calculus rate was 10% and 30% (P = 0.372), 0% and 15% (P = 0.532), respectively. Neither group had hemorrhage- or bile leakage-related deaths. Robotic radical resection for HCCA may offer perioperative outcomes comparable to conventional laparoscopic procedures and tends to be advantageous in terms of anastomosis time and quality. We are optimistic about its wide application in the future with the improvement of surgical techniques and experience.

METHODS: A systematic review and meta-analysis.
BACKGROUND: The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement.
METHODS: A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications.
RESULTS: Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75-3.91, P < 0.0001). However, there were no statistically significant differences in achieving \"perfect\" screw placement between the two groups (OR: 1.52, 95% CI: 0.95-2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25-64.74, P < 0.0001) but shorter postoperative hospital stays (MD: - 1.12, 95% CI: - 2.15 to - 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation.
CONCLUSIONS: Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss.

BACKGROUND: There are few available studies that compare the feasibility, efficacy, and safety of robotic pelvic lateral lymph node dissection compared to laparoscopic pelvic lateral lymph node dissection (LPLND) in advanced rectal cancer. This meta-analysis aims to compare perioperative outcomes between robotic and LPLND.
METHODS: We performed a systemic literature review of PubMed, Embase, and Web of Science databases. Perioperative parameters were extracted and pooled for analysis. This meta-analysis provided an analysis of heterogeneity and prediction intervals.
RESULTS: Five studies were included: 567 patients divided between 266 robotic and 301 LPLND. Overall operation time was longer in the robotic group than laparoscopic group (difference in means = 67.11, 95% CI [30.80, 103.42], p < 0.001) but the difference in the pelvic lateral lymph dissection time was not statistically significant (difference in means =  - 1.212, 95% CI [ - 11.594, 9.171], p = 0.819). There were fewer overall complications in the robotic than in the laparoscopic group (OR = 1.589, 95% CI [1.009, 2.503], p = 0.046), especially with respect to urinary retention (OR = 2.23, 95% CI [1.277, 3.894], p = 0.005). More pelvic lateral lymph nodes were harvested by robotic surgery than by laparoscopy (differences in means =  - 1.992, 95% CI [ - 2.421, 1.563], p < 0.001).
CONCLUSIONS: In this meta-analysis, robotic pelvic lateral lymph node dissection was associated with more pelvic lateral lymph nodes harvested and lower overall complications, especially urinary retention when compared to LPLND. Further studies are needed to reinforce these findings.

UNASSIGNED: Robotic radical hysterectomy (RRH) is a newly developed minimally invasive surgery that has been suggested as a substitute for laparoscopic radical hysterectomy (LRH). This meta-analysis aims to assess the clinical efficacy and safety of robot-assisted radical hysterectomy (RRH) for cervical cancer.
UNASSIGNED: A systematic search was conducted in four databases (Medline, Embase, Web of Science, and CENTRAL) for studies comparing the utilization of RRH and LRH in the treatment of cervical cancer. The search included articles published from the inception of the databases up until July 18, 2023. Meta-analyses were conducted to assess several surgical outcomes, including operation time, estimated blood loss, length of hospital stay, pelvic lymph nodes, positive surgical margin, total complications, one-year recurrence rate, one-year mortality, and one-year disease-free survival rate.
UNASSIGNED: Six studies were included for meta-analysis. In total, 234 patients were in the RRH group and 174 patients were in the LRH group. RRH had significantly longer operative time (MD=14.23,95% CI:5.27~23.20, P=0.002),shorter hospital stay (MD= -1.10,95% CI:-1.43~0.76, P <0.00001),more dissected pelvic lymph nodes(MD=0.89,95%CI:0.18~1.60, P =0.01) and less blood loss(WMD = -27.78,95%CI:-58.69 ~ -3.14, P=0.08, I2 = 80%) compared with LRH. No significant difference was observed between two groups regarding positive surgical margin (OR = 0.59, 95% CI 0.18~2.76, P=0.61), over complications (OR = 0.77, 95% CI, 0.46-1.28, P=0.31), one-year recurrence rate (OR = 0.19, 95% CI 0.03-1.15, P=0.13), one-year mortality rate (OR = 0.19, 95% CI 0.03-1.15, P=0.07) and disease-free survival at one year (OR = 1.92, 95% CI 0.32-11.50, P=0.48).
UNASSIGNED: RRH is an increasingly popular surgical method known for its high level of security and efficiency. It has many benefits in comparison to LRH, such as decreased blood loss, a higher quantity of dissected pelvic lymph nodes, and a shorter duration of hospitalization. Further multicenter, randomized controlled trials with extended follow-up durations are necessary to conclusively determine the safety and efficacy of RRH, as no significant differences were observed in terms of positive surgical margin, postoperative complications, 1-year recurrence, 1-year mortality, and 1-year disease-free survival.
UNASSIGNED: PROSPERO, identifier CRD42023446653.

Robot-assisted laparoscopic anterior resection is a novel technique. However, evidence in the literature regarding the advantages of robot-assisted laparoscopic surgery (RLS) is insufficient. The aim of this study was to compare the outcomes of RLS versus conventional laparoscopic surgery (CLS) for the treatment of sigmoid colon cancer. We performed a retrospective study at the Northern Jiangsu People\'s Hospital. Patients diagnosed with sigmoid colon cancer and underwent anterior resection between January 2019 to September 2023 were included in the study. We compared the basic characteristics of the patients and the short-term and long-term outcomes of patients in the two groups. A total of 452 patients were included. Based on propensity score matching, 212 patients (RLS, n = 106; CLS, n = 106) were included. The baseline data in RLS group was comparable to that in CLS group. Compared with CLS group, RLS group exhibited less estimated blood loss (P = 0.015), more harvested lymph nodes (P = 0.005), longer operation time (P < 0.001) and higher total hospitalization costs (P < 0.001). Meanwhile, there were no significant differences in other perioperative or pathologic outcomes between the two groups. For 3-year prognosis, overall survival rates were 92.5% in the RLS group and 90.6% in the CLS group (HR 0.700, 95% CI 0.276-1.774, P = 0.452); disease-free survival rates were 91.5% in the RLS group and 87.7% in the CLS group (HR 0.613, 95% CI 0.262-1.435, P = 0.259). Compared with CLS, RLS for sigmoid colon cancer was found to be associated with a higher number of lymph nodes harvested, similar perioperative outcomes and long-term survival outcomes. High total hospitalization costs of RLS did not translate into better long-term oncology outcomes.

To compare the clinical efficacy and safety of robot-assisted resection and open surgery for cholangiocarcinoma (CCA). We conducted a comprehensive search of PubMed, the Cochrane Library, and Embase databases for studies comparing treatment for CCA, covering the period from database inception to January 30, 2024. Two researchers will independently screen literature and extract data, followed by meta-analysis using Review Manager 5.3 software. A total of 5 articles with 513 patients were finally included. Among them, 231 in the robotic group, and 282 in the open group. The Meta-analysis revealed that the robotic group had a significant advantage in terms of intraoperative blood loss (MD =  - 101.44, 95% CI - 135.73 to - 67.15, P < 0.05), lymph node harvest(MD = 1.03, 95% CI 0.30- 1.76, P < 0.05) and length of hospital stay(MD =  - 1.92, 95% CI - 2.87 to- 0.97, P < 0.05). However, there were no statistically significant differences between the two groups in terms of transfusion rate (OR = 0.62, 95% CI 0.31-1.23, P > 0.05), R0 resection (OR = 1.49, 95% CI 0.89- 2.50, P > 0.05), 30-day mortality (OR = 1.68, 95% CI 0.43-6.65, P > 0.05) and complications (OR = 0.76, 95% CI 0.30- 1.95, P > 0.05). Robotic-assisted radical resection for CCA is feasible and safe, and its long-term efficacy and oncological outcomes need to be confirmed by further studies.

BACKGROUND: The primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST.
METHODS: The clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD).
RESULTS: A total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group. All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups.
CONCLUSIONS: Minimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.

Laparoscopic and robotic surgery is a challenge to the surgeon\'s hand-eye coordination ability, which requires constant practice. Traditional mentor training is gradually shifting to simulation training based on various models. Laparoscopic and robotic bilioenteric anastomosis is an important and difficult operation in hepatobiliary surgery. We constructed and optimized the reusable modular 3D-printed models of choledochal cyst. The aim of this study was to verify the ability of this optimized model to distinguish between surgeons with different levels of proficiency and the benefits of repeated practice. A total of 12 surgeons with different levels participated in the study. Operation completion time and OSATS score were recorded. The model was validated by Likert scale. Surgeons were shown the steps and contents before performing laparoscopic or robotic bilioenteric anastomosis using the model. Surgeons with different levels of experience showed different levels when performing laparoscopic bilioenteric anastomosis on this model. Repeated training can significantly shorten the time of laparoscopic bilioenteric anastomosis and improve the operation scores of surgeons with different levels of experience. At the same time, preliminary results have shown that the performance of surgeons on the domestic robotic platform was basically consistent with their laparoscopic skills. This model may distinguish surgeons with different levels of experience and may improve surgical skills through repeated practice. It is worth noting that in order to draw more reliable conclusions, more subjects should be collected and more experiments should be done in the future.

OBJECTIVE: To observe the safety and short-term outcomes of a new way of laparoscopic trocar placement in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux.
METHODS: The retrospective study included 32 patients under 14 years diagnosed with primary vesicoureteral reflux (VUR). All these patients underwent robotic-assisted Lich-Gregoir ureteral reimplantation in our department from December 2020 to August 2022. These patients were divided into the following groups according to the different ways of trocar placement: 13 patients in group single-port plus one (SR) and 19 patients in group multiple-port (MR). Patients\' characteristics as well as their perioperative and follow-up data were collected and evaluated.
RESULTS: There was no significant difference in the data regarding patients\' characteristics and preoperative data. These data included the grade of vesicoureteral reflux according to the voiding cystourethrogram (VCUG), and the differential degree of renal function (DRF) at the following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference between the two groups. During surgery, the time of artificial pneumoperitoneum establishment, ureteral reimplantation time, and total operative time in the SR group were longer than those in the MR group. Yet only the time of artificial pneumoperitoneum establishment shows a statistical difference (P < 0.0001). Also, the peri-operative data, including the volume of blood loss, fasting time, hospitalization, and length of time that a ureteral catheter remained in place, and the number of postoperative complications demonstrate no difference. In addition, the SFU grade and VCUG grade at the following time point also show no difference between the two groups.
CONCLUSIONS: The study demonstrates that SR in robotic-assisted Lich-Gregoir ureteral reimplantation has reached the same surgical effects as MR. In addition, the single-port plus one trocar placement receives a higher cosmetic satisfaction score from parents and did not increase the surgical time and complexity.

Current meta-analysis was performed to compare robotic hepatectomy (RH) with conventional open hepatectomy (OH) in terms of peri-operative and postoperative outcomes. PubMed, EMBASE, and the Cochrane Library were all searched up for comparative studies between RH and OH. RevMan5.3 software and Stata 13.0 software were used for statistical analysis. Nineteen studies with 1747 patients who received RH and 23,633 patients who received OH were included. Pooled results indicated that patients who received RH were generally younger than those received OH (P < 0.00001). Moreover, RH was associated with longer operative time (P = 0.0002), less intraoperative hemorrhage (P < 0.0001), lower incidence of intraoperative transfusion (P = 0.003), lower incidence of postoperative any morbidity (P < 0.00001), postoperative major morbidity (P = 0.0001), mortalities with 90 days after surgery (P < 0.0001), and shorter length of postoperative hospital stay (P < 0.00001). Comparable total hospital costs were acquired between RH and OH groups (P = 0.46). However, even at the premise of comparable R0 rate (P = 0.86), RH was associated with smaller resected tumor size (P < 0.00001). Major hepatectomy (P = 0.02) and right posterior hepatectomy (P = 0.0003) were less frequently performed in RH group. Finally, we concluded that RH was superior to OH in terms of peri-operative and postoperative outcomes. RH could lead to less intraoperative hemorrhage, less postoperative complications and an enhanced postoperative recovery. However, major hepatectomy and right posterior hepatectomy were still less frequently performed via robotic approach. Future more powerful well-designed studies are required for further exploration.