Managerial perspectives of scaling up robotic-assisted surgery in healthcare systems:A systematic literature review

Objectives Robotic-assisted surgery(RAS)is a minimally invasive technique practiced in multiple specialties.Standard training is essential for the acquisition of RAS skills.The cost of RAS is considered to be high,which makes it a burden for institutes and unaffordable for patients.This systematic literature review(SLR)focused on the various RAS training methods applied in different surgical specialties,as well as the cost elements of RAS,and was to summarize the opportunities and challenges associated with scaling up RAS.Methods An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines.The PubMed,EBSCO,and Scopus databases were searched for reports from January 2018 through January 2024.Full-text reviews and research articles in the English language from Asia-Pacific countries were included.Articles that outlined training and costs associated with RAS were chosen.Results The most common training system is the da Vinci system.The simulation technique,which includes dry-lab,wet-lab,and virtual reality training,was found to be a common and important practice.The cost of RAS encompasses the installation and maintenance costs of the robotic system,the operation theatre rent,personnel cost,surgical instrument and material cost,and other miscellaneous charges.The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.Conclusions The results of this SLR will help stakeholders such as decision-makers,influencers,and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective.For any healthcare innovation to reach a vast population,cost-effectiveness and standard training are crucial.

Robotic-assisted versus laparoscopic repair of type II, III and IV hiatal hernias: A retrospective study comparing adverse outcomes

Objective:Robotic-assisted surgery(RAS)is continuing to expand in use in surgical specialties,including foregut surgery.The available data on its use in large hiatal hernia(HH)repair are limited and conflicting.This study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs.a laparoscopic approach.This study was limited to outcomes in patients with type II,III,and IV HHs,as these hernias are typically more challenging to repair.Methods:A retrospective analysis was performed from data obtained from TriNetX,a large deidentified clinical database,over a 10-year period.Adult patients who underwent type II,III,or IV HH repair were included in the study.HH with robotic repair was compared to laparoscopic repair.Cohorts were propensity score matched for demographic information and comorbidities.Risk ratios,risk differences(RDs)with 95%confidence intervals(CIs),and t test for each examined adverse outcome were used to estimate the effects of robotic repair vs.laparoscopic repair.Results:In total,20,016 patients who met the inclusion criteria were identified;1,515 patients utilized RAS,and 18,501 used laparoscopy.Prior to matching,there were significant differences in age,sex,comorbidity,and BMI between the two cohorts.After 1:1 propensity score matching,analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or comorbidities.Patients who underwent robotic repair were more likely to experience major complications,including venous thromboembolism(RD:0.007,95%CI:0.003,0.011;p?0.002),critical care(RD:0.023,95%CI:0.007,0.039;p?0.004),urinary/renal complications(RD:0.027,95%CI:0.014,0.041;p<0.001),and respiratory complications(RD:0.046,95%CI:0.028,0.064;p<0.001).RAS was associated with a significantly shorter length of stay(32.4±27.5 h vs.35.7±50.1 h,p?0.031),although this finding indicated a reduction in the length of stay of less than 4 hours.No statistically significant differences in risk of esophageal perforation,infection,postprocedural shock,bleeding,mortality,additional emergency room visits,cardiac complications,or wound disruption were found.Conclusions:Patients who undergo robotic-assisted large HH repair are at increased risk of venous thromboembolism,need critical care,urinary or renal complications and respiratory complications.Due to variations in RAS technique,experience,and surgical volumes,further study of this surgical approach and complication rates is warranted.

Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease:A multicenter prospective study

BACKGROUND Robotic surgery is a cutting-edge minimally invasive technique that overcomes many shortcomings of laparoscopic techniques,yet few studies have evaluated the use of robotic surgery to treat Hirschsprung’s disease(HSCR).AIM To analyze the feasibility and medium-term outcomes of robotic-assisted proctosigmoidectomy(RAPS)with sphincter-and nerve-sparing surgery in HSCR patients.METHODS From July 2015 to January 2022,156 rectosigmoid HSCR patients were enrolled in this multicenter prospective study.Their sphincters and nerves were spared by dissecting the rectum completely from the pelvic cavity outside the longitudinal muscle of the rectum and then performing transanal Soave pull-through procedures.Surgical outcomes and continence function were analyzed.RESULTS No conversions or intraoperative complications occurred.The median age at surgery was 9.50 months,and the length of the removed bowel was 15.50±5.23 cm.The total operation time,console time,and anal traction time were 155.22±16.77,58.01±7.71,and 45.28±8.15 min.There were 25 complications within 30 d and 48 post-30-d complications.For children aged≥4 years,the bowel function score(BFS)was 17.32±2.63,and 90.91%of patients showed moderate-to-good bowel function.The postoperative fecal continence(POFC)score was 10.95±1.04 at 4 years of age,11.48±0.72 at 5 years of age,and 11.94±0.81 at 6 years of age,showing a promising annual trend.There were no significant differences in postoperative complications,BFS,and POFC scores related to age at surgery being≤3 mo or>3 mo.CONCLUSION RAPS is a safe and effective alternative for treating HSCR in children of all ages;it offers the advantage of further minimizing damage to sphincters and perirectal nerves and thus providing better continence function.

Clinical outcomes of robotic-assisted and manual total hip arthroplasty in the same patient:A case report

BACKGROUND Total hip arthroplasty(THA)is an effective treatment for advanced osteonecrosis of the femoral head,which can significantly relieve pain and improve patients'quality of life.Robotic-assisted THA enhances the accuracy and stability of THA surgery and achieves better clinical outcomes than manual THA.CASE SUMMARY We report the clinical outcomes of robotic-assisted THA and manual THA in the same patient with osteonecrosis of the femoral head.A 49-year-old male patient attended our hospital due to more than 3 years of pain in both hip joints.The left hip was treated with robotic-assisted THA.The patient underwent manual THA of the right hip 3 mo after robotic-assisted THA.We obtained postoperative radiograph parameters,Harris hip score and forgotten joint score of the patient 1 year after surgery.CONCLUSION Compared with manual THA,the patient’s left hip felt better 1 year after roboticassisted THA.Robotic-assisted THA resulted in a better Harris hip score and forgotten joint score than manual THA in the same patient with osteonecrosis of the femoral head.

Coordinated control strategy for robotic-assisted gait training with partial body weight support

Walking is the most basic and essential part of the activities of daily living. To enable the elderly and non-ambulatory gait-impaired patients, the repetitive practice of this task, a novel gait training robot(GTR) was designed followed the end-effector principle, and an active partial body weight support(PBWS) system was introduced to facilitate successful gait training. For successful establishment of a walking gait on the GTR with PBWS, the motion laws of the GTR were planned to enable the phase distribution relationships of the cycle step, and the center of gravity(COG) trajectory of the human body during gait training on the GTR was measured. A coordinated control strategy was proposed based on the impedance control principle. A robotic prototype was developed as a platform for evaluating the design concepts and control strategies. Preliminary gait training with a healthy subject was implemented by the robotic-assisted gait training system and the experimental results are encouraging.

Robotic-assisted cholecystectomy: Current status and future application

Robotic-assisted cholecystectomy(RC)is increasingly common.However,its exact role remains unde-fined,with multiport conventional laparoscopic cholecystectomy(LC)being regarded as the established gold standard.This review aims to provide an overview of the evidence for RC and to define its current and future role.A literature search was performed on the PubMed and Medline databases to identify relevant articles published between 1994 and February 2022.The evidence obtained was summarised in a narrative style.Greater emphasis was placed on recent 10-year articles and studies of higher meth-odological quality.RC is noninferior to LC.The robotic platform facilitates the application of minimally invasive surgery in a way conventional laparoscopy cannot.LC remains appropriate for the majority of patients requiring cholecystectomy.The advantages of RC include inherent technical benefits,facilitating the learning of new surgical technology and its potential to reduce the risk of open conversion and bile leakage in certain populations(Mirizzi syndrome,complicated calculous disease,chronic liver disease and possibly malignancy).It also has increasing applicability to related biliary surgery.The limitations include cost,loss of tactile feedback and the learning curve associated with initial implementation.Future applications of robotic surgical systems include utilisation in difficult cholecystectomy,cases of biliary malignancy,telerobotic surgery and telementoring.

Laparoscopic Observations in Acquired Inguinal Hernia before and after Robotic-Assisted Laparoscopic Prostatectomy

Background: The mechanism of the development of acquired inguinal hernia, especially indirect inguinal hernia, is not well known. Although anatomical studies have been performed to explain development of inguinal hernia, they have mainly involved autopsy or temporal findings at the time of hernioplasty. To elucidate the pattern of development of acquired inguinal hernia, we studied the occurrence of inguinal hernia after robotic-assisted laparoscopic prostatectomy (RALP). Methods: From March 2009 to November 2011, RALP for prostatic cancer was performed on 60 patients in our institute. The RALP was performed by one urologist using the da Vinci Surgical System. The postsurgical development of inguinal hernia was diagnosed based on patients’ symptoms. Seven patients were treated with laparoscopic hernioplasty, and one underwent mesh-plug repair. Using video recordings, the laparoscopic findings during RALP and laparoscopic hernioplasty were compared among all patients. Results: Seven of 59 patients (11.9%) developed an inguinal hernia. One patient had a pre-existing pantaloon inguinal hernia at the time of RALP. Eleven inguinal lesions in the seven patients who underwent laparoscopic hernioplasty were reviewed, and all were indirect inguinal hernias. Conclusion: A main factor in the development of inguinal hernia after RALP could be a combination of outer-side intact layers and inner-side hard scar of the inguinal ring, which seems like “out swing door”.

Intraoperative Ureteral Identification Utilizing StimSite™ Technology during Robotic-Assisted Sacral Colpopexy Procedure: A Case Report

Identification of the pelvic ureter location is crucial during robotic-assisted sacral colpopexy procedures to avoid iatrogenic injury. In this case study, StimSite&#8482 technology (Allotrope Medical;Houston, TX) was used to assist with ureter identification. StimSite is a novel, minimally invasive surgical device designed to facilitate ureter identification by delivering on-demand mild electrical impulses to stimulate visible ureteral peristalsis. Visualization of the ureter can help prevent inadvertent injury which can cause significant patient morbidity, and in some cases mortality. The use of StimSite permitted ureter mapping along the pelvic sidewall and assisted with creating the proper peritoneal dissection for synthetic mesh placement. StimSite provides a minimally invasive, time-conscious option for real-time ureter identification during robotic-assisted sacral colpopexy procedures.

Trends in hospital readmissions and emergency room visits 60 days after robotic-assisted and laparoscopic hysterectomy

Objective:Hospital readmission after surgery is one of the major contributors to the increased healthcare cost.Robotic-assisted hysterectomy(RAH)is an innovative surgical procedure most commonly performed within the last decade.The purpose of this study was to analyze the effects on hospital readmission patterns and emergency room(ER)visits within 60 days of discharge for women who had RAH versus laparoscopic hysterectomy(LH)in an academic community hospital in Texas.Method:We performed a retrospective study of women with RAH or LH.We used the univariate and multivariate logistic regression to examine the impact of patients'risk factors,the type of surgery,age,number of comorbidities,and duration of surgery on the 60-day hospital readmissions and ER visits.Results:A total of 291 cases with RAH or LH for benign and malignant indications were examined.The number of comorbidities and duration of surgery were similar between the two treatment groups(p>0.05).Patients in the RAH group were younger than the LH group(RAH:45.4±9.9 y,LH:49.8±11.5 y,p<0.05).No significant difference neither in hospital readmission or ER visits between the two groupswas observed(p?0.544 and p=0.109,respectively).Younger age and longer duration of surgery were significantly associated with a higher risk of ER visits(p<0.05).Conclusion:RAH is comparable with LH in hospital readmissions and ER visits.The younger age and longer operation time could lead to ER visits.

Robotic-assisted esophagectomy: A literature review and our experience at a tertiary care centre

Esophageal cancer is a common cancer with a high case-related mortality worldwide,and radical resection offers the best survival.Initial reports have suggested that esophagus is an ideal organ which could benefit with robotic assistance.However,it remains to be seen whether robotic technology translates into better surgical outcomes and survival for the patients with esophageal cancer.We searched PubMed,Scopus and Google Scholar for English language articles.The search terms included minimally invasive esophagectomy or MIE,robotic-assisted esophagectomy,hybrid esophagectomy,robot-assisted minimal invasive esophagectomy or RAMIE,esophageal cancer,esophageal carcinoma.We review the development of robotic-assisted esophagectomy to focus on the surgical techniques and oncological clearance,and present a brief summary of our experience in this approach.Controlled trials will be required to establish the benefit of robotic-assisted esophagectomy,however the current literature points towards the safety and feasibility of this approach.

Evaluation of the short-term outcomes of robotic-assisted radical resection for perihilar cholangiocarcinoma:a propensity-scored matching analysis

Background:The application of robotic-assisted radical resection in perihilar cholangiocarcinoma(pCCA)remains poorly defined.This study aimed to evaluate the safety and efficacy of robotic-assisted radical resection for pCCA in our institute.Methods:Between July 2017 and July 2022,pCCA patients undergoing robotic-assisted and open radical resection at First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)were included.The short-term outcomes were compared by using propensity-scored matching(PSM)analysis.Results:Eighty-six pCCA patients were enrolled.After PSM at a ratio of 1:2,10 and 20 patients were assigned to the roboticassisted and open groups,respectively.There were no significant disparities in the clinicopathological features between the two groups.The robotic-assisted group had significantly longer operation time(median:548 vs 353 min,P=0.004)and larger total number of lymph nodes examined(median:11 vs 5,P=0.010)than the open group.The robotic-assisted group tended to have a lower intraoperative blood loss(median:125 vs 350 mL,P=0.067),blood transfusion rates(30.0%vs 70.0%,P=0.056),and post-operative overall morbidities(30.0%vs 70.0%,P=0.056)than the open group,even though the differences were not statistically significant.There were no significant differences in the negative resection margin,post-operative major morbidities,or post-operative length-of-stay between the robotic-assisted and open groups(all P>0.05).Conclusions:Robotic-assisted radical resection of pCCA may get a larger total number of lymph nodes examined than open surgery.Provided robotic-assisted surgery may be a feasible and safe technique for selected pCCA patients.

Learning curves of resection and reconstruction procedures in robotic-assisted pancreatoduodenectomy by a single surgeon:a retrospective cohort study of 160 consecutive cases

Background:Robotic-assisted pancreatoduodenectomy(RPD)has been routinely performed in a few of centers worldwide.This study aimed to evaluate the perioperative outcomes and the learning curves of resection and reconstruction procedures in RPD by one single surgeon.Methods:Consecutive patients undergoing RPD by a single surgeon at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between July 2016 and October 2022 were included.The perioperative outcomes and learning curves were retrospectively analysed by using cumulative sum(CUSUM)analyses.Results:One-hundred and sixty patients were included.According to the CUSUM curve,the times of resection and reconstruction procedures were shortened significantly after 30 cases(median,284 vs 195 min;P<0.001)and 45 cases(median,138 vs 120 min;P<0.001),respectively.The estimated intraoperative blood loss(median,100 vs 50 mL;P<0.001)and the incidence of clinically relevant post-operative pancreatic fistula(29.2%vs 12.5%;P=0.035)decreased significantly after 20 and 120 cases,respectively.There were no significant differences in the total number of lymph nodes examined,post-operative major complications,or post-operative length-of-stay between the two groups.Conclusions:Optimization of the resection procedure and the acquisition of visual feedback facilitated the performance of RPD.RPD was a safe and feasible procedure in the selected patients.

Is HPB robotic-assisted surgery an evolution or a revolution in laparoscopy?

Robotic-assisted surgery technology demonstrates a new prospect for surgery.Its advantages are particularly prominent in specific surgery divisions or for specific surgical procedures,which has set off a new wave of surgical technology following laparoscopic surgery.Looking back at the history of surgical development over the past century,there have been many technological waves,some of which have become classics and standards,some of which are constantly evolving,and some of which have been gradually abandoned in practice.In the context of the increasingly mature and accurate laparoscopic surgery,which has become a standard operation of many types of surgery,the government,medical institutions and surgeons should carefully consider the role and future development of robotic-assisted surgery.

Robotic-assisted bronchoscopy in the diagnosis of peripheral pulmonary lesions

More peripheral pulmonary lesions(PPLs)are detected by low-dose helical computed tomography(CT)either in-cidentally or via dedicated lung cancer screening programs.Thus,using methods for safe and accurate diagnosis of these lesions has become increasingly important.Transthoracic needle aspiration(TTNA)and transbronchial lung biopsy(TBLB)are routinely performed during the diagnostic workup for PPLs.However,TTNA often car-ries the risk of pneumothorax,uncontrollable airway hemorrhage,and does not allow mediastinal staging in one procedure.In contrast,traditional TBLB often has a poorer diagnostic yield despite fewer complications.With the ongoing development of technology applied to bronchoscopy,guided bronchoscopy has become widely used and the diagnostic yield of TBLB has improved.Additionally,guided bronchoscopy continues to demonstrate a better safety profile than TTNA.In recent years,robotic-assisted bronchoscopy(RAB)has been introduced and imple-mented in the diagnosis of PPLs.At present,RAB has two platforms that are commercially available:Monarch TM and Ion TM;several other platforms are under development.Both systems differ in characteristics,advantages,and limitations and offer features not seen in previous guided bronchoscopy.Several studies,including cadaveric model studies and clinical trials,have been conducted to examine the feasibility and performance of RAB using these two systems;large multicenter studies are underway.In this review,published experimental results,focus-ing on diagnostic yield and complications of RAB,are analyzed and the potential clinical application of RAB is discussed,which will enable the operators to have a clear overview of RAB.

Robotic-assisted microsurgery for lymphedema treatment

The recent development of robotic-assisted microsurgery and supermicrosurgery has raised great expectations to support some of the most demanding microsurgical procedures,which are applied in lymphatic reconstructive surgery to restore lymphatic vascular integrity and treat lymphedema.Procedures such as the establishment of lymphovenous anastomosis(LVA),the harvest of lymph nodes from anatomic locations that reduce donor-side morbidity and the transplantation of the vascularized lymph node flaps(VLNT)present procedures necessitating extreme precision and dexterity in often difficult-to-reach areas,thus pushing the physical limitations of the performing microsurgeon.Despite being limited in number,recent preclinical and clinical studies of independent groups using different robotic systems demonstrate the feasibility of robotic technology to perform supermicrosurgical procedures successfully.The robotic assistance offers unparalleled precision,refining the surgical techniques and minimizing potential side effects,with clinical outcomes comparable to the conventional techniques.Although the relative disadvantages of robotic assistance mostly appear to be related to adequate training and the prolonged learning curve,the technology promises to revolutionize the field of supermicrosurgery and improve the clinical outcomes of lymphatic reconstructive surgery.

Current surgical practices of robotic-assisted tissue repair and reconstruction

This paper systematically reviewed and analyzed the recent publications of robotic-assisted surgeries in the field of tissue repair and reconstruction.Surgical robots can elevate skin flap more accurately and shorten the time of tissue harvest.In addition,robotic-assisted surgery has the advantage of minimal tissue trauma and thus forms minimal scar.The utilization of surgical robots reduces the occurrence of complications after oral radical tumor resection while achieving cosmetic sutures.Robotic-assisted radical mastectomy could radically remove invasive breast cancer lesions and achieve breast reconstruction in the first stage through the small incisions in the operation areas.Surgical robots enable precise microvascular anastomosis and reduce tissue edema in the surgical field.Robotic-assisted technology can help appropriately locate the target tissues at different angles during sinus and skull base surgeries and accurately place tissues during urethroplasty.The robotic-assisted technology provides a new platform for surgical innovation in the field of tissue repair and reconstruction.However,the uncertainty in the survival rate after tumor radical surgery,the increase of operating time,and the high costs are barriers for its clinical application in tissue repair and reconstructive surgery.Nevertheless,robotic-assisted technology has already demonstrated an impact on the field of tissue repair and reconstruction in a meaningful way.

Robotic-assisted versus open total pancreatectomy: a propensity score-matched study

Background:Total pancreatectomy(TP)is a complex surgical procedure with significant postoperative morbidity.Despite the narrowed range of indications for TP,the introduction of neoadjuvant chemotherapy and the increasing complexity of surgical resections performed in high-volume centers has increased the number of annually performed TPs,especially regarding malignant disease.The introduction of robotic-assisted pancreatic surgery has provided a novel and minimally invasive approach for TP,yet the feasibility of this technique is still unknown.This study assessed the safety and efficacy of robotic-assisted total pancreatectomy(RTP)compared to conventional open total pancreatectomy(OTP).Methods:All patients who underwent TP between March 2015 and July 2019 in a high-volume institution for pancreatic surgery were included in this retrospective study.Clinical data and perioperative outcomes were derived from the prospectively maintained institutional database.A 1:1 propensity score matching(PSM)method was utilized to compare the RTP and OTP cohorts to minimize bias.Results:A standardized surgical protocol was utilized for RTP following a learning curve of RPD and RDP.The median operative time for patients who underwent RTP was significantly decreased compared to those who underwent OTP[300(IQR,250-360)vs.360 min(IQR,300-525),P=0.031].Additionally,en bloc resection and spleen-preserving rates were also higher in the RTP cohort.Major 30-day morbidity(Clavien-Dindo>IIIa)and 90-day mortality were similar between the two cohorts.After a median follow-up time of 15(IQR,8-24)months,both the RTP and OTP cohorts had a comparable quality of life regarding exocrine and endocrine insufficiency.Conclusions:RTP appears to be safe and feasible when utilized in high-volume centers for the indicated management of benign and highly selected malignant pancreatic disease.However,further prospective randomized studies are needed to assess the feasibility of this approach.

Determining the component-based operative time learning curve for robotic-assisted radical prostatectomy

Objectives:To determine the learning curve(LC)of total operative time and the discrete components of the robotic-assisted radical prostatectomy(RARP)for a recent robotic fellowship-trained urologic surgeon.Materials and methods:We performed a retrospective analysis of RARP procedures performed by a single new attending surgeon from August 2015 to April 2019.Patients'demographics and operative details were assessed.Total operative time was divided and prospectively recorded in 7 parts:(a)docking robot,(b)dissecting seminal vesicles(SVs)(c)dissecting endopelvic fascia(EPF),(d)incising bladder neck(BN),(e)completing the dissection,(f)lymph node dissection,and(g)urethrovesical anastomosis(UVA)and robot undocking.Cumulative sum analysis was used to ascertain the LC for total operative time and the 7 parts of the procedure.Results:One hundred twenty consecutive RARPs were performed.The LC was overcome at 25 cases for total operative time,13 cases for docking the robot,33 cases for dissecting SVs,31 cases for dissecting EPF,46 cases for incising BN,38 cases for prostate dissection,25 cases for lymph node dissection,and 52 cases for UVA.Total operative time was decreased 22.8%(p<0.0001)and time for robot docking,dissecting SVs,dissecting EPF,incising BN,completing prostate dissection,lymph node dissection,and UVA were decreased 16.7%,30.5%,29.5%,36.2%,37.3%,32.2%,and 26.9%,respectively(all p<0.05).Conclusions:We observed a 25-case LC for a fellowship-trained urologist to achieve stable operative performance of RARP surgery.Procedural components demonstrated variable LCs including the UVA that required upward of 52 cases.

Description of a novel robotic early post-prostatectomy anastomotic repair technique and institutional outcomes

Objective:A vesicourethral anastomotic leak(VUAL)is a known complication following robotic-assisted radical prostatectomy.The natural history of a VUAL has been well described and is frequently managed with prolonged catheterization.With increasing emphasis on patient reported outcomes,catheter duration and VUAL are associated with significant short-term quality of life impairment.We aimed to present a case series of our robotic early post-prostatectomy anastomotic repair technique,defined as revision within 6 weeks from index surgery.Methods:A single institution prospective database identified eleven patients with a VUAL from July 2016 to October 2022 who underwent robotic early post-prostatectomy anastomotic repair by a single surgeon.Patients were diagnosed with a VUAL on pre-operative CT urogram or CT/fluoroscopic cystogram.The primary outcome was resolution of the anastomotic leak,defined as no contrast extravasation on post-operative cystography.Secondary outcomes included post-repair catheter duration and continence on the last follow-up defined as pad(s)per day.Results:The mean time to intervention after robotic-assisted radical prostatectomy was 21 days.Eight of the eleven(72.7%)patients had no evidence of extravasation on postrepair cystogram.The range from intervention to first cystogram was 7e20 days.The median catheter duration for those with successful intervention was 10 days.The median catheter duration for those with the leak on initial post-operative cystogram was 20 days.At a mean follow-up time of 25 months,eight(72.7%)patients reported using no pads per day,and three(27.3%)patients reported one pad per day.Conclusion:Management of a VUAL has traditionally relied on prolonged catheter drainage and the tincture of time.As the role of robotic reconstruction has been shown to be a viable modality for management of bladder neck contracture,it is important to reconsider prior dogmas of urologic care.Our case series suggests that an early repair is safe and has a high success rate.Early robotic intervention gives providers an additional tool in aiding patient recovery.

Harnessing the Power of Artificial Intelligence in Neuromuscular Disease Rehabilitation: A Comprehensive Review and Algorithmic Approach

Neuromuscular diseases present profound challenges to individuals and healthcare systems worldwide, profoundly impacting motor functions. This research provides a comprehensive exploration of how artificial intelligence (AI) technology is revolutionizing rehabilitation for individuals with neuromuscular disorders. Through an extensive review, this paper elucidates a wide array of AI-driven interventions spanning robotic-assisted therapy, virtual reality rehabilitation, and intricately tailored machine learning algorithms. The aim is to delve into the nuanced applications of AI, unlocking its transformative potential in optimizing personalized treatment plans for those grappling with the complexities of neuromuscular diseases. By examining the multifaceted intersection of AI and rehabilitation, this paper not only contributes to our understanding of cutting-edge advancements but also envisions a future where technological innovations play a pivotal role in alleviating the challenges posed by neuromuscular diseases. From employing neural-fuzzy adaptive controllers for precise trajectory tracking amidst uncertainties to utilizing machine learning algorithms for recognizing patient motor intentions and adapting training accordingly, this research encompasses a holistic approach towards harnessing AI for enhanced rehabilitation outcomes. By embracing the synergy between AI and rehabilitation, we pave the way for a future where individuals with neuromuscular disorders can access tailored, effective, and technologically-driven interventions to improve their quality of life and functional independence.