Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 37 appraisals
Journal of robotic surgery
From robot assistance to surgical intelligence: global research trends and emerging frontiers of artificial intelligence-enhanced robotic surgery in urology.
To systematically characterize global publication trends, collaboration patterns, intellectual foundations, research hotspots, and emerging frontiers in artificial intelligence (AI)-enhanced robotic and robot-assisted surgery in urology. Publications were retrieved from the Web of Science Core Collection (WoSCC) using a topic search strategy that included three keyword groups: robot-assisted surgery, urologic diseases or procedures, and AI-related technologies. English-language articles and reviews were included. Meeting abstracts, conference proceedings, editorials, letters, non-English publications, studies unrelated to urologic robotic surgery, and studies without substantive AI or intelligent algorithmic content were excluded. RStudio was used for descriptive statistics and annual publication trend visualization. VOSviewer was used for auxiliary bibliometric network construction and visualization. CiteSpace was used to construct collaboration networks, co-citation networks, keyword co-occurrence maps, cluster maps, timeline and time-zone maps, and citation burst maps. A total of 401 records were initially retrieved, and 253 publications were finally included after screening by document type, language, and topical relevance. These comprised 199 articles (78.66%) and 54 reviews (21.34%). Publications in this field began in 2004 and increased rapidly after 2018, reaching a peak of 53 publications in 2025. Because 2026 was an incomplete retrieval year, only 23 publications were recorded. Italy, the United States, the Netherlands, China, and Japan were the leading contributing countries. The University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, IRCCS Fondazione del Piemonte per l'Oncologia, the Netherlands Cancer Institute, and Leiden University Medical Center were the most productive institutions. Keyword clustering showed that the major research hotspots included renal cell carcinoma, augmented reality, image-guided surgery, indocyanine green, machine learning, registration, deep learning, and bladder cancer. AI-enhanced robotic surgery in urology has evolved from early research on registration, navigation, and image-guided surgery toward a surgical intelligence stage characterized by augmented reality, three-dimensional reconstruction, machine learning-based prediction, deep learning-based segmentation, surgical video understanding, and skill assessment. Future studies should prioritize multicenter standardized datasets, sharing of intraoperative video and robotic platform data, model interpretability, prospective validation, and integration into real-world clinical workflows.
27 July 2026
Read appraisal →Journal of robotic surgery
Robot-assisted versus open kidney transplantation: an umbrella review of systematic reviews and meta-analyses
Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative to open kidney transplantation (OKT). However, the comparative benefits and limitations of both approaches remain unclear. To compare the outcomes of RAKT and OKT through an umbrella review of published systematic reviews and meta-analyses. This umbrella review was written following PRISMA guidelines. Only meta-analysis and systematic review were included. Many outcomes were studied such as warm (WIT) and cold ischemia times (CIT), rewarming time, total ischemia time, blood loss, blood transfusion, delayed graft function, surgical site infections (SSI), hospital stay, graft rejection, graft failure, all-cause mortality, operation time, incision length, hospital readmission, vascular and ureteral anastomosis time, and other complications. We assessed methodological quality via the AMSTAR-2 tool. Consistency and strength of evidence were also evaluated. 6 studies were included: four meta-analyses and two systematic reviews. Studies were of low to moderate quality. Robotic kidney transplant surgery yields better outcomes in terms of blood loss (MDs ranging from - 16 to - 55 mL across studies), post-operative pain, incision length, SSI and ureteral leak. On the other hand, CIT, rewarming time, total ischemia time, operative time and ileus rate were favored in open surgery. Same rejection rates, graft failure, mortality and hospital readmission rate were found between both techniques. RAKT appears to improve several perioperative outcomes while maintaining comparable graft and patient survival outcomes to OKT. However, the available evidence remains limited by the low-to-moderate quality of existing reviews, highlighting the need for high-quality prospective studies.
27 July 2026
Read appraisal →Journal of robotic surgery
Reliability and readability of AI chatbot responses to patient questions about robot-assisted radical cystectomy
Robot-assisted radical cystectomy (RARC) is a complex procedure that requires patients to understand surgical indications, urinary diversion, perioperative treatment, complications, recovery, and long-term functional outcomes. Although artificial intelligence (AI) chatbots are increasingly used to obtain medical information, their suitability for RARC patient education remains unclear. We conducted a cross-sectional comparative evaluation of four contemporary AI chatbots: ChatGPT-5, DeepSeek-V4, Claude Sonnet 4.6, and Gemini 3.5 Pro. A set of 20 core patient-education questions on RARC was developed by three senior urologic experts. Chatbot responses were assessed using DISCERN, the Ensuring Quality Information for Patients tool, the Global Quality Scale, and JAMA benchmark criteria. Readability was evaluated using the Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Index, and SMOG. Reliability scores differed significantly across models for DISCERN, EQIP, and GQS, while JAMA benchmark criteria were summarized descriptively as transparency signals. DeepSeek-V4 achieved the highest mean scores for DISCERN, EQIP, and GQS, while ChatGPT-5 and DeepSeek-V4 showed the strongest JAMA benchmark performance. Gemini 3.5 Pro generally had the lowest reliability and transparency scores. Readability also varied across models. DeepSeek-V4 produced the most readable responses overall, whereas Gemini 3.5 Pro generated the most complex text. However, all models exceeded the recommended sixth-grade reading level, and FRES scores remained below the recommended threshold. Contemporary AI chatbots generated responses with variable presentation quality, transparency, and readability for common RARC patient-education questions. Because factual accuracy was not directly assessed, these tools should not be interpreted as validated sources of clinical guidance and should not replace individualized counseling by urologists.
23 July 2026
Read appraisal →Journal of robotic surgery
Perioperative outcomes and nodal station assessment after robotic-assisted versus video-assisted thoracoscopic segmentectomy for early-stage NSCLC: a systematic review and meta-analysis
The relative benefits of Robotic-assisted thoracoscopic segmentectomy (RATS) versus video-assisted thoracoscopic segmentectomy (VATS) for early-stage NSCLC remain uncertain. This meta-analysis compared perioperative outcomes, lymph node assessment, and postoperative safety between the two approaches. PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to April 2026. Comparative studies of RATS versus VATS segmentectomy for early-stage NSCLC were included. Outcomes were pooled as weighted mean differences or odds ratios with 95% confidence intervals. Random-effects models were used for substantial heterogeneity (I² >50% or P < 0.05); otherwise, fixed-effects models were applied. Leave-one-out sensitivity plots are provided in the supplementary materials. Nine retrospective comparative studies involving 19,805 patients were included. Robotic-assisted segmentectomy was associated with a greater number of lymph node stations examined (WMD = 1.16, 95% CI: 0.51, 1.81, P < 0.001) and a shorter length of hospital stay (WMD = - 0.75, 95% CI: -1.36, - 0.15, P = 0.015). No significant differences were observed in operative time (WMD = 1.86, 95% CI: -8.80, 12.52, P = 0.732), duration of drainage (WMD = - 0.37, 95% CI: -0.79, 0.06, P = 0.090), overall complications (OR = 0.94, 95% CI: 0.67, 1.34, P = 0.745), air leak (OR = 1.02, 95% CI: 0.54, 1.91, P = 0.949), pneumonia (OR = 1.33, 95% CI: 0.89, 1.99, P = 0.170), or 30-day readmission (OR = 1.09, 95% CI: 0.94, 1.26, P = 0.257). Current retrospective evidence suggests that RATS may offer more examined lymph node stations and shorter hospital stay without increased morbidity, but these findings are limited by risk of bias and should not be interpreted as evidence of oncologic superiority.
22 July 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic and open surgery for endometrial cancer: a systematic review of randomized trials and pooled analysis of conversion rates
To summarize randomized evidence assessing robotic surgery in relation to conventional laparoscopic and open abdominal approaches for endometrial cancer treatment, with particular attention to perioperative outcomes and conversion to open surgery. Randomized controlled trials evaluating robot-assisted surgical treatment of endometrial cancer were identified across major biomedical databases up to December 2025. Eligible studies compared the robotic approach against laparoscopic or open abdominal surgery. Quantitative pooling was undertaken only when outcome reporting was sufficiently consistent across studies. Eight randomized trials including 647 patients met the inclusion criteria. Overall, 322 patients underwent robotic surgery, 244 conventional laparoscopy, and 81 laparotomy. Most perioperative endpoints were reported heterogeneously, limiting formal pooling. Operative time varied across trials when robotics was compared with laparoscopy and was generally longer than laparotomy. Intraoperative blood loss and postoperative hospitalization did not show consistent differences between the two minimally invasive approaches. Compared with laparotomy, the robotic approach was linked to reduced postoperative stay. Conversion to laparotomy occurred less frequently after robotic surgery than after laparoscopy (0.7% vs. 8.4%; OR 0.17; p = .03). Complication reporting was inconsistent, although trials comparing robotics with laparotomy generally favored the robotic approach. Direct procedural costs were higher for robotics, whereas indirect costs favored robotics in the single study evaluating them. The robotic approach resulted in a lower need for open conversion compared with conventional laparoscopy. Other perioperative outcomes appeared broadly comparable between the two minimally invasive approaches, while comparisons with laparotomy suggested shorter hospital stay and fewer postoperative complications, although these findings should be interpreted cautiously because of the limited and heterogeneous randomized evidence.
21 July 2026
Read appraisal →Journal of robotic surgery
Transperitoneal versus retroperitoneal single-port robot-assisted partial nephrectomy: systematic review and meta-analysis of perioperative and functional outcomes
To systematically compare the safety and efficacy of the transperitoneal (TP) and retroperitoneal (RP) approaches in single-port robot-assisted partial nephrectomy (SP-RAPN). PubMed, Web of Science, and Embase were searched for comparative studies published before October 2025. The primary evaluated outcomes were grouped as Perioperative Outcomes (operative time, blood loss, ischemia time, positive surgical margin, postoperative eGFR, and hospital stay) and Surgical Safety (complication rate). Study inclusion and exclusion standards followed the PICOS guidelines. Four comparative studies with 384 patients (188 TP and 196 RP) were analyzed. Compared with the RP group, the TP group had higher intraoperative blood loss (WMD = 27.95 mL, 95% CI = 4.90-51.02, p = 0.018), longer hospital stay (WMD = 0.56 days, 95% CI = 0.34-0.78, p < 0.001), and higher absolute postoperative eGFR (WMD = 6.87, 95% CI = 2.65-11.10, p = 0.001). Operative time did not differ significantly in the main analysis (p = 0.356); an exploratory sensitivity analysis suggested a possible small difference (≈ 12 min) that requires confirmation. Warm ischemia time, positive surgical margin rate, and complication rate showed no significant differences between the two groups. Sensitivity analysis confirms the robustness of these findings, with overall low heterogeneity. Both transperitoneal and retroperitoneal SP RAPN are safe and feasible based on this limited evidence. Preliminary findings suggest the RP approach may offer advantages in blood loss, hospital stay, and renal preservation, but these results are hypothesis generating. Importantly, tumor location strongly influenced approach selection, and observed differences may be attributable to tumor location rather than the approach itself; causal inference is not possible from this observational data. Validation in larger, prospective, and preferably randomized studies is required.
21 July 2026
Read appraisal →Journal of robotic surgery
Safety and feasibility of robotic telesurgery in urological procedures: a systematic review and meta-analysis of clinical data
Robotic telesurgery has emerged as a potential solution to expand access to specialized surgical care; however, clinical evidence remains fragmented across procedures and robotic platforms. We conducted this meta-analysis to assess the feasibility and safety of robotic telesurgery across urological procedures. An electronic search was conducted on PubMed, Scopus, Web of Science (WoS) and the Cochrane Library from inception through April 2026 according to PRISMA guidelines. Clinical studies reporting robotic telesurgery in urology were included regardless of study design. The primary outcome of interest was procedural success, defined as completion without conversion to a local surgeon or an alternative surgical approach. Secondary outcomes included complication rates and round-trip latency (RTL). Nineteen studies involving 164 patients were included. The pooled procedural success rate was 0.92 (95% CI: 0.86-0.96). No conversions to open or laparoscopic surgery were reported across the included studies. The pooled complication rate was 0.12 (95% CI: 0.07-0.20), with events occurring in a limited number of studies. RTL data were available from 14 studies, with a pooled mean latency of 123.30 milliseconds (ms) (95% CI: 81.76-164.83) demonstrating substantial heterogeneity (I² = 99.99%). Robotic telesurgery in urology demonstrates excellent technical feasibility and a favorable short-term safety profile in carefully selected cases. However, variability in network performance and procedure-specific requirements remain important considerations. Further prospective studies with standardized reporting and long-term outcome assessment are needed before widespread clinical adoption can be recommended.
21 July 2026
Read appraisal →Journal of robotic surgery
Technical advancements in robot-assisted radical prostatectomy: systematic review and bibliometric analysis
Robot-assisted radical prostatectomy has transformed the surgical management of localized prostate cancer, yet its research landscape remains incompletely mapped. We conducted a systematic review and bibliometric analysis of 578 articles and conference papers from Scopus and Web of Science (2005-2026), following PRISMA guidelines, and analyzed publication trends, geographic and institutional distribution, author networks, journal output, keyword co-occurrence, and thematic evolution. The results reveal exponential growth in research, with an inflection around 2015-2016 and accelerated momentum after 2020, reflecting the widespread adoption and maturation of robotic programs. The United States leads in publication volume, followed by Italy and the rapidly growing contribution of China, while The University of Turin (Italy) emerges as the most productive institution due to its pioneering Retzius-sparing approach; the Journal of Robotic Surgery remains the leading publication venue. Thematic analysis demonstrates a progression from early feasibility studies to the standardization of nerve-sparing and continence-preserving techniques, advancing toward single-port surgery, augmented reality navigation, and AI-assisted intraoperative decision-making. Emerging technologies such as augmented reality, the NeuroSAFE protocol, and deep learning models for outcome prediction are particularly transformative, and geographic disparities are highlighted as critical priorities for future research.
21 July 2026
Read appraisal →Journal of robotic surgery
Mapping the evolution of deep learning and computer vision in robotic surgery: a bibliometric analysis of surgical video intelligence, instrument perception, and clinical translation.
Deep learning and computer vision are increasingly embedded in robotic surgery, yet the development and translational direction of this research domain remain incompletely characterized. We conducted a bibliometric and visualization analysis of publications retrieved from the Web of Science Core Collection using Bibliometrix/Biblioshiny, VOSviewer, and CiteSpace. A total of 1,186 documents published between 2010 and 2026 across 356 sources were included. Scientific output increased rapidly, with an annual growth rate of 16.09% and a peak of 216 publications in 2025. The field involved 5,296 authors, and international collaboration accounted for 30.69% of publications. IEEE Robotics and Automation Letters was the most productive and locally influential source. China and the United States were the leading contributors, with China showing the most rapid recent expansion and the United States retaining the highest citation impact. Citation-burst and keyword analyses identified U-Net, residual learning, transformer architectures, and foundation-model-enabled segmentation as major methodological drivers. The conceptual structure evolved from image guidance, registration, and navigation toward surgical video intelligence, instrument perception, workflow understanding, autonomous assistance, and clinical translation. Instrument perception emerged as a central link between algorithmic development and operative application. Future progress will require diverse multi-institutional datasets, external and prospective validation, integrated scene understanding, and rigorous evaluation of intelligent assistance within real robotic surgical workflows.
21 July 2026
Read appraisal →World journal of surgical oncology
Robotic-assisted versus conventional nipple-sparing mastectomy with immediate implant-based breast reconstruction: a GRADE-assessed systematic review and meta-analysis of prospective studies
BACKGROUND: Robotic nipple-sparing mastectomy with immediate implant-based reconstruction is increasingly adopted to improve cosmetic outcomes and patient experience; however, its comparative perioperative value against conventional or open nipple-sparing mastectomy remains uncertain when restricted to prospective evidence. METHODS: We performed a PRISMA-aligned systematic review and random-effects meta-analysis of prospective comparative studies and randomized trials comparing robotic versus conventional or open nipple-sparing mastectomy with immediate implant-based reconstruction. The primary outcome was the total operative time, and the secondary outcomes were major complications, nipple-areolar complex ischemia or necrosis, and length of hospital stay. The risk of bias was assessed using RoB 2 for randomized data and ROBINS-I for nonrandomized data. Leave-one-out sensitivity analyses were conducted for outcomes with substantial heterogeneity, and the certainty of the evidence was graded using GRADE. RESULTS: Three prospective studies were included. Robotic surgery was associated with a significantly longer total operative time (mean difference 64.01 min, 95% confidence interval 8.54-119.47). Major complications did not differ between the approaches (risk ratio 0.63, 95% confidence interval 0.27-1.47), nor did nipple areolar complex ischemia or necrosis (risk ratio 0.56, 95% confidence interval 0.28-1.11) or length of hospital stay (mean difference 0.22 days, 95% confidence interval - 0.26 to 0.70). Heterogeneity was high for operative time and moderate to substantial for length of stay. The certainty of the evidence was low overall, driven by imprecision, heterogeneity, and limitations of the non-randomized design. CONCLUSIONS: Robotic nipple-sparing mastectomy is associated with a longer operative time than conventional or open approaches. No statistically significant differences were observed in major complications or nipple-areolar complex viability; however, the current prospective evidence base is limited, heterogeneous, and imprecise, and clinically important differences cannot be excluded. In experienced centers, robotic nipple-sparing mastectomy may be considered for carefully selected patients who prioritize scar concealment and minimally invasive access; however, its broader role in routine practice remains uncertain pending stronger prospective data on safety, patient-reported outcomes, and resource use.
26 June 2026
Read appraisal →Journal of robotic surgery
A focused systematic review and meta-analysis of robot-assisted inguinal lymphadenectomy versus open inguinal lymph node dissection in penile cancer
This focused systematic review and meta-analysis evaluated robot-assisted inguinal lymphadenectomy (RAIL) versus open inguinal lymph node dissection (OILND) in penile cancer, aiming to provide robot-specific comparative estimates rather than a broad minimally invasive synthesis. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched through December 2025 for comparative studies. All meta-analyses were conducted using STATA 18, employing random-effects modeling. Binary outcomes were summarized using odds ratios (ORs), and continuous outcomes were presented as weighted mean differences (WMDs), with all estimates accompanied by 95% confidence intervals (CIs). Risk of bias in the included non-randomized comparative studies was assessed using the ROBINS-I tool. Four retrospective comparative studies involving 276 patients were included, and no randomized controlled trials were identified. A lower odds of total postoperative complications was observed with RAIL (OR = 0.52, 95% CI: 0.27, 0.97; P = 0.047), but this borderline finding should be interpreted cautiously given the small number of retrospective studies and potential residual confounding. Across individual studies, operative time generally tended to be longer with RAIL, whereas findings for estimated blood loss and drainage-related outcomes were inconsistent. Lymph node yield, skin-related complications, minor complications, and groins with positive nodes did not differ significantly between approaches. According to the GRADE assessment, the certainty of evidence was low for most pooled outcomes and very low for skin-related complications and lower-limb edema/lymphedema. RAIL may be associated with lower overall postoperative complications than open surgery, but the evidence remains low certainty and insufficient to establish a definitive morbidity-reduction benefit. In addition, several continuous perioperative variables showed extreme between-study heterogeneity and were not clinically interpretable as reliable pooled effects.
22 June 2026
Read appraisal →Journal of robotic surgery
Outcomes in laparoscopic versus robotic-assisted surgery for median arcuate ligament syndrome: a systematic review and meta-analysis
Median Arcuate Ligament Syndrome (MALS) is a rare condition caused by external compression of the coeliac artery by the median arcuate ligament (MAL), leading to postprandial abdominal pain, nausea, vomiting, and weight loss. This study aims to compare outcomes of robotic (RMALR) and laparoscopic (LMALR) MAL release. A systematic search of PubMed/MEDLINE, Scopus, and Embase databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare perioperative and postoperative outcomes of LMALR versus RMALR. Comparative studies including adult patients undergoing either approach were included. Outcomes assessed were conversion to open surgery, resolution of pain, length of admission, postoperative complications, symptom recurrence and time to recurrence. Five retrospective comparative studies comprising 158 patients were included. No differences were found between laparoscopic and robotic approaches in conversion to open, resolution of pain, postoperative complications, length of admission, or overall time to recurrence. However, RMALR showed a significantly longer time to symptom recurrence (9.04 months, 95% CI 4.18-13.89; p = 0.0003). Both LMALR and RMALR are safe and effective for MALS, with comparable perioperative and postoperative outcomes. The longer symptom-free interval after robotic surgery may reflect greater precision in dissection around the coeliac axis. However, further prospective studies with standardised follow-up are needed to validate these findings.
20 June 2026
Read appraisal →Journal of robotic surgery
Robot-assisted peritoneal flap vaginoplasty in gender-affirming genital reconstruction: a systematic review and single-arm meta-analysis
Robot-assisted peritoneal flap vaginoplasty has emerged as an evolving reconstructive option in gender-affirming genital surgery. This systematic review and single-arm meta-analysis aimed to synthesize the available evidence regarding its perioperative, functional canal, and postoperative safety outcomes. This study was conducted according to PRISMA guidelines and prospectively registered in PROSPERO. PubMed, Cochrane Library, Embase, and Web of Science were searched from database inception to May 2026. Eligible studies included transfeminine or gender-diverse individuals undergoing robot-assisted peritoneal flap-based vaginoplasty with extractable clinical outcomes. Continuous outcomes were synthesized as weighted mean estimates with 95% confidence intervals (CIs), and overall postoperative complications were pooled using Stata version 18.0. Heterogeneity was assessed using the I² statistic, and leave-one-out sensitivity analyses were performed. Ten studies involving 974 patients were included. The pooled mean operative time was 305.37 min (95% CI 244.62, 366.12), and the pooled length of hospital stay was 5.80 days (95% CI 4.72, 6.87). At the last available follow-up, pooled neovaginal depth was 13.41 cm (95% CI 12.86, 13.96), and pooled neovaginal width was 3.61 cm (95% CI 3.55, 3.67). The pooled overall postoperative complication rate was approximately 30.1%. Sensitivity analyses suggested that the pooled estimates were not driven by any single study. Robot-assisted peritoneal flap vaginoplasty appears feasible and may achieve neovaginal dimensions broadly comparable to those reported for other full-depth vaginoplasty approaches. However, predominantly retrospective single-arm evidence precludes conclusions regarding superiority and highlights the need for standardized prospective studies with longer follow-up and patient-reported outcomes.
20 June 2026
Read appraisal →Journal of robotic surgery
The need for a dedicated surgical consent framework for robotic telesurgery: a global call to action
Robotic telesurgery has progressed from experimental demonstrations to real-world clinical implementation across multiple continents. Landmark interconnected procedures, including intercontinental robotic prostatectomies, humanitarian implementations in underserved regions, and expansion of teleproctoring/tele-mentoring networks, showcase a rapidly maturing field. Despite this proliferation, no standardized, procedure-specific surgical consent for telesurgery exists in the medical literature. Current consent processes for robotic surgery, telemedicine, and surgical research fail to address critical elements unique to telesurgery, including latency thresholds, technical redundancies, network architecture, cybersecurity risks, remote surgeon responsibilities, and contingency planning. Our article aims to define the essential elements that should compose a dedicated telesurgery-specific informed consent and to highlight why current consent frameworks are insufficient for this rapidly expanding global practice. This expert-opinion paper synthesizes high-impact literature on consent ethics, digital surgery, telehealth governance, and robotic surgery; evaluates current consents used in pioneering telesurgery programs across North America, South America, Africa, Europe, and Asia; and incorporates multidisciplinary insights from surgery, anesthesiology, biomedical engineering, cybersecurity, telecommunications, ethics, and global health. We identify major gaps in contemporary consent frameworks, including (1) inadequate disclosure of connectivity-related risks; (2) insufficient explanation of data transmission, cybersecurity, and encryption; (3) absence of latency thresholds and safety-based interruption criteria; (4) lack of transparency regarding remote surgeon responsibility and handover protocols; and (5) limited patient education regarding contingency conversion and chain-of-care accountability. We thus propose a 9-component International Telesurgery Consent Framework, providing standardized language and structure for global implementation. The rapid expansion of telesurgery demands an equally rapid evolution in patient-centered informed consent. A dedicated telesurgery consent should become the ethical, medicolegal, and operational standard for any remote robotic clinical procedure. This paper serves as the basis for an international consensus effort involving global leaders in robotic surgery, telehealth, AI-enabled surgery, and digital health regulation.
14 June 2026
Read appraisal →Journal of robotic surgery
Transoral robotic surgery using the da Vinci single-port system: current evidence and clinical indications - a systematic review and meta-analysis
The DaVinci Single-Port (SP) transoral robotic surgery (TORS) platform was developed to overcome spatial constraints and instrument collisions encountered with multiport systems in head and neck surgery. We systematically reviewed and meta-analyzed perioperative performance, safety, functional recovery, and oncologic outcomes of SP TORS. Following PRISMA 2020, we searched PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and the first 25 pages of Google Scholar through January 1, 2026. Peer-reviewed English-language clinical and cadaveric studies evaluating SP TORS were included. Three reviewers screened studies and extracted data. Random-effects meta-analyses were performed where appropriate. Fourteen studies (2019-2025) including 479 patients met inclusion criteria. Patient-level evidence was concentrated in oncologic cohorts, with additional smaller clinical applications in obstructive sleep apnoea-related tongue-base surgery (37 patients), hypopharyngeal foreign body removal (1 patient), parapharyngeal space surgery (2 patients), and SP-assisted reconstruction (3 patients), as well as preclinical feasibility studies. No study reported intraoperative conversion to multiport or open surgery. Pooled estimates were console time 60.04 min (95% CI 29.56-90.51; I² = 99.1%), docking time 10.13 min (0.47-19.79; I² = 97.9%), operative time 57.72 min (37.23-78.21; I² = 0.0%), length of stay 10.63 days (2.43-18.82; I² = 99.8%), and blood loss 24.16 mL (- 6.95 to 55.27; I² = 86.8%). Bleeding was the most consistently reported surgical complication, with major bleeding requiring operative management reported in larger cohorts but remaining uncommon. Functional recovery suggested early oral intake, although timing was inconsistently reported. Margin status was predominantly R0 in several oncologic cohorts, although one matched cohort reported a lower R0 rate. SP TORS appears feasible across indications, but current evidence is limited by nonrandomized designs, inconsistent long-term reporting, and between-study heterogeneity.
14 June 2026
Read appraisal →Techniques in coloproctology
Robotic versus laparoscopic TME for rectal cancer: meta-analysis of pathological quality indicators
BACKGROUND: Total mesorectal excision (TME) quality is a key determinant of oncological outcomes in rectal cancer. While robotic surgery offers technical advantages over laparoscopy in the confined pelvis, its superiority regarding pathological outcomes remains debated. We conducted a meta-analysis comparing robotic and laparoscopic TME focusing on quality indicators of TME and risk factors for incomplete TME. METHODS: A PROSPERO-registered systematic search of PubMed and EMBASE up to May 2025. Comparative studies reporting pathological outcomes of robotic versus laparoscopic TME were included. Primary endpoints were TME completeness, circumferential resection margin (CRM) positivity and distal resection margin (DRM) positivity. Secondary analysis included baseline characteristics (male gender, BMI, bulky tumours, distance to anal verge, neoadjuvant radiotherapy) and local recurrence rate. RESULTS: Fifty-six studies (27,648 patients; robotic 10,629, laparoscopic 17,019) were included. Robotic surgery was associated with significantly more complete TME specimens (OR 1.50, 95% CI 1.23-1.82, p < 0.001) and fewer positive DRMs (OR 0.68, 95% CI 0.48-0.97, p = 0.031). CRM positivity was comparable between groups (OR 0.93, 95% CI 0.77-1.12, p = 0.44). In random-effects analysis, there was a non-significant trend towards fewer local recurrences after robotic TME (OR 0.75, 95% CI 0.54-1.05, p = 0.09). Robotic cohorts more frequently included male patients, distal tumours and neoadjuvant chemoradiotherapy, suggesting preferential selection of technically challenging cases. CONCLUSIONS: Robotic TME is associated with higher specimen completeness and lower DRM positivity compared with laparoscopic TME, while CRM positivity and local recurrence rates appear broadly similar. These data support the use of robotics as a primary minimally invasive option for mid-low rectal cancer; however, as a result of low certainty of evidence, these findings should be interpreted cautiously. SYNOPSIS: This meta-analysis provides the most up-to-date synthesis of pathological outcomes comparing robotic and laparoscopic TME for rectal cancer, incorporating data from 56 studies including the recent REAL and COLRAR randomized trials. Unlike previous reviews, it exclusively analyses total mesorectal excision procedures, excluding partial or high anterior resections, thereby eliminating a major source of heterogeneity. The findings demonstrate that robotic TME is associated with higher specimen completeness and fewer positive distal margins, even in technically demanding mid- and low-rectal cancers, supporting the role of robotics as the preferred minimally invasive approach in mid-low, difficult tumours.
1 June 2026
Read appraisal →Journal of robotic surgery
Comparative efficacy and safety of open, laparoscopic, and robot-assisted radical cystectomy: a systematic review and network meta-analysis
The most appropriate surgical strategy for radical cystectomy in bladder cancer remains to be established. This study performed a network meta-analysis of randomized controlled trials to evaluate open, laparoscopic, and robot-assisted approaches. Outcomes were systematically classified into intraoperative metrics, postoperative recovery, perioperative safety, and oncological efficacy. A random effects model was employed, and treatment hierarchy was determined using the surface under the cumulative ranking curve. Eleven studies comprising 1270 patients met the inclusion criteria. Compared with open surgery, minimally invasive techniques were associated with reduced intraoperative blood loss and lower transfusion rates, although they required longer operative time. Among these, laparoscopic surgery was associated with a potentially greater likelihood of enhanced postoperative recovery and fewer complications, although these findings should be interpreted with caution given the sparse network and substantial heterogeneity in some outcomes. Robot-assisted procedures did not demonstrate consistent superiority over laparoscopy in perioperative measures. Oncological outcomes were similar across all modalities. Overall, minimally invasive approaches confer perioperative benefits and appear comparable to open surgery with respect to short-term surrogate oncological endpoints, although long-term outcomes remain to be determined.
31 May 2026
Read appraisal →Journal of robotic surgery
Robot-assisted percutaneous pelvic channel screw placement for unstable pelvic ring injuries: a systematic review and meta-analysis with narrative technical comparison of multi-platform differences
Percutaneous pelvic channel screw fixation is a key technique for the minimally invasive treatment of pelvic ring injuries. Robotic-assisted systems aim to improve accuracy and reduce radiation, but direct comparative studies across platforms are lacking. This systematic review and meta-analysis primarily compares robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement, with a secondary narrative comparison of technical differences across TiRobot, Mazor X, and ROSA platforms. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and CBM databases up to April 2026. Comparative studies of robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement in adult pelvic ring injury patients were included. Primary outcomes were screw accuracy (Gras classification) and radiation exposure. Secondary outcomes included operative time, functional recovery (Majeed score), complications, and cost. No direct head-to-head studies comparing different robotic platforms for pelvic screw placement were identified; therefore, platform comparisons are primarily narrative and indirect, with spine surgery data presented as hypothesis-generating only. Risk of bias was assessed using ROBINS-I and RoB-2, and evidence was graded using the GRADE system. Fifteen studies (1,247 patients, 2,893 screws) were included. Primary meta-analysis showed that robot-assisted placement significantly improved screw accuracy (excellent/good rate: 98.2% vs. 86.4%; OR = 5.32, 95%CI: 3.18-8.89, p < 0.001; GRADE: Low certainty due to risk of bias) and reduced radiation exposure (SMD=-1.84, 95%CI: -2.43 to -1.25; GRADE: Low certainty due to serious inconsistency). Operative time showed no significant difference in studies by experienced surgeons (MD=-5.2 min, 95%CI: -11.0 to 0.6). Functional outcomes (Majeed score) were comparable between groups (MD = 0.8, 95%CI: -0.7 to 2.3). Overall complications were significantly reduced with robotic assistance (OR = 0.46, 95%CI: 0.30-0.71; GRADE: Low certainty due to risk of bias). For platform comparisons, TiRobot has the strongest pelvic trauma-specific evidence from 11 studies (847 patients). Evidence for Mazor X and ROSA in pelvic trauma is limited to technical descriptions and indirect spine surgery data; no direct pelvic trauma validation is available. Robot-assisted pelvic channel screw placement is superior to conventional methods in accuracy and radiation reduction, with comparable functional outcomes and fewer complications. TiRobot demonstrates the strongest pelvic trauma-specific evidence based on available comparative studies. Mazor X and ROSA require direct pelvic trauma validation before their performance can be reliably compared. TiRobot may have lower acquisition costs in Chinese healthcare settings, but formal cost-effectiveness analyses are lacking for all platforms. Significant evidence gaps remain, including lack of high-quality RCTs, absence of direct platform comparisons in pelvic trauma, and insufficient cost-effectiveness analyses.
28 May 2026
Read appraisal →Journal of robotic surgery
Global evolution of robot-assisted cholecystectomy research in the era of artificial intelligence: a bibliometric and knowledge-mapping study
OBJECTIVE: To systematically map the global evolution, collaborative networks, knowledge structure, and emerging research hotspots in robot-assisted cholecystectomy (RAC) using bibliometric and visualization techniques. METHODS: A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (2005-2025). Publications were retrieved using predefined search strategies and screened according to strict inclusion criteria. CiteSpace, VOSviewer, and R software were employed to analyze publication trends, co-authorship networks, institutional and national collaborations, co-citation patterns, keyword co-occurrence, and research bursts. Knowledge mapping techniques were used to visualize thematic evolution and intellectual structure. RESULTS: A total of 926 eligible publications were included. Global output demonstrated a continuous and marked increase, particularly after 2016, with citations following a similar upward trajectory, reflecting growing academic impact. The United States dominated both publication output and citation influence, while collaboration networks remained largely regionally clustered with limited cross-national integration. Research was primarily concentrated in high-impact surgical journals, with foundational contributions emphasizing feasibility, safety, and comparative effectiveness. Keyword and co-citation analyses revealed a knowledge structure centered on laparoscopic surgery, bile duct injury, and robotic systems, with emerging clusters highlighting artificial intelligence (AI) and surgical education. Evolutionary trajectory analysis demonstrated a transition from technical feasibility (early stage), to safety and evidence-based evaluation (middle stage), and to training and technological integration (recent stage). Burst detection further identified recent hotspots in AI, cost-effectiveness, and surgical training systems. Emerging evidence also indicates increasing integration of AI-driven systems into RAC, enabling intraoperative decision support, workflow recognition, and early-stage semi-autonomous surgical execution, particularly in standardized procedures such as cholecystectomy. CONCLUSION: RAC research has evolved from early exploratory studies toward increasing technological integration and methodological refinement. Although RAC is not currently among the most dominant clinical indications for robotic surgery, it provides a valuable model for studying surgical standardization, training systems, and emerging intelligent surgical technologies. While current applications remain largely assistive, emerging advances in AI and robotic technologies suggest the potential for future development toward more intelligent and partially automated surgical systems. However, most evidence currently remains experimental and has not yet translated into widespread clinical practice. Future research should focus on strengthening global collaboration, improving high-quality evidence generation, and carefully evaluating the safety, feasibility, and clinical applicability of emerging intelligent surgical technologies.
26 May 2026
Read appraisal →Journal of robotic surgery
Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for resectable esophageal cancer: a systematic review and meta-analysis
Robot-assisted minimally invasive esophagectomy (RAMIE) has emerged as an alternative to conventional minimally invasive esophagectomy (MIE) for esophageal cancer, but its short-term perioperative advantages remain uncertain. To compare early postoperative outcomes of RAMIE and MIE in patients with resectable esophageal cancer, this systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed was searched for randomized controlled trials, propensity score-matched studies, and retrospective comparative studies published between January 2005 and December 2024. Adult patients undergoing RAMIE or conventional MIE for resectable esophageal cancer were included. Random-effects models were used to pool standardized mean differences and odds ratios with 95% confidence intervals. Study quality was assessed using the MINORS criteria and Cochrane RoB 2 tool. In addition, a post hoc GRADE assessment was carried out for key outcomes to evaluate the certainty of evidence. Forty-one studies involving 13,321 patients were included, of whom 4,327 underwent RAMIE and 8,994 underwent MIE. Compared with MIE, RAMIE was associated with lower blood loss, reduced conversion to open surgery, higher total lymph node yield, greater left recurrent laryngeal nerve lymph node harvest, fewer pulmonary complications, and lower overall postoperative morbidity. ICU stay and hospital stay were also e shorter after RAMIE, whereas operative time was longer. No significant differences were observed in R0 resection, anastomotic leak, recurrent laryngeal nerve palsy, cardiac complications, chyle leak, surgical site infection, or 30- and 90-day mortality. Post hoc GRADE assessment showed that the certainty of evidence was very low across key outcomes, mainly because of the predominance of non-randomized studies, substantial heterogeneity across several pooled analyses, and outcome-specific concerns regarding imprecision and publication bias. RAMIE is safe and may offer some short-term perioperative advantages over conventional MIE without clear evidence of increased major morbidity or short-term mortality. However, the certainty of evidence across key outcomes was very low, and the predominance of nonrandomized studies and substantial heterogeneity across several analyses warrant cautious interpretation. Further adequately powered randomized trials are required.
25 May 2026
Read appraisal →Journal of robotic surgery
AI-based automated bleeding monitoring in conventional and robot-assisted laparoscopic surgery: a systematic review
Artificial intelligence has emerged as a promising approach for improving the detection and management of intraoperative bleeding during conventional and robotic-assisted laparoscopic surgery, where delayed recognition of hemorrhage can lead to increased morbidity and procedural complexity. This review synthesizes current evidence on the use of artificial intelligence for intraoperative bleeding monitoring, with a particular focus on performance, feasibility, and clinical integration. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Comprehensive searches of PubMed, Scopus, Web of Science, IEEE Xplore, Embase, and grey literature identified studies published between 2016 and 2025 that applied artificial intelligence to bleeding prediction, detection, localization, tracking, and quantitative blood-loss estimation during conventional and robotic-assisted laparoscopic surgery. Data relating to study design, model architectures, evaluation metrics, latency, and integration feasibility were extracted and summarized narratively. Across the included studies, artificial intelligence models demonstrated high detection accuracy in predominantly single-centre, retrospective, or simulation-based settings, with several approaches reporting promising real-time feasibility under controlled experimental conditions. Emerging work also explored bleeding source tracking, blood-loss estimation, and early integration into surgical workflows. However, most studies relied on small, single-center datasets and retrospective validation, limiting generalizability and clinical translation. Overall, artificial intelligence-based bleeding monitoring in conventional and robotic-assisted laparoscopic surgery shows increasing technical maturity and potential, though largely unvalidated in prospective clinical settings. Future research should prioritize large, multi-institutional datasets, prospective clinical evaluation, and optimized low-latency deployment within real surgical workflows to support safe and effective intraoperative use.
24 May 2026
Read appraisal →Journal of robotic surgery
A randomized controlled trial comparing robotic NOSES versus robotic TME for Mid-rectal cancer: short-term oncological and perioperative outcomes
This randomized study compared perioperative outcomes between robotic natural orifice specimen extraction surgery (R-NOSES) and robotic total mesorectal excision (R-TME) in participants with mid-rectal cancer. After exclusions, 71 participants in the R-TME cohort and 69 in the R-NOSES cohort were included in the final analysis, from an initial randomized cohort of 150 eligible participants (1:1 allocation). The two cohorts had comparable preoperative characteristics. Intraoperative and pathological outcomes, including blood loss, operative duration, and harvested lymph nodes, showed no notable differences. The rates of overall complication were comparable between the two groups (R-NOSES 13.0% vs. R-TME 15.5%, P = 0.679), and anastomotic leakage did not vary significantly. Conversely, the R-TME group experienced a higher rate of wound complications (5.6% vs. 0.0%, P = 0.045). Notably, the R-NOSES group demonstrated significant advantages in postoperative recovery, including shorter time to first flatus (48 vs. 53 h, P = 0.02), earlier resumption of a liquid diet (79 vs. 84 h, P = 0.041), and markedly reduced VAS pain ratings on postoperative days 1 and 3. In conclusion, for selected patients with middle rectal cancer, R-NOSES appears to be a safe and feasible alternative to R-TME, with similar short-term oncological outcomes. It may offer some benefits in terms of faster recovery, less postoperative pain, and fewer wound-related complications.Trial Registration: ClinicalTrials.gov Identifier NCT06454201.
22 May 2026
Read appraisal →Journal of robotic surgery
Intraoperative surgical needle loss in robotic-assisted and laparoscopic surgery: a systematic review and practical troubleshooting framework
Intraoperative loss of a surgical needle during minimally invasive surgery (MIS) is uncommon but clinically important. In robotic-assisted surgery (RAS), altered sensory conditions and evolving trocar designs may influence both needle-loss mechanisms and retrieval strategy. We systematically reviewed the literature and developed a practical troubleshooting framework. PubMed, Embase, CNKI, and Wanfang were searched from inception to January 2026 in accordance with PRISMA 2020. Studies reporting intraoperative needle loss during abdominal or pelvic MIS or RAS were included. Because of substantial heterogeneity, findings were synthesized narratively. Thirty-three studies were included, comprising 27 original studies and 6 narrative reviews. Quantitative outcome aggregation was restricted to clinical patient-level studies, yielding 37 extractable lost-needle events: 22 during RAS and 15 during conventional laparoscopy. Minimally invasive retrieval was successful in 35/37 cases, whereas incision extension or open conversion was required in 2/37. Recurrent practical risk scenarios included trocar-pathway entrapment, including the hypothesized "Trocar Trap," and possible risk amplification related to absent haptic feedback in RAS. Evidence supporting adjunctive localization tools, including fluoroscopy and magnetic assistance, remained limited and largely non-comparative. Needle loss in contemporary MIS and RAS should be regarded as a workflow-sensitive patient safety event supported mainly by low-level evidence. The most relevant contemporary implications concern robotic workflow, port-pathway inspection, disciplined handoff, and selective use of adjunctive retrieval tools within a stepwise troubleshooting framework. Registration: PROSPERO (CRD420261294460).
22 May 2026
Read appraisal →Journal of robotic surgery
Emerging robotic platforms in partial nephrectomy: a comparative systematic review and network meta-analysis
Robotic-assisted partial nephrectomy (RAPN) is the preferred minimally invasive nephron-sparing technique, with outcomes comparable to open and laparoscopic surgery. While most evidence derives from the da Vinci system, newer robotic platforms such as Hugo, Hinotori, KangDuo and MP1000 are emerging. This systematic review and network meta-analysis evaluated perioperative outcomes across available RAPN platforms. A systematic search of PubMed, Cochrane Library, CINAHL, and Scopus identified studies reporting RAPN outcomes across available robotic platforms. Eligible studies included randomized and observational cohorts. Risk of bias was assessed with ROBINS-I. Outcomes included in the analysis operative time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). A frequentist NMA using the "netmeta" R package generated standardized mean differences (SMD) with 95% CIs, and P-scores ranked platform performance. The review was registered on PROSPERO (ID: CRD420251032233). This review was conducted in accordance with PRISMA guidelines. Thirteen studies (n = 2,450) were included. Under fixed-effects model, da Vinci SP (SMD - 0.63, 95% CI - 0.87 to - 0.40) and Xi (-0.52, 95% CI - 0.67 to - 0.38) revealed shorter operative times; however, under random-effects models these differences were not statically significant due to substantial heterogeneity. Heterogeneity (I² ≈ 84%) attenuated these effects. For ischemia time, Hugo RAS (-0.88, 95% CI - 1.45 to - 0.30) and Xi (-0.58, 95% CI - 0.73 to - 0.44) outperformed Si, though differences lost significance under random-effects (I² >90%). No significant differences were found for length of stay, blood loss, or R.E.N.A.L. nephrometry scores, although ranking differences were observed. Preoperative outcomes were revealed a comparable outcome using emerging robotic system with the established system. Favourable trends in operative and ischemia times were showed in some platforms; however, these differences were not vigorous under random-effects models and are limited by substantial heterogeneity. This raised the need for long-term, comparative follow-up studies, as the current evidence remains elementary.
22 May 2026
Read appraisal →Journal of robotic surgery
Oncologic, functional, and economic outcomes of transoral robotic surgery for HPV-associated oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis of pathology and treatment strategies
The incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has increased substantially. Transoral robotic surgery (TORS) provides detailed pathological assessment that may support risk-adapted treatment strategies; however, integrated evidence on oncologic, functional, and economic outcomes remains limited. To systematically evaluate oncologic, functional, and economic outcomes of TORS-based treatment strategies in patients with HPV-positive OPSCC. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed, Wiley Online Library, MDPI, Cureus, and medRxiv were searched for studies published between 2019 and 2025. Pre-specified subgroup meta-analyses (randomized/clinical trial versus observational studies, and primary versus salvage settings) were performed using random-effects models for overall survival (OS), postoperative bleeding, tracheostomy rate, and long-term gastrostomy dependence. Twenty-two studies (20 clinical and 2 economic) were included, with 14 contributing to quantitative synthesis. The pooled 2-year OS was 94% (95% CI: 0.90-0.98), the 3-year OS was 96% (95% CI: 0.92-0.99), and the 5-year OS was 92% (95% CI: 0.90-0.95). In the salvage setting, the pooled 2-year OS was 76% (95% CI: 0.71-0.80), with no observed statistical heterogeneity, although based on a limited number of studies. Subgroup analyses indicated higher survival estimates in randomized/clinical trial settings compared with observational cohorts. Functional outcomes were generally favorable, with pooled postoperative hemorrhage of 7% (95% CI: 0.04-0.11), tracheostomy rate of 9% (95% CI: 0.03-0.14), and long-term gastrostomy dependence of 2% (95% CI: 0.00-0.03).Across included studies, TORS provided detailed pathological information that may support risk stratification and inform adjuvant treatment decisions; however, the extent of treatment de-escalation varied across studies. TORS appears to be an effective treatment option in selected patients with HPV-positive OPSCC, with generally favorable oncologic and functional outcomes. However, interpretation of these findings is limited by heterogeneity in study design and patient populations. Further prospective studies are required to clarify its role in treatment de-escalation and long-term outcomes.Registration: PROSPERO (CRD420251240194).
22 May 2026
Read appraisal →Journal of robotic surgery
Perioperative and oncological outcomes of robotic versus laparoscopic low anterior resection in younger rectal cancer cohorts: a systematic review and meta-analysis with narrative functional assessment
Robotic low anterior resection (R-LAR) has been proposed to overcome technical limitations of laparoscopy in rectal surgery. However, previous meta-analyses have evaluated mixed-age populations, and no meta-analysis has specifically investigated younger patients (aged < 65 years) undergoing low anterior resection. This study aimed to compare operative, short-term postoperative, and oncological outcomes between robotic and laparoscopic low anterior resection in this cohort. A systematic review and meta-analysis were conducted according to PRISMA 2020 and the Cochrane Handbook, with prospective registration in Prospero. PubMed, Scopus, and the Cochrane Library were searched up to January 2026. Comparative studies evaluating R-LAR versus L-LAR in younger rectal cancer cohorts, defined as studies with mean patient age ≤ 65 years, were included. Random-effects models were used to calculate pooled mean differences (MD), odds ratios (OR), and hazard ratios (HR) with 95% confidence intervals (CI). Risk of bias was assessed using ROBINS-I and RoB2, and certainty of evidence using GRADE. A total of 16 studies were included. Compared with laparoscopy, R-LAR was associated with longer operative duration (MD 24.59 min, 95% CI 3.85-45.33, p = 0.02, I² = 96%), lower conversion to open surgery (OR 0.38, 95% CI 0.27-0.53, p < 0.0001, I² = 38%), lower overall complications (OR 0.84, 95% CI 0.73-0.97, p = 0.02, I² = 0%), lower 30-day mortality (OR 0.59, 95% CI 0.45-0.77, p = 0.006, I² = 0%), lower 30-day reoperation (OR 0.77, 95% CI 0.61-0.98, p = 0.04, I² = 0%), higher complete TME rates (OR 3.30, 95% CI 2.14-5.10, p = 0.003, I² = 0%) and shorter hospital stay (MD -0.82, 95% CI -1.50 to -0.13, p = 0.02, I²=97%). Estimated blood loss (p = 0.05) and major complications (p = 0.05) were borderline significant in favor of R-LAR. Anastomotic leakage (p = 0.17), postoperative ileus (p = 0.49), time to first flatus (p = 0.12), time to diet initiation (p = 0.10), CRM positivity (p = 0.56), lymph node yield (p = 0.09), local recurrence (p = 0.67), loop ileostomy (p = 0.56), disease-free survival (p = 0.53), and overall survival (p = 0.73) were comparable. The certainty of evidence ranged from very low to moderate. Functional outcomes were insufficient for pooling. Robotic low anterior resection in younger rectal cancer cohorts may improve several perioperative and technical outcomes without compromising oncological adequacy. Further high-quality studies are required to confirm these findings.
19 May 2026
Read appraisal →Journal of robotic surgery
Perioperative outcomes of transoral endoscopic vs. robotic thyroidectomy: a systematic review and meta-analysis
BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have emerged as scarless alternatives to conventional open thyroidectomy, offering excellent cosmetic outcomes. However, the comparative perioperative outcomes between these two minimally invasive techniques remain to be systematically evaluated. This meta-analysis aimed to compare the perioperative outcomes of TOETVA and TORT in patients undergoing thyroid surgery. METHODS: A systematic search was performed in PubMed, Embase, the Cochrane Library, and Web of Science from inception to March 1, 2026, for studies comparing TOETVA and TORT. The primary outcomes included recurrent laryngeal nerve injury, hypoparathyroidism, mental nerve injury, seroma, surgical site infection, and postoperative hemorrhage. The secondary outcome included operation time, length of hospital stay, number of lymph nodes dissected, and postoperative pain score. Pooled weighted mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Study quality was assessed using the ROBINS-I tool. RESULTS: A total of 5 studies involving 1,080 patients were included (639 in the TOETVA group and 441 in the TORT group). Compared with TOETVA, TORT was associated with significantly longer operation time (MD = -56.74 min, 95% CI [-73.41, -40.07], p < 0.05) but shorter hospital stay (MD = 0.26 days, 95% CI [0.03, 0.49], p < 0.05). The incidence of transient recurrent laryngeal nerve injury was significantly higher in the TOETVA group than in the TORT group (OR = 3.56, 95% CI [1.14, 11.06], p = 0.03). There were no significant differences between the two groups in the number of lymph nodes dissected, the number of metastatic central compartment lymph nodes, the incidence of permanent recurrent laryngeal nerve injury, mental nerve injury, transient or permanent hypoparathyroidism, seroma, surgical site infection, or postoperative hemorrhage. CONCLUSION: Although TORT is associated with longer operative time, it demonstrates potential advantages in terms of length of hospital stay and neuroprotection.The two procedures are comparable in terms of radicality of lymph node dissection, postoperative pain, and low complication rates. TORT is a safe and effective minimally invasive surgical option with better neural protection, especially suitable for patients prioritizing cosmetic outcomes. Long-term oncological safety still needs to be verified in future multicenter studies with larger samples and longer follow-up durations.
18 May 2026
Read appraisal →Journal of robotic surgery
Comparative outcomes of da Vinci SP versus da Vinci Xi platforms in robotic cholecystectomy: a systematic review and meta-analysis
As robotic cholecystectomy adoption accelerates, the evidence comparing the perioperative outcomes of the Da Vinci Xi (DV-Xi) multiport platform to the Da Vinci Single-Port (DV-Sp) platform remains scarce. This meta-analysis provides the first systematic comparison of perioperative outcomes between these platforms. To compare perioperative safety and operative efficiency outcomes between the DV-Sp and the DV-Xi systems performing cholecystectomy. We thoroughly searched PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov from inception till December 22, 2025. The key outcomes of interest included mean operative time, console time, docking time, pain scores on the day of the operation, pain scores after 24 h, estimated blood loss, and length of hospital stay. We conducted random-effects meta-analysis and leave-one-out sensitivity analysis using RStudio v 4.5.2. The ROBINS-I was used for the risk of bias assessment. A GRADE assessment through GRADEpro was performed. Four observational studies comprising 833 patients (DV-Sp: n = 416; DV-Xi: n = 417) met the set inclusion criteria, and no RCTs were found. The DV-Sp showed significantly decreased mean operative time (MD = -2.41 min; 95% CI - 4.09 to - 0.73, p = 0.0049) and console time (MD = - 7.24; 95% CI - 9.77 to - 4.72, P < 0.0001) with no heterogeneity (I² = 0%). Two studies reported reduced pain scores in the DV-SP group. There was no significant difference found in the pooled estimates of post-operative pain scores, blood loss, docking time, and length of hospital stay between the two platforms. The DV-Sp demonstrated modest but consistent reductions in operative and console time with comparable safety to the DV-Xi system. Pain scores on the day of surgery and after 24 h of operation were reported low in the DV-SP group. While the magnitude of time differences is unlikely to impact individual patient outcomes, cumulative reductions across high-volume operating centers may translate into meaningful gains in operating room efficiency. However, substantial heterogeneity, particularly in pain-related outcomes and docking time, warrants cautious interpretation of these outcomes.
17 May 2026
Read appraisal →Journal of robotic surgery
Robot-assisted versus laparoscopic distal pancreatectomy: an updated systematic review and meta-analysis including patient subgroups and meta-regression analyses
Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD - 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD - 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.
15 May 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic low anterior resection for rectal cancer: an updated systematic review and meta-analysis
Robotic surgery has increasingly been adopted for the treatment of rectal cancer. However, most previous meta-analyses included heterogeneous rectal procedures, limiting conclusions specific to low anterior resection. The present study aimed to provide an updated systematic review and meta-analysis comparing robotic versus laparoscopic low anterior resection for rectal cancer. This systematic review and meta-analysis was conducted according to PRISMA guidelines and recommendations from the Cochrane Handbook. PubMed, Scopus, and the Cochrane Library were systematically searched from inception to the most recent date. Comparative studies evaluating robotic low anterior resection (R-LAR) versus laparoscopic low anterior resection (L-LAR) for rectal cancer were included. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Certainty of evidence was evaluated using the GRADE approach. Thirty-three studies including 82,149 patients were analyzed (R-LAR: 56,290; L-LAR: 25,859). R-LAR was associated with a significantly lower conversion rate (OR 0.45, 95% CI 0.40-0.51, p < 0.00001, I²=28%), lower 30-day reoperation rate (OR 0.86, 95% CI 0.77-0.96, p = 0.01, I²=0%), reduced 30-day mortality (OR 0.65, 95% CI 0.52-0.82, p = 0.002, I²=0%), and higher rate of complete total mesorectal excision (OR 2.71, 95% CI 1.38-5.33, p = 0.01, I²=72%). Operative time was significantly longer in the robotic group (MD + 30.58 min, 95% CI 13.71-47.45, p = 0.001, I²=97%). No significant differences were observed for estimated blood loss, overall complications, major complications, anastomotic leakage, postoperative ileus, recovery parameters, length of hospital stay, readmission, circumferential margin positivity, lymph node yield, local recurrence, diverting ileostomy formation, disease-free survival, or overall survival. Robotic LAR may reduce conversion, reoperation, and short-term mortality and may improve completeness of total mesorectal excision, although operative time is longer. These findings suggest potential technical advantages of R-LAR, but high-quality randomized trials are required to determine whether these translate into meaningful clinical benefit.PROSPERO: CRD420261326600.
15 May 2026
Read appraisal →Journal of robotic surgery
Longitudinal health-related quality of life after remote-access versus open thyroidectomy for thyroid cancer: a systematic review and meta-analysis
As remote-access thyroidectomy (RAT) becomes more widely used, evidence on patient- reported outcomes, particularly health-related quality of life (HRQoL), remains scarce and inconsistent. This meta-analysis compared postoperative HRQoL between thyroid cancer (TC) patients undergoing RAT and open thyroidectomy (OT) and assessed changes over time. A comprehensive search of five major databases was conducted from inception to August 2025. Studies reporting HRQoL after RAT or OT were included. Outcomes were grouped by postoperative timepoints. Outcomes were stratified across distinct postoperative timepoints to calculate pooled standardized mean difference (SMD) or mean difference (MD). Heterogeneity was explored through rigorous subgroup analyses encompassing surgical modalities, countries, and assessment instruments. Forty-one studies met the inclusion criteria, and 29 records were included in the quantitative synthesis. RAT demonstrated early advantages in comprehensive quality of life at 1 month and 3 months, and these advantages dissipated long term. Pain trajectories exhibited a biphasic pattern: RAT was associated with lower pain scores on postoperative day 1 but paradoxically higher scores during the 1-2 week period, with subsequent convergence. Cosmetic satisfaction and swallowing function consistently favored RAT from 1-2 weeks through 6 months, while voice outcomes showed no discernible differences. RAT appears to confer selected short- to medium-term patient-reported advantages over OT, particularly in cosmetic satisfaction and swallowing function. But these benefits are heterogeneous and not consistently maintained across all domains or timepoints. Future studies should standardize cross-culturally validated PRO instruments and adopt harmonized follow-up intervals and reporting guidelines to clarify the patient-centered value of RAT.
15 May 2026
Read appraisal →Journal of robotic surgery
NeuroSAFE-guided robot-assisted radical prostatectomy versus standard RARP: systematic review and meta-analysis of comparative studies
Prostate cancer is the most common male malignancy, and although robotic-assisted radical prostatectomy (RARP) is widely used, urinary incontinence and erectile dysfunction remain significant issues. NeuroSAFE, an intraoperative frozen section technique aimed at optimizing nerve preservation without compromising cancer control, is increasingly used, but its overall impact on outcomes remains unclear.To systematically evaluate the effectiveness and safety of the NeuroSAFE technique during RARP, comparing functional recovery and oncologic outcomes with non-NeuroSAFE approaches.This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251032774). A comprehensive search of Embase, MEDLINE, and ClinicalTrials.gov (March, 2026) identified studies reporting oncologic and/or functional outcomes in men undergoing RARP with NeuroSAFE. Two reviewer teams independently conducted study selection, data extraction, and risk-of-bias assessment using ROBINS-I tool. Random-effects meta-analyses estimated pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was quantified with the I2 statistic, and publication bias was evaluated using Egger's test.Thirteen studies (2 randomized controlled trials and 11 observational cohorts) comprising 22,183 patients met the inclusion criteria. NeuroSAFE was associated with significantly improved postoperative erectile function (OR 2.00; 95% CI 1.46-2.74) and urinary continence recovery (OR 1.36; 95% CI 1.05-1.76). Positive surgical margins were significantly reduced in the NeuroSAFE group (OR 0.73; 95% CI 0.59-0.89). No differences in biochemical recurrence were observed (OR 0.81; 95% CI 0.43-1.56). Heterogeneity was substantial for some outcomes, and most nonrandomized studies carried a serious risk of bias, which limits causal inference.This systematic review and meta-analysis, including randomized evidence, demonstrates that NeuroSAFE is a safe and effective intraoperative strategy that is associated with improved erectile function, enhanced continence recovery, and negative surgical margins without compromising oncologic outcomes. These findings support integrating NeuroSAFE into surgical decision-making for patients undergoing RARP, particularly when nerve preservation can be achieved without compromising oncologic outcomes.In this study, we compared a surgical approach that uses real-time analysis during prostate cancer surgery with the standard technique. This method helps surgeons decide how much tissue to preserve while the operation is still ongoing. We found that this approach is safe and may improve recovery of urinary continence and sexual function, while also reducing the risk of leaving cancer behind, without compromising cancer control.
14 May 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic intracorporeal anastomosis learning curve: a systematic review
The learning curve for robotic colorectal surgery is increasingly characterised. However, the specific learning curve for intracorporeal anastomosis (IA) remains poorly defined. This review compares robotic and laparoscopic IA with respect to operative time, cases required for proficiency, complication rates, and conversion to extracorporeal anastomosis (EA). A systematic review was conducted in accordance with PRISMA guidelines. The protocol was registered on Open science framework ( https://doi.org/10.17605/OSF.IO/K4MYZ ). On March 18, 2025, OVID and PubMed were searched using the search terms; "laparoscopic," "robotic," "anastomosis," "learning," "education," and "training." Yielding a total of 273 results from PubMed (179) and OVID (94). After screening a total of thirteen studies were included. Thirteen studies met inclusion criteria, including eight comparative analyses and six directly comparing robotic and laparoscopic techniques. Four studies evaluated robotic learning curves without a comparator group, while one was a literature review incorporating institutional experience. Most studies were retrospective (n = 8), with two prospective clinical studies and two experimental simulation-based studies. Hybrid approaches (robotic mobilisation with laparoscopic EA) contributed to heterogeneity (Reitz et al. 2018, https://doi.org/10.1007/s00464-018-6074-7 ). Learning curve assessment was heterogeneous, with most studies using cumulative sum (CUSUM) or risk-adjusted CUSUM (RA-CUSUM) analyses based on operative time or technical performance metrics. Proficiency in robotic IA was reported after approximately 11-29 cases in some series and around 20 cases in others, although larger studies of robotic colorectal surgery demonstrated broader ranges of up to 100 cases. Robotic right hemicolectomy with IA demonstrated a shorter learning curve and reduced anastomosis time compared with laparoscopic IA. Complication rates, conversion rates, and oncological outcomes were comparable between approaches (Gachabayov et al. 2019, Surg Technol Int, 34:163-168). Robotic intracorporeal anastomosis, particularly in right hemicolectomy, appears to have a shorter and less technically demanding learning curve compared with laparoscopic techniques, without compromising safety or oncological outcomes. These findings support a potential role for robotic platforms in facilitating adoption of intracorporeal anastomosis. However, current evidence is limited by retrospective design, small cohorts, and inconsistent definitions of proficiency (Gachabayov et al. 2019, Surg Technol Int, 34:163-168; Van Eetvelde et al. 2022, https://doi.org/10.1007/s11701-022-01514-6 ).
14 May 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Comparison of Functional Outcomes Between Robotic and Laparoscopic Surgery in Rectal Cancer Patients: Systematic Review and Meta-Analysis
BACKGROUND: Robotic and laparoscopic approaches are widely used for rectal cancer surgery. Although robotic systems provide enhanced visualization and dexterity, it remains unclear whether these advantages improve postoperative urinary and sexual function. METHODS: MEDLINE, Embase, Web of Science, and CENTRAL (2000-2025) were searched for studies comparing robotic and laparoscopic rectal cancer surgery. Outcomes included postoperative ileus, urinary retention, and urinary and sexual function. Random-effects meta-analysis was performed using RevMan. Study quality was assessed with MINORS, and certainty of evidence with GRADE. Publication bias was evaluated using funnel plots and Egger's test. RESULTS: Forty-four observational studies (6,121 patients) were included. Robotic surgery was associated with lower urinary retention, though this may reflect publication bias. No significant difference was found in postoperative ileus. Subgroup analyses at 3, 6, and 12 months showed no significant differences in urinary or sexual function. Although pooled results slightly favored robotic surgery, these effects were inconsistent, not sustained, and clinically modest. CONCLUSION: Robotic surgery may reduce urinary retention but shows no consistent functional superiority over laparoscopy. Outcomes at key follow-up points are comparable. As all studies were observational, evidence certainty is low, and findings should be interpreted cautiously. This study provides an updated and comprehensive synthesis of functional outcomes following robotic versus laparoscopic rectal cancer surgery, with a specific focus on clinically relevant time-point analyses (3, 6, and 12 months). Unlike prior meta-analyses, which often emphasize pooled outcomes across heterogeneous follow-up periods, this study demonstrates that no consistent or durable improvements in urinary or sexual function are observed at predefined postoperative intervals. Furthermore, by integrating GRADE-based certainty assessment, this work highlights that the current evidence is predominantly observational and of low to very low certainty. Importantly, the study incorporates contemporary evidence up to 2025, including recent systematic reviews and randomized data, and provides a clinically grounded interpretation by contextualizing effect sizes against minimal clinically important difference (MCID) thresholds. Collectively, this analysis offers a more cautious and clinically meaningful appraisal of functional outcomes, challenging assumptions of functional superiority associated with robotic rectal surgery.
2 May 2026
Read appraisal →The bone & joint journal
Robotic-assisted surgery and functional alignment in total knee arthroplasty: the RASKAL registry-nested 2 × 2 factorial randomized trial
AIMS: Robotic-assisted surgery and functional alignment are increasingly being adopted in total knee arthroplasty (TKA). This study assessed the individual and combined effectiveness of robotic-assisted surgery and functional alignment in improving outcomes in TKA, compared with computer-assisted surgery and mechanical alignment, respectively. METHODS: A registry-nested, multicentre, blinded, 2 × 2 factorial, randomized trial was performed with 303 TKA patients randomized to robotic-assisted or computer-assisted surgery, and functional or mechanical alignment. The primary outcome was the between-group differences in postoperative change over two years in the mean Knee Injury and Osteoarthritis Outcome Score (KOOS-12). Secondary outcomes included knee-specific and general patient-reported outcome measures (PROMs), operative and functional outcomes, and adverse events. Primary modified intention-to-treat and secondary per-protocol analyses were performed. RESULTS: There were no differences comparing robotic-assisted with computer-assisted surgery in KOOS-12 at three months, six months, one year, and two years (mean two-year difference -2.8; 95% CI -6.4 to 0.9; p = 0.137), and no differences comparing functional with mechanical alignment at three months, six months, one year, and two years (mean two-year difference 0.3 (95% CI -3.4 to 4.0); p = 0.867). No differences were found in Oxford Knee Score, Forgotten Joint Score, EuroQol five-dimension five-level visual analogue scale, patient satisfaction, joint-related improvement, and pain comparing technology or alignment groups at three months, six months, one year, and two years. Robotic-assisted surgery had a shorter mean operating time by 11.5 minutes (95% CI 7.3 to 15.9; p < 0.001) and better mean posterior cruciate ligament macroscopic soft-tissue injury score (mean difference 0.7 (95% CI 0.3 to 1.1); p = 0.001) compared with computer-assisted surgery. Mechanical alignment had a higher soft-tissue release rate compared with functional alignment (44.8% vs 8.1%; OR 9.2 (95% CI 4.6 to 18.3); p < 0.001). In most cases, surgeons preferred the use of robotics and functional alignment. CONCLUSION: Robotic-assisted surgery and functional alignment were not superior to computer-assisted surgery and mechanical alignment, respectively, in improving clinical and functional outcomes up to two years post-TKA.
8 Apr 2026
Read appraisal →Journal of the American Heart Association
A Position Statement on Endovascular Models and Effectiveness Metrics for Mechanical Thrombectomy Navigation, on Behalf of the Stakeholder Taskforce for Artificial Intelligence-Assisted Robotic Thrombectomy (START)
Although we are making progress in overcoming infectious diseases and cancer, one of the major medical challenges of the mid-21st century will be the increasing prevalence of stroke. Occlusions in large vessels are especially debilitating, yet effective treatment-needed within hours to achieve best outcomes-remains limited because of geographic accessibility. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the widespread deployment of robotic surgical systems. Artificial intelligence assistance may enable the safe and effective upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating artificial intelligence-assisted robots for thrombectomy. Objectives included standardizing effectiveness metrics and defining reference testbeds across in silico, in vitro, ex vivo, and in vivo environments. To achieve this, we convened experts in neurointervention, robotics, data science, health economics, policy, statistics, and patient advocacy. Consensus was built through an incubator day, a Delphi process, and a final position statement. We identified that the 4 essential testbed environments each had distinct validation roles. Realism requirements vary: simpler testbeds should include realistic vessel anatomy compatible with guidewire and catheter use, whereas standard testbeds should incorporate deformable vessels. More advanced testbeds should include blood flow, pulsatility, and disease features, such as atheromatous plaques. There are 2 macroclasses of effectiveness metrics: one for in silico, in vitro, and ex vivo stages focusing on technical navigation (eg, path-following error), and another for in vivo stages, focused on clinical outcomes (eg, modified treatment in cerebral infarction scores). Patient safety is central, and not a barrier, to this technology's development. One requisite patient safety task needed now is to correlate in vitro measurements to in vivo complications.
8 Apr 2026
Read appraisal →Methodist Debakey Cardiovasc J
Vascular Robotics: Webcast
This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.
1 Jan 2025
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