UNASSIGNED: Robotic-assisted total knee arthroplasty (RATKA) has been reported to enhance operative decision-making. The purpose of this study was intended to assess the predictive accuracy of bone cuts, lower limb alignment, and component size of a novel system for RATKA preoperatively and intraoperatively.
UNASSIGNED: Preoperatively planned bone cuts, limb alignment, and component size were projected using a reconstructed 3D model. Intraoperative bone cuts and postoperative limb alignment were measured. Errors between planned and real bone cuts, limb alignment, and component size were compared.
UNASSIGNED: The mean absolute errors for bone cuts and alignment were within 1.40mm/1.30° with a standard deviation (SD) of 0.96mm/1.12°. For all errors of bone cuts and alignment compared with the plan, there were no statistically significant differences except for the lateral distal of femoral cuts (P=0.004). The accuracy for predicting the femoral, tibial, and polyethylene component sizes was 100% (48/48), 90% (43/48), and 88% (42/48), respectively. Regarding all mean absolute errors of bone cuts and alignments, no significant differences were observed among surgeons.
UNASSIGNED: The novel robotically-assisted system for RATKA donated reliable operative decision-making based on the predictive accuracy regardless of the surgeon\'s level of experience.

Robotic surgery has been increasingly adopted in various surgical fields, but the cost-effectiveness of this technology remains controversial due to its high cost and limited improvements in clinical outcomes. This study aims to explore the health economic implications of robotic pancreatic surgery, to investigate its impact on hospitalization costs and consumption of various medical resources. Data of patients who underwent pancreatic surgery at our institution were collected and divided into robotic and traditional groups. Statistical analyses of hospitalization costs, length of stay, costs across different service categories, and subgroup cost analyses based on age, BMI class, and procedure received were performed using t tests and linear regression. Although the total hospitalization cost for the robotic group was significantly higher than that for the traditional group, there was a notable reduction in the cost of medical consumables. The reduction was more prominent among elderly patients, obese patients, and those undergoing pancreaticoduodenectomy, which could be attributed to the technological advantages of the robotic surgery platform that largely facilitate blood control, tissue protection, and suturing. The study concluded that despite higher overall costs, robotic pancreatic surgery offers significant savings in medical consumables, particularly benefiting certain patient subgroups. The findings provide valuable insights into the economic viability of robotic surgery, supporting its adoption from a health economics perspective.

OBJECTIVE: The Surgical Apgar Score quantifies three intraoperative parameters: lowest heart rate, lowest mean arterial pressure, and estimated blood loss (EBL). This scoring system predicts postoperative complications based on these measured factors. The aim of this study was to investigate the value of modified Surgical Apgar Score (mSAS) in predicting postoperative complications in patients with rectal cancer treated with robotic surgery in order to improve the survival and quality of life of rectal cancer patients.
METHODS: The study included patients with rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to December 2023. In minimally invasive surgery, we developed a modified Surgical Apgar Score (mSAS) tailored for robotic rectal cancer surgery, incorporating an adjusted threshold for EBL. This threshold was derived from quartile analysis of a cohort of 524 patients, with a median EBL of 100 mL (IQR 80-130 mL). We analyzed the association of postoperative complications with low mSAS.
RESULTS: This study included 524 patients, of which 91 (17.4%) experienced complications and 22 (4.2%) suffered severe complications. mSAS of 6 provided maximal Youden index and were determined as the cut-off values. The area under the ROC curve for predicting complications using the mSAS was 0.740. Univariate and multivariate analyses indicated that an older age, lower tumor localization, longer operation time, radiotherapy alone, combined chemoradiotherapy, and lower mSAS as independent risk factors for complications. The AUC of the prediction nomogram was 0.834 (95% CI 0.774-0.867). The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve ft the diagonal well.
CONCLUSIONS: This study suggests that mSAS might be a valuable predictive indicator for postoperative complications following robotic rectal cancer surgery, with potentially higher clinical utility.

UNASSIGNED: The Da Vinci Surgical System (DVSS) has the advantages of minimal invasion, rapid recovery, safety, and reliability. Although the DVSS has been widely used in various abdominal surgeries, descriptions of its use in robot-assisted retroperitoneal tumor resection (RRTR) are limited to case reports; large-sample systematic studies are lacking. The present study was performed to analyze the data of RRTR in our center, summarize our experience, and provide a reference for other retroperitoneal tumor centers.
UNASSIGNED: We retrospectively analyzed the clinical data of 105 patients who underwent RRTR at the Affiliated Hospital of Qingdao University from January 2015 to December 2022. Logistic univariate and multivariate analyses were performed to identify independent risk factors affecting RRTR. A receiver operating characteristic curve was used to find the cut-off value, which was then included in the logistic multivariate analysis for verification.
UNASSIGNED: Among the 105 patients, 87 successfully underwent RRTR (DVSS group) and 18 underwent conversion to open surgery (conversion group). There was no significant difference in sex, age, body mass index, history of abdominal surgery, or tumor location between the two groups (P > 0.05). The maximum tumor diameter [odds ratio (OR), 1.041; 95% confidence interval (CI), 1.015-1.067; P = 0.002] and pathological property (OR, 8.646; 95% CI, 2.370-31.544; P = 0.001) were independent risk factors for conversion to open surgery. Further analysis confirmed that the success rate of RRTR was higher for tumors with a maximum diameter of ≤64 mm and benign tumors. Based on our experience and statistical results, we believe that retroperitoneal tumors that meet the following criteria have a higher success rate of DVSS resection: maximum tumor diameter of ≤64 mm, benign tumors, the tumor has relatively clear boundary, no obvious invasion of surrounding tissues and organs, and no need for combined organ resection.
UNASSIGNED: RRTR is safe and effective in the treatment of RPT, and the clinical prognosis is similar to that of open surgery. The success rate of RRTR in patients with appropriate surgical indications for this procedure is higher.

Although the safety and short-term outcomes of robotic surgery for sigmoid colon and rectal cancer patients are well-documented, there is limited research on the long-term survival outcomes of robotic colorectal surgery. This is a retrospective study that includes 502 patients who underwent either laparoscopic or robotic anterior resection and abdominoperineal resection for rectal or sigmoid colon cancer between August 2016 and September 2021. All patients were diagnosed with rectal or sigmoid colon adenocarcinoma. Propensity score matching (PSM) was implemented to minimize selection bias. Perioperative outcomes, complication rates, and pathological data were evaluated and compared. The 5-year overall survival rate and disease-free survival rate were calculated and compared. Before matching, patients in the robotic group had earlier pathological T and N stages and were more likely to have received neoadjuvant chemoradiotherapy compared to the laparoscopic group. After matching, most clinicopathological outcomes were similar between the two groups, but the robotic group had longer operative times and a lower conversion rate to open surgery compared with laparoscopic group. After matching for clinical factors, the 5-year DFS rates were 88.19% for the robotic group and 82.46% for the laparoscopic group (P = 0.122), and the OS rates were 90.5% and 79.5% (P = 0.342), showing no significant differences. In the stratified analysis, patients in the robotic surgery group had significantly higher 5-year DFS rates in the following subgroups: age < 65 years, TNM stage I-II, received neoadjuvant therapy, and primary tumor located in the rectum. The safety and efficacy of robotic surgery for sigmoid colon and rectal cancer were validated compared to laparoscopic surgery, with both groups of patients exhibiting comparable long-term prognoses.

BACKGROUND: With the popularization of robotic surgical systems in the field of surgery, robotic gastric cancer surgery has also been fully applied and promoted in China. The Chinese Guidelines for Robotic Gastric Cancer Surgery was published in the Chinese Journal of General Surgery in August 2021.
METHODS: We have made a detailed interpretation of the process of robotic gastric cancer surgery regarding the indications, contraindications, perioperative preparation, surgical steps, complication, and postoperative management based on the recommendations of China\'s Guidelines for Robotic Gastric Cancer Surgery and supplemented by other surgical guidelines, consensus, and single-center experience.
RESULTS: Twenty experiences of perioperative clinical management of robotic gastric cancer surgery were described in detail.
CONCLUSIONS: We hope to bring some clinical reference values to the front-line clinicians in treating robotic gastric cancer surgery.
BACKGROUND: The guidelines were registered on the International Practice Guideline Registration Platform ( http://www.guidelines-registry.cn ) (registration number: IPGRP-2020CN199).

OBJECTIVE: The purpose of this study was to retrospectively compare the short-term outcomes of robotic- (RAD) and laparoscopic-assisted duodenal diamond-shaped anastomosis (LAD) in neonates.
METHODS: Neonates who underwent RAD (n = 30) or LAD (n = 38) between January 2019 and December 2022 were analyzed retrospectively. Major patient data were collected, including preoperative, intraoperative, and postoperative information.
RESULTS: All patients were neonates below the age of 30 days weighing 4 kg. Thirty (44.1%) neonates underwent RAD and 38 neonates (55.9%) underwent LAD. Compared to the LAD group, the RAD group had a shorter intra-abdominal operation time (RAD, 60.0(50.0 ~ 70.0) min; LAD, 79.9(69.0 ~ 95.3) min; p < 0.001). There were no significant differences in immediate and 30-day complications between the two groups.
CONCLUSIONS: RAD is safe and effective in neonates. Compared to traditional LAD, RAD showed comparable results.

UNASSIGNED: To explore the method of preventing heat steam induced skin damage in robotic nipple-sparing mastectomy and immediate breast reconstruction (R-NSM-IBR) using Da Vinci Robots.
UNASSIGNED: A clinical data of 128 female patients with breast cancer, who were treated with R-NSM-IBR between September 2022 and December 2023 and met the selection criteria, was retrospectively analyzed. During robotic nipple-sparing mastectomy, the breasts were covered with gauze cooled by ice water to reduce skin temperature in 99 cases (group A) and were not treated in 29 cases (group B). There was no significant difference in the age, affected side, body mass index, pathological type of breast cancer, and constituent ratios of adjuvant chemotherapy and neoadjuvant chemotherapy between the two groups ( P>0.05). Intraoperative breast skin temperature, unilateral robotic nipple-sparing mastectomy time, and the incidence of complications of breast heat steam induced skin damage were recorded.
UNASSIGNED: The time for unilateral robotic nipple-sparing mastectomy was (77.18±9.23) minutes in group A and (76.38±12.88) minutes in group B, with significant difference between the two groups ( P<0.05). The intraoperative breast skin temperature was significantly lower in group A than in group B [(25.61±0.91)℃ vs (33.38±1.14)℃; P<0.05]. Seven cases of heat steam skin damage occurred during operation, including 2 cases (2.0%) in group A and 5 cases (17.2%) in group B, with a significant difference in incidence between the two groups ( P<0.05). Among them, 1 patient in group B had a vesication rupture and infection, which eventually led to the removal of the implant; the rest of the patients were treated with postoperative interventions for skin recovery.
UNASSIGNED: The use of breast covered with gauze cooled by ice water during R-NSM-IBR can effectively reduce the risk of heat steam induced skin damage.
UNASSIGNED: 探讨达芬奇机器人保留乳头乳晕乳腺切除即刻假体乳房重建术（robotic nipple-sparing mastectomy and immediate breast reconstruction，R-NSM-IBR）中预防热蒸汽损伤皮肤组织的方法。.
UNASSIGNED: 回顾性分析2022年9月—2023年12月接受R-NSM-IBR治疗且符合选择标准的128例乳腺癌女性患者临床资料。术中乳腺切除期间，99例采用覆盖冰水冷却后纱布来降低乳房皮肤温度（A组），29例不作处理（B组）。两组患者年龄、手术侧别、身体质量指数、乳腺癌病理类型及接受辅助化疗、新辅助化疗构成比比较，差异均无统计学意义（ P>0.05）。记录并比较术中乳房表面温度、单侧乳腺切除时间以及术中乳房热损伤并发症发生情况。.
UNASSIGNED: A、B组单侧乳腺切除时间分别为（77.18±9.23）、（76.38±12.88）min，差异有统计学意义（ P<0.05）。A组术中乳房表面温度为（25.61±0.91）℃，低于B组（33.38±1.14）℃，差异亦有统计学意义（ P<0.05）。术中7例发生皮肤热损伤，其中A组2例（2.0%）、B组5例（17.2%），发生率差异有统计学意义（ P<0.05）。其中，B组1例水疱破裂并感染，最终导致假体取出；其余患者均干预处理后恢复正常。.
UNASSIGNED: R-NSM-IBR术中采用在乳房表面覆盖冰水冷却后纱布降温方法可有效降低热蒸汽损伤皮肤的风险。.

UNASSIGNED: To review the research progress related to endoscopic surgery and robotic surgery for breast diseases, aiming to provide references for clinical practice.
UNASSIGNED: The recent domestic and international literature on endoscopic surgery and robotic surgery for breast diseases was reviewed, then the challenges in their development, the innovative evolution of endoscopic surgery combined with clinical practice by our team, and its clinical applications were summarized.
UNASSIGNED: Traditional endoscopic surgery, despite its advantages such as minimal invasiveness, good cosmetic outcomes, and high patient\'s satisfaction, has been limited in its development due to specific difficulties in establishing the operative field. Our team innovatively proposed the \"reverse sequence method\" and the Huaxi Hole 1 theory and methods, cleverly altering the surgical procedure sequence, adding small operative orifices to transform single-port operations into multi-port ones, effectively overcoming the challenges restricting the advancement of endoscopic surgery in the field of breast diseases, thereby enabling further proliferation of endoscopic procedures. In terms of breast endoscopic reconstruction surgery, the parachute patch technique has broadened the indications for reconstruction surgery, benefiting patients with a certain degree of breast ptosis; and the postoperative adjustment concept, through early intervention in the post-reconstruction breast shape, has further refined the reconstruction procedure. Robot-assisted surgery derived from endoscopic surgery theory has further enhanced the precision and stability of surgeries, reducing surgical risks; however, excessive time and economic costs are urgent issues that must be addressed.
UNASSIGNED: Through theoretical innovations, endoscopic surgery has been applied in the excision and reconstruction of breast lesions, while robotic surgery shows promising applications in autologous breast reconstruction, especially in the latissimus dorsi reconstruction field. Nevertheless, the lack of high-level large-sample, multi-center randomized controlled clinical trials to confirm its surgical safety, oncological safety, and postoperative cosmetic outcomes is an important direction for future research.
UNASSIGNED: 对针对乳腺疾病开展的腔镜和机器人手术相关研究进展进行综述，为临床提供参考。.
UNASSIGNED: 查阅近年来国内外乳腺疾病腔镜与机器人手术相关研究文献，从其发生发展的困境、本团队结合临床实践对腔镜手术的创新性演变及其临床应用等方面进行总结分析。.
UNASSIGNED: 传统腔镜手术尽管具备创伤小、美容学效果好、患者满意度高等优点，但由于建腔存在一定困难，限制了其发展。本团队创新性提出“逆序法”、辅助孔等理论与方法，通过改变手术操作顺序、增加微小辅助孔将单孔操作变成多孔操作等技巧，解决了制约腔镜手术在乳腺疾病领域进展的困难，有利于腔镜手术普及并推广。在乳腺腔镜假体重建手术方面，降落伞补片法拓宽了其适应证，使乳房具备一定下垂度患者也能获益；而术后调整思想通过对重建术后乳房外形的早期干预，进一步完善了重建手术的美容学效果。源于腔镜手术理论的机器人手术进一步提升了手术精准度和稳定性，降低了学习难度，然而时间成本和经济成本过度消耗是当前需要解决的问题。.
UNASSIGNED: 经过理论创新，腔镜手术已普遍适用于乳腺疾病领域的肿物切除和全乳切除后重建，沿用其理论的机器人手术在乳房重建方面可以进一步降低学习难度，但目前仍缺少高水平大样本、多中心的随机对照临床试验验证腔镜及机器人乳腺手术的外科学安全性、肿瘤学安全性以及术后美容学效果，这也是后续研究的重要方向。.

BACKGROUND: Postoperative delirium (POD) often occurs in oncology patients, further increasing the medical and financial burden. Robotic technology in lower abdominal tumors resection reduces surgical trauma but increases risks such as carbon dioxide (CO2) absorption. This study aimed to investigate the differences in their occurrence of POD at different end-tidal CO2 levels.
METHODS: This study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn , Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO2 was performed depending on the randomized grouping after intubation. Group L received lower level etCO2 management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis.
RESULTS: Among the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO2 groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups.
CONCLUSIONS: With robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.