Spilled gallstones during laparoscopic cholecystectomy can potentially lead to serious complications in patients. We present a case of a patient with gallstone spillage during cholecystectomy who was found years later to have gallstones stuck in a difficult location, requiring robotic surgery. A robotic approach allows for greater visual angles compared to conventional laparoscopy. The patient tolerated the robotic procedure successfully, and no patient symptoms were reported during follow-up. This case addresses retained gallstones for difficult anatomical positions and confirms that a robotic abdominal approach is a safe, minimally invasive option.

BACKGROUND Reversed intestinal malrotation is an extremely rare disease, with an incidence of 1 in 250 000. In Japan, application of robotic-assisted colorectal cancer surgery is expected to increase. There are no reports of robot-assisted surgery for cecal cancer with reversed intestinal malrotation. CASE REPORT An 84-year-old Japanese man with epigastric pain and abdominal distention was referred to our hospital\'s Department of Gastroenterology for thorough examination. Colonoscopy revealed a semicircumferential type 2 tumor in the cecum and ascending colon. Gastrografin contrast study showed that the large intestine was entirely on the patient\'s right side and the small intestine was shifted to the left side. Contrast-enhanced computed tomography revealed enlarged lymph nodes near the tumor, and masses were observed at the liver, which were believed to be metastases. Following examination, reversed intestinal malrotation and concurrent cecal cancer was diagnosed. The patient was referred to our department for surgery and underwent robot-assisted ileocecal resection with D3 lymphadenectomy. The postoperative course was favorable, and patient was discharged on the sixth postoperative day, without complications. According to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th edition, the pathological diagnosis was pT4b (ileum), pN1b, cM1a (H1 [grade A]), and pStage IVa cancer. After considering tumor stage and patient\'s overall condition in consultation with his family, we decided against palliative systemic therapy. The patient was provided with best supportive care. CONCLUSIONS Robot-assisted surgery might be useful in manipulation of the dissection of adhesions, owing to its capacity for high-resolution 3-dimensional imaging and forceps manipulation, using articulated functions.

BACKGROUND: Gap tension is an important factor influencing the clinical outcomes of total knee arthroplasty (TKA). Traditional mechanical alignment (MA) places importance on neutral alignment and often requires additional soft tissue releases, which may be related to patient dissatisfaction. Conversely, the functional alignment requires less soft tissue release to achieve gap balance. Conventional gap tension instruments present several shortcomings in practice. The aim of this study is to introduce a new gap balancing technique with FA using the modified spacer-based gap tool and the MAKO robotic arm system.
METHODS: A total of 22 consecutive patients underwent primary TKA using the MAKO robotic arm system. The gap tension was assessed and adjusted with the modified spacer-based gap tool during the operation. Patient satisfaction was evaluated post-operatively with a 5-point Likert scale. Clinical outcomes including lower limb alignment, Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were recorded before surgery, 3 months and 1 year after surgery.
RESULTS: The range of motion (ROM) was significantly increased (p < 0.001) and no patients presented flexion contracture after the surgery. KSS and WOMAC score were significantly improved at 3 months and 1 year follow-up (p < 0.001 for all). During the surgery, the adjusted tibial cut showed more varus than planned and the adjusted femoral cut presented more external rotation than planned (p < 0.05 for both). The final hip-knee-ankle angle (HKA) was also more varus than planned (p < 0.05).
CONCLUSIONS: This kind of spacer-based gap balancing technique accompanied with the MAKO robotic arm system could promise controlled lower limb alignment and improved functional outcomes after TKA.

Robotic-assisted bronchoscopy (RAB) allows for targeted bronchoscopic biopsy in the lung. A robotic-assisted bronchoscope is navigated through the airways under direct vision after establishing a pathway to a target lesion based on mapping performed on a 3-dimensional (3D) lung and airway reconstruction obtained from a pre-procedure thin-slice computed tomography chest. RAB has maneuverability to distal airways throughout the lung, precise catheter tip articulation, and stability with the robotic arm. Adjunct imaging tools such as fluoroscopy, radial endobronchial ultrasound (r-EBUS), and cone beam computed tomography (CBCT) can be used with RAB. Studies using shape-sensing robotic-assisted bronchoscopy (ssRAB) have shown favorable diagnostic outcomes and safety profiles in both malignant and non-malignant processes for the biopsy of peripheral pulmonary lesions (PPLs). A 1.1 mm cryoprobe combined with ssRAB has been shown to be safe and effective for the diagnosis of PPLs compared to a traditional bronchoscopy with forceps biopsy. This technique can also be used for targeted lung sampling in benign processes. The aim of this article is to describe a stepwise approach to performing RAB combined with fluoroscopy, r-EBUS, and CBCT to obtain targeted transbronchial lung cryobiopsies (TBLC).

Spleen-preserving distal pancreatectomy offers an alternative surgical approach to the traditional distal pancreatectomy combined with splenectomy for removing benign and low-grade malignant lesions in the distal pancreas, avoiding complications associated with splenectomy. This procedure can be accomplished either by resecting and ligating the splenic vessels (Warshaw technique) or by preserving them (Kimura technique). Currently, the widespread use of minimally invasive surgery has established laparoscopic and robotic approaches for spleen-preserving distal pancreatectomy as valid and safe options for treating such conditions. Our protocol aims to describe how the Warshaw and Kimura techniques of spleen-preserving distal pancreatectomy can be performed robotically. The first patient is a 36-year-old female with a neuroendocrine tumor (NET) in the pancreatic body who underwent a spleen-preserving distal pancreatectomy with the ligation of the splenic vessels (WT). The second patient is a 76-year-old male with chronic pancreatitis presenting with a dilated main pancreatic duct in the tail of the pancreas who underwent a spleen-preserving distal pancreatectomy with a vessel-preserving approach (KT).

UNASSIGNED: Epiretinal membranes (ERM) pose a common challenge in vitreoretinal pathology, often causing vision impairment in older adults. The Preceyes Surgical System (PSS) supports the surgical removal of ERM through robot-assisted membrane peeling (RA-MP). This study compares surgical times and iatrogenic hemorrhages between manual membrane peeling (MMP) and RA-MP using PSS.
UNASSIGNED: Nine patients underwent RA-MP with PSS, whereas 16 patients (18 eyes) underwent MMP for comparative analysis. Surgical durations were categorized into RA-MP, manual forceps utilization in PSS surgeries (mRA-MP), and traditional MMP. Cumulative manual manipulation duration (cMMP), instrument grasps, and intraoperative hemorrhages were statistically analyzed using the Mann-Whitney U test.
UNASSIGNED: RA-MP showed significantly longer peeling times compared to MMP (P < 0.001). Flap initiation grasps were similar between methods (P = 0.86), RA-MP demonstrated a significant reduction in peeling grasps (P = 0.01) and mean grasps per minute (P < 0.001). Although RA-MP resulted in fewer hemorrhages, the difference did not reach statistical significance relative to MMP (P = 0.08).
UNASSIGNED: Although RA-MP tended to extend surgical time, it offered advantages in reducing tissue trauma and intraoperative hemorrhages. Further research is needed to explore the learning curve for novice surgeons and evaluate the safety profile of RA-MP.
UNASSIGNED: RA-MP may offer potential advantages over manual surgery, particularly in terms of reduced tissue trauma and intraoperative hemorrhages. Despite its longer duration compared with manual techniques, RA-MP may lead to fewer grasping maneuvers and lower rates of hemorrhages, thereby enhancing the safety and precision of vitreoretinal surgeries.

Cost, logistics, and availability of robotic simulation opportunities suppose a real challenge for robotic surgery training. We aimed to test a new methodology for introduction to robotic surgery pre-congress courses. Two different \"introduction to robotic surgery\" pre-congress courses were developed. A new methodology using a sleeve/bypass, a ventral TAPP and an inguinal TAPP silicone models was implemented. After the session, the trainees answered a questionnaire to evaluate the course and the methodology using 1-5 Likert scales. A total of 21 participants participated in the courses and (72.2%) had no experience in robotic surgery. All trainees rated the course as good or excellent. There was a strong agreement between participants regarding the adequacy of the silicone models for this type of simulation/course. Trainees agree that the course gave them more confidence to perform a real robotic procedure, increased their interest in robotic surgery and made them feel ready to start their robotic surgery pathway. Congresses are a frequent way of contact between surgeons and robotic systems, mostly in the form of technical demonstrations or pre-congress courses. Our methodology showed that it is possible to allow for this contact in a low-cost way. This kind of courses is well received by congress delegates and have a positive educational impact. Despite of being \"Discovery\" courses, they have a positive impact on the congress, on the acquisition of robotic surgery skills and increase the interest in robotic surgery.

Hypertensive intracerebral hemorrhage (HICH), particularly affecting the basal ganglia, is a devastating condition with high mortality and morbidity rates. Traditional management, primarily conservative or invasive craniotomy, often leads to poor outcomes. This study highlights the potential of robot-assisted drainage as a superior treatment option for minor basal ganglia hemorrhage. A retrospective comparison of robot-assisted drainage and conservative treatment demonstrated significantly improved patient outcomes in the surgical group, with higher rates of favorable prognosis and better functional recovery. Additionally, robot-assisted surgery has been shown to reduce operation time, blood loss, and hospital stay compared to traditional neuroendoscopic hematoma evacuation. While these findings are encouraging, the study\'s limitations, including small sample size and retrospective design, necessitate further research. A large-scale randomized controlled trial is essential to evaluate the long-term cost-effectiveness and overall impact of robot-assisted drainage on patient outcomes.

暂无摘要。

We demonstrate robot-assisted treatment of a patient with benign pancreatic insulinoma. A 31-year-old patient suffered from attacks of weakness, numbness of the fingertips and «turbidity of consciousness» for 2 years. These symptoms occurred on an empty stomach and regressed after eating. We found pancreatic insulinoma. The patient underwent robotic enucleation of pancreatic tumor. Surgery time was 145 min. Postoperative period proceeded without complications. Hyperglycemia up to 10.5 mmol/l on the first postoperative day was followed by normalization after 4 days. The patient was discharged in 6 days after surgery. Minimally invasive robotic enucleation of insulinoma minimizes surgical trauma and provides precise resection of tumor. The key aspect of safe enucleation is localization of tumor at a distance of at least 2 mm from the pancreatic duct.
Продемонстрирован опыт лечения пациента с инсулиномой поджелудочной железы методом робот-ассистированной энуклеации опухоли. Пациент, 31 год, в течение 2 лет отмечал приступы слабости, онемение кончиков пальцев на руках, «помутнения сознания», которые возникали натощак и купировались приемом пищи. При клинико-инструментальном обследовании обнаружена опухоль в теле-хвосте поджелудочной железы, выставлен диагноз инсулиномы. Пациенту выполнена робот-ассистированная энуклеация опухоли поджелудочной железы, длительность вмешательства составила 145 мин. Послеоперационный период протекал без осложнений. В первые послеоперационные сутки наблюдалась гипергликемия до 10,5 ммоль/л с последующей полной компенсацией гликемии до нормальных значений к 4 сут послеоперационного периода. Пациент выписан на 6-е сутки после операции. Применение робот-ассистированного мини-инвазивного доступа при выполнении энуклеации инсулином поджелудочной железы позволяет прецизионно удалить опухоль и минимизировать операционную травму. Ключевым моментом возможности безопасного выполнения энуклеации является расположение опухоли на расстоянии не менее 2 мм от протока поджелудочной железы.