Treatment of hemolymphangioma by robotic surgery: A case report

BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.

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 surgery in living liver donors and liver recipients

There have been nearly 60 years since Thomas Starzl’s first liver transplant.During this period,advancements in medical technology have progressively enabled the adoption of new methods for transplantation.Among these innovations,robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine.Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery.The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients.In living donors,robotic hepatectomy reduces postoperative pain,minimizes scarring,and accelerates recovery.For liver recipients,robotic liver implantation enhances surgical accuracy,leading to better graft positioning and vascular anastomosis.Robotic systems provide more precise and maneuverable control of instruments,allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients.This review encompasses publications on minimally invasive donor liver surgery,with a specific focus on robotic liver resection in transplantation,and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation,focusing on liver resection in donors and graft implantation in recipients.

Comparing short-term outcomes of robot-assisted and conventional laparoscopic total mesorectal excision surgery for rectal cancer in elderly patients

BACKGROUND Da Vinci Robotics-assisted total mesorectal excision(TME)surgery for rectal cancer is becoming more widely used.There is no strong evidence that roboticassisted surgery and laparoscopic surgery have similar outcomes in elderly patients with TME for rectal cancer.AIM To determine the improved oncological outcomes and short-term efficacy of robot-assisted surgery in elderly patients undergoing TME surgery.METHODS A retrospective study of the clinical pathology and follow-up of elderly patients who underwent TME surgery at the Department of Gastrointestinal Oncology at the Affiliated Hospital of Nanjing University of Chinese Medicine was conducted from March 2020 through September 2023.The patients were divided into a robotassisted group(the R-TME group)and a laparoscopic group(the L-TME group),and the short-term efficacy of the two groups was compared.RESULTS There were 45 elderly patients(≥60 years)in the R-TME group and 50 elderly patients(≥60 years)in the L-TME group.There were no differences in demographics,conversion rates,or postoperative complication rates.The L-TME group had a longer surgical time than the R-TME group[145(125,187.5)vs 180(148.75,206.25)min,P=0.005),and the first postoperative meal time in the L-TME group was longer than that in the R-TME(4 vs 3 d,P=0.048).Among the sex and body mass index(BMI)subgroups,the R-TME group had better out-comes than did the L-TME group in terms of operation time(P=0.042)and intraoperative assessment of bleeding(P=0.042).In the high BMI group,catheter removal occurred earlier in the R-TME group than in the L-TME group(3 vs 4 d,P=0.001),and autonomous voiding function was restored.CONCLUSION The curative effect and short-term efficacy of robot-assisted TME surgery for elderly patients with rectal cancer are similar to those of laparoscopic TME surgery;however,robotic-assisted surgery has better short-term outcomes for individuals with risk factors such as obesity and pelvic stenosis.Optimizing the learning curve can shorten the operation time,reduce the recovery time of gastrointestinal function,and improve the prognosis.

Robotic Surgery: An Effective Treatment Option for Epiphrenic Diverticulum Associated with Nutcracker Esophagus

Background: Epiphrenic Diverticulum is frequently associated with esophageal motility disorders, such as nutcrackers esophagus. The diagnosis is usually made using imaging studies such as a Barium esophagogram, and esophageal manometry. Surgical treatment options for epiphrenic diverticulum and EN include diverticulectomy and wide myotomy. Aim: The resection of three epiphrenic diverticula and extensive myotomy were performed by robotic thoracoscopy uneventfully. Case presentation: A 65-year-old female complaining of dysphagia for solid foods, Chest pain and regurgitation. Esophagogastroduodenoscopy (EDG) with difficulty in advancing the endoscope at 25 cm and demonstrating an ED, no hiatal hernia and normal stomach and duodenum. Barium Esophagogram showed multiple diverticula and tortuosity throughout the esophagus. Conclusion: With robotic surgery, surgeons can perform highly precise operations with enhanced 3D vision and control. Through this cutting-edge approach, the treatment of ED associated with EN can be drastically changed, promising better outcomes for patients.

Clinical Study of Tianji Robotic-Assisted Surgery for Upper Cervical Spine Fractures

Object: To compare the safety, clinical efficacy, and complication rate of “Tianji” robot-assisted surgery with traditional open surgery in the treatment of cervical vertebrae fracture. Methods: 60 patients with upper cervical vertebrae fracture admitted to Baise People’s Hospital between November 2018 and April 2024 were retrospectively analyzed. Among these patients, 29 underwent “Tianji” robot-assisted surgery (Robot group), and 31 underwent traditional C-arm fluoroscopy-assisted open surgery (Open group). Statistical analysis of the data was performed using SPSS 27.0 software to compare general data (gender, age, BMI), preoperative and postoperative visual analogue scale (VAS) scores, neck disability index (NDI), intraoperative blood loss, accuracy of screw placement on imaging, and the number of complications in both groups for comprehensive evaluation. A P value < 0.05 was deemed to have achieved statistical significance. Results: There was no significant difference in preoperative VAS scores between the two groups (Robot group: 8.34 ± 0.61;Open group: 8.26 ± 0.68, P = 0.317). There was also no significant difference in VAS scores at 1 week postoperatively (Robot group: 6.90 ± 0.31;Open group: 6.94 ± 0.36, P = 0.3237). Preoperative NDI scores showed no significant difference between the two groups (Robot group: 43.31 ± 2.67;Open group: 43.84 ± 2.67, P = 0.2227), and the difference in NDI scores at 1 week postoperatively was also not significant (Robot group: 35.69 ± 4.24;Open group: 37.35 ± 3.48, P = 0.0509). Intraoperative blood loss in the Robot group was significantly lower than in the Open group (246.21 ± 209 ml vs 380.65 ± 328.04 ml, P = 0.0308), with a statistically significant difference. The operation time was longer in the Robot group (3.75 ± 0.74 h) compared to the Open group (2.74 ± 0.86 h). In terms of screw placement accuracy, the Robot group had a higher accuracy rate for Class A screws compared to the Open group (102 screws vs 94 screws, P = 0.0487), and the accuracy rate for Class B screws was also higher in the Robot group (13 screws vs 29 screws, P = 0.0333), with both differences being statistically significant. There was no significant difference in the number of complications between the two groups (Robot group: 8 cases;Open group: 10 cases, P = 0.6931). Conclusion: Patients treated with “Tianji” robot-assisted surgery for upper cervical vertebrae fracture had lower intraoperative blood loss and higher screw placement accuracy compared to those undergoing traditional C-arm fluoroscopy-assisted open surgery, indicating that this robot-assisted surgery can effectively reduce intraoperative blood loss and improve screw placement accuracy.

Comparative study on the efficacy of transoral robotic surgery and non-robotic surgery for tongue base tumors

Objective:To compare the efficacy of transoral robotic surgery(TORS)and non-robotic surgery(NRS)in the treatment of tongue base tumors.Methods:A total of 45 patients with tongue base tumors treated in our hospital were selected,and they were divided into the TORS group and NRS group according to different surgical methods.The surgical indicators and postoperative complications of patients in the two groups were compared and analyzed.Results:Compared with the NRS group,the operative time,bleeding volume and length of hospital stay were less in the TORS group,and the postoperative recurrence rate was less in the TORS group than that in the NRS group.The incidence rate of dysphagia and restricted mouth opening in the TORS group was lower than that in the NRS group within 30 d after surgery,and the difference was statistically significant(P<0.05).Conclusion:TORS has better minimally invasive advantages in the treatment of tongue base tumors,including less intraoperative bleeding,smaller trauma,shorter length of hospital stay and faster recovery.

Laparoscopic and robot-assisted laparoscopic digestivesurgery:Present and future directions

Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.

Total mesorectal excision for mid and low rectal cancer: laparoscopic vs robotic surgery

AIM: To compare the short- and long-term outcomes of laparoscopic and robotic surgery for middle and low rectal cancer.METHODS: This is a retrospective study on a prospectively collected database containing 111 patients who underwent minimally invasive rectal resection with total mesorectal excision (TME) with curative intent between January 2008 and December 2014 (robot, n = 53; laparoscopy, n = 58). The patients all had a diagnosis of middle and low rectal adenocarcinoma with stage&#x02005;I-III disease. The median follow-up period was 37.4 mo. Perioperative results, morbidity a pathological data were evaluated and compared. The 3-year overall survival and disease-free survival rates were calculated and compared.RESULTS: Patients were comparable in terms of preoperative and demographic parameters. The median surgery time was 192 min for laparoscopic TME (L-TME) and 342 min for robotic TME (R-TME) (P &#x0003c; 0.001). There were no differences found in the rates of conversion to open surgery and morbidity. The patients who underwent laparoscopic surgery stayed in the hospital two days longer than the robotic group patients (8 d for L-TME and 6 d for R-TME, P &#x0003c; 0.001). The pathologic evaluation showed a higher number of harvested lymph nodes in the robotic group (18 for R-TME, 11 for L-TME, P &#x0003c; 0.001) and a shorter distal resection margin for laparoscopic patients (1.5 cm for L-TME, 2.5 cm for R-TME, P &#x0003c; 0.001). The three-year overall survival and disease-free survival rates were similar between groups.CONCLUSION: Both L-TME and R-TME achieved acceptable clinical and oncologic outcomes. The robotic technique showed some advantages in rectal surgery that should be validated by further studies.

Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

Robotic surgery for rectal cancer: A systematic review of current practice

AIM: To give a comprehensive review of current litera-ture on robotic rectal cancer surgery.METHODS: A systematic review of current literature via PubMed and Embase search engines was per-formed to identify relevant articles from january 2007 to november 2013. The keywords used were: "robotic surgery", "surgical robotics", "laparoscopic computer-assisted surgery", "colectomy" and "rectal resection". RESULTS: After the initial screen of 380 articles, 20 pa-pers were selected for review. A total of 1062 patients(male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review.Out of 1062 robotic-assisted operations, 831(78.2%) anterior and low anterior resections, 132(12.4%) in-tersphincteric resection with coloanal anastomosis, 98(9.3%) abdominoperineal resections and 1(0.1%) Hart-mann's operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has con-tinued to evolve to its current state with promising re-sults; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost.

Robotic surgical systems in maxillofacial surgery:a review

Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.

Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer

AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were calculated using either the fixed effects model or random effects model. RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion(WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile, operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.

Robotic assisted andrological surgery

The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation （for chronic orchialgia） and robotic assisted microsurgical testicular sperm extraction （microTESE）.

Current status of robot-assisted gastric surgery

In an effort to minimize the limitations of laparoscopy,a robotic surgery system was introduced,but its role for gastric cancer is still unclear.The objective of this article is to assess the current status of robotic surgery for gastric cancer and to predict future prospects.Although the current study was limited by its small number of patients and retrospective nature,robot-assisted gastrectomy with lymphadenectomy for the treatment of gastric cancer is a feasible and safe procedure for experienced laparoscopic surgeons.Most studies have reported satisfactory results for postoperative short-term coutcomes,such as:postoperative oral feeding,gas out,hospital stay and complications,compared with laparoscopic surgery;the difference is a longer operation time.However,robotic surgery showed a shallow learning curve compared with the familarity of conventional open surgery;after the accumulation of several cases,robotic surgery could be expected to result in a similar operation time.Robotic-assisted gastrectomy can expand the indications of minimally invasive surgery to include advanced gastric cancer by improving the ability to perform lymphadenectomy.Moreover," total" robotic gastrectomy can be facilitated using a robotsewing technique and gastric submucosal tumors near the gastroesophageal junction or pylorus can be resected safely by this novel technique.In conclusion,robotassisted gastrectomy may offer a good alternative to conventional open or laparoscopic surgery for gastric cancer,provided that long-term oncologic outcomes can be confirmed.

Critical analysis of the literature investigating urogenital function preservation following robotic rectal cancer surgery

AIM To analyses the current literature regarding the urogenital functional outcomes of patients receiving robotic rectal cancer surgery. METHODS A comprehensive literature search of electronic databases was performed in October 2015. The following search terms were applied: "rectal cancer" or "colorectal cancer" and robot* or "da Vinci" and sexual or urolog* or urinary or erect* or ejaculat* or impot* or incontinence. All original studies examining the urological and/or sexual outcomes of male and/or female patients receiving robotic rectal cancer surgery were included. Reference lists of all retrieved articles were manually searched for further relevant articles. Abstracts were independently searched by two authors. RESULTS Fifteen original studies fulfilled the inclusion criteria. A total of 1338 patients were included; 818 received robotic, 498 laparoscopic and 22 open rectal cancer surgery. Only 726(54%) patients had their urogenital function assessed via means of validated functional questionnaires. From the included studies, three found that robotic rectal cancer surgery leads to quicker recovery of male urological function and five of male sexual function as compared to laparoscopic surgery. It is unclear whether robotic surgery offers favourable urogenital outcomes in the long run for males. In female patients only two studies assessed urological and threesexual function independently to that of males. In these studies there was no difference identified between patients receiving robotic and laparoscopic rectal cancer surgery. However, in females the presented evidence was very limited making it impossible to draw any substantial conclusions. CONCLUSION There seems to be a trend towards earlier recovery of male urogenital function following robotic surgery. To evaluate this further, larger well designed studies are required.

Robotic rectal surgery: State of the art

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases (PubMed and EMBASE) using the key words &ldquo;rectum&rdquo;, &ldquo;rectal&rdquo;, &ldquo;cancer&rdquo;, &ldquo;laparoscopy&rdquo;, &ldquo;robot&rdquo;. After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection (1450 patients, 48.1%), followed by anterior resections (997 patients, 33%), ultra-low anterior resections (393 patients, 13%) and abdominoperineal resections (173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultra-low anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

Robotic-assisted surgery for pediatric choledochal cyst: Case report and literature review

Our paper describes the key surgical points of pediatric choledochocystectomy performed completely by Da Vinci robotic system. A choledochocystectomy was safely carried out for a girl at our hospital, and without any complication. Then systematic literature review was done to discuss the methods of intestine surgery and intestinal anastomosis, the use of 3 rd robotic arm, the surgical safety and advantages comparing open and laparoscopic surgery. We systematically reviewed choledochocystectomy for children performed by robotic surgery. We included a total of eight domestic and foreign reports and included a total of 86 patients, whose average age was 6.3(0.3-15.9) years; the maleto-female ratio was 1:3.5(19:67). Seven patients experienced conversion to open surgery, and the surgery success rate was 91.9%(79/86). The average total operation time was 426(180-520) min, the operation time on the machine was 302(120-418) min, 11 cases used the number 3 arm, and the remaining mainly used the hitch-stitch technique to suspend the stomach wall and liver. Forty-seven patients underwent pull-through intestine and intestinal anastomosis, and 39 patients underwent complete robotic intestine surgery and intestinal anastomosis. The hospitalization time of roboticassisted choledochocystectomy was 8.8 d. Eight patientshad biliary fistula and were all cured by conservative treatment and continuous observation. One patient had anastomotic stenosis, and one patient had wound dehiscence, both cured by surgery. Choledochocystectomy for children performed by completely robotic surgery and Roux-en-Y hepaticojejunostomy is safe and feasible. The initial experience shows that this surgical approach has a clearer field than the traditional endoscopy, and its operation is more flexible, the surgery is more accurate, and the injury is smaller. With the advancement of technology and the accumulation of surgeons' experience, robotic surgery may become a new trend in this surgical procedure.

International consensus statement on robotic hepatectomy surgery in 2018

The robotic surgical system has been applied in liver surgery. However,controversies concerns exist regarding a variety of factors including the safety,feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts' consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication,techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Dealing with robot-assisted surgery for rectal cancer:current status and perspectives

The laparoscopic approach for treatment of rectal cancer has been proven feasible and oncologically safe, and is able to offer better short-term outcomes than traditional open procedures, mainly in terms of reduced length of hospital stay and time to return to working activity. In spite of this, the laparoscopic technique is usually practised only in high-volume experienced centres, mainly because it requires a prolonged and demanding learning curve. It has been estimated that over 50 operations are required for an experienced colorectal surgeon to achieve proficiency with this technique. Robotic surgery enables the surgeon to perform minimally invasive operations with better vision and more intuitive and precise control of the operating instruments, thus promising to overcome some of the technical difficulties associated with standard laparoscopy. It has high-definition threedimensional vision, it translates the surgeon's hand movements into precise movements of the instruments inside the patient, the camera is held and moved by the first surgeon, and a fourth robotic arm is available as a fixed retractor. The aim of this review is to summarise the current data on clinical and oncologic outcomes of robot-assisted surgery in rectal cancer, focusing on short- and long-term results, and providing original data from the authors' centre.