Development of a Robotic Navigation and Fracture Fixation System

Disclosure: H.M. Heshmati: None. N. Zameni: None.Background: Robotic surgery is quickly replacing traditional surgery performed by humans. It has significantly influenced the field of endocrine surgery. This review presents an update on the use of robotic surgery and artificial intelligence for adrenal tumors. Methods: A systematic search of literature was conducted using the search terms robotic surgery, artificial intelligence, adrenal tumors, safety, outcome, and cost. Results: Adrenal tumors are found in 10% of people who have imaging of the adrenal gland. They are typically unilateral and benign in the majority of cases. Robotic systems such as da Vinci Surgical System provide surgeons with enhanced dexterity and 3D visualization. Autonomous surgical robots can be categorized into various levels of autonomy including supervised autonomy (e.g., performance of specific tasks with human oversight), collaborative autonomy (e.g., robots working alongside human surgeons, sharing tasks and responsibilities), and fully autonomous systems (e.g., robots performing entire surgical procedures independently with human intervention when necessary). Robotic surgery allows access through tight spaces to remove adrenal tumors with small incision and minimal impact on surrounding tissues. The review of 1,162 patients who underwent adrenalectomy (robotic surgery in 747 patients, laparoscopic adrenalectomy in 415 patients) showed comparable blood loss and complications with the two techniques but patients with robotic surgery had significantly shorter hospital stay. The future of robotic surgery can be revolutionized by the integration of autonomous robots and artificial intelligence (AI), a field rapidly advancing. These innovations promise to further enhance the precision, safety, and effectiveness of surgery involving the adrenal glands. AI-powered systems provide real-time guidance and feedback to surgeons, enhancing decision-making and surgical precision. Autonomous systems can ensure consistent execution of surgical tasks, reducing variability and enhancing patient safety. AI algorithms can analyze extensive surgical data to refine techniques and predict potential complications, improving surgical outcomes. AI can customize surgical plans based on individual patient anatomy and pathology, potentially leading to better outcomes. The current high cost of these new procedures is a potential limitation for their use. Conclusion: Robotic surgery represents significant progress in minimally invasive techniques for the removal of adrenal tumors. It has improved dexterity and precision, and is associated with shorter recovery time compared to laparoscopic adrenalectomy. Collaboration between human surgeons and robotic systems can improve patient care and surgical outcomes. The precision, safety, and effectiveness of the adrenal surgery can be further enhanced by the integration of AI and robotics.Presentation: Saturday, July 12, 2025

English

To establish an appropriate policy for robotic surgery in Korea, the National Evidence-based Collaborating Agency (NECA) and the Korean Society of Health Policy and Administration held a round-table conference (RTC) to gather opinions through a comprehen-sive discussion of scientific information in gastric cancer. The NECA RTC is a public discussion forum wherein experts from diverse fields and members of the lay public conduct in-depth discussions on a selected social issue in the health and medical field. For this study, representatives from the medical field, patient groups, industry, the press, and policy makers participated in a discussion fo-cused on the medical and scientific evidence for the use of robotic surgery in gastric cancer. According to the RTC results, robotic surgery showed more favorable results in safety and efficacy than open surgery and it is similar to laparoscopy. When the cost-effec-tiveness of robotic surgery and laparoscopy is compared, robotic surgery costs are higher but there was no difference between the two of them in terms of effectiveness (pain, quality of life, complications, etc.). In order to resolve the high cost issue of the robotic surgery, a proper policy should be implemented to facilitate the development of a cost-effective model of the robotic surgery equipment. The higher cost of robotic surgery require more evidence of its safety and efficacy as well as the cost-effectiveness is-sues of this method. Discussions on the national insurance coverage of robotic surgery seems to be necessary in the near future.Keywords: Robotic surgery; Stomach neoplasms; Round-table conference

Today, robots have not only penetrated to create microchips in electronics but also in medicine, where it helps to perform difficult operations, especially where precision is needed and the size is small and any human error could be fatal to the patient. Robots assist the doctor in heart, brain, kidney operations, not to mention bone implants and repair of damaged bones, cartilage and muscles. In this area, new materials adapted to the requirements of the human body also play an important role. The robotic systems used in today's operating blocks are very expensive and bulky and they need to be permanently adapted and prepared before a difficult operation, but in the end their help is unsurpassed because the operation takes place with the help of the machine and the computer, so they can perform a giant precision of hundredth of a millimeter, precision that stops the scalpel from cutting accidentally such as a nerve, a blood vessel, healthy tissue and anything else. Assisted operation brings infinitely more advantages than the disadvantage that the operator block is voluminous and costly. However, apart from the related space, the costs are amortized over time and the satisfaction of the successful operations is great for both the patients and the medical team. Surgery has taken advantage of this technology relatively late. Initial use of robots in surgery began in the late 1980s when an industrial robot was used to support instruments for stereotactic biopsy in neurosurgery. Also in the late 1980s, IBM built the first robot used in clinical practice, called Robo-doc. The first use of a robot in human surgery was for a transurethral prostate resection. In 1993, Computer Motion, Inc. introduced a voice-controlled arm, Automated Endoscopic System for Optimal Positioning (AESOPTM), used to support instruments, of optics in laparoscopic surgery. Its version, AESOPTM 2000 is the first human-controlled robot approved by the Food and Drug Administration of the United States. In 1998, Reichenspurner introduced the ZEUS Microsurgical Robotic System into Germany. Today, the most complex and efficient robot in use is the daVinci system. With the birth of laparoscopy and information technology, surgery went into a new era. The development of surgical robots is primarily motivated by their desire the need to increase the effectiveness of surgical medical interventions. Medical actions are chosen based on information from various sources, including patient-specific data (vital signs and images of human body tissues and organs), general medical knowledge (atlases of human anatomy) and medical experiences. First, a robot can usually do things much more accurate than a man. This provides the first motivation for using CAD/CAM systems. Robots can be used successfully if the patient has been radiated (e.g., with X-radiation), thus not endangering the health of the medical team. Since ancient times, the imagination of mankind has been concerned with the idea of making cars equipped with artificial intelligence to execute operations similar to those performed by man. Technicians have been used for many years in various fields other than medical, such as the automotive industry, the underwater environment, the alien space, or the areas at risk of nuclear radiation.

Credentialing and Patient Safety in Robotic Gynecologic Surgery: Changes over the Last Nine Years

The use of robotics in surgery has increased significantly in the last decade from its initial applications in urologic procedures. Robotic surgery has been increasingly utilized not only for urologic and gynecologic procedures, but also in other gastrointestinal disease sites, particularly for cancers of the rectum, pancreas, stomach, and esophagus. As the use of robotic surgery becomes more widespread for gastrointestinal malignancies and the potential benefits of this approach become better defined, an understanding of disparities in access and availability of robotic surgery across different racial and socioeconomic factors is increasingly relevant. In this short commentary, we aim to discuss the use of robotic surgery specifically for gastrointestinal malignancies with a focus on disparate patient factors that have recently been associated the receipt of this approach.

Minimally invasive surgical approaches in transplantation are gaining increasing interest, and many centers are reporting their, mainly laparoscopic, experiences. Robotic surgery (RS) has some hypothetical advantages over traditional laparoscopy and has been successfully applied, although infrequently to organ transplantation. Our goal was to review and critique the publications reporting RS use in organ transplantation. Most of the RS experience has been with living renal donor organ procurement and, to a lesser extent, with RS procedures in the transplant recipient. The available literature suggests that RS appears to be a safe surgical alternative to standard open procedures. RS in living liver donor surgery remains limited, and more experience is required before commenting on RS-related outcomes RS in pancreatic transplantation is exceedingly rare. The enhanced precision and ergonomics of RS may expand its applicability to liver living donation and pancreas transplantation at some point in the future.

Over the last two decades, the quantity of papers published in relation to robotic surgery in obstetrics and gynecology has continued to grow globally. However, no bibliometric analysis based on VOSviewer has been performed to evaluate the past and present of global research in the field. In this study, we aimed to analyze the bibliometric characteristics of papers on robotic surgery in obstetrics and gynecology to reveal research hotspots and trends in this field. The Web of Science Core Collection was searched for scientific papers on robotic surgery in obstetrics and gynecology published between January 1, 1998 and December 31, 2023. Bibliometric metadata of each selected paper was extracted for analysis. The results were visualized by VOSviewer (version 1.6.18). A total of 1,430 papers met the inclusion criteria. The United States had the highest total link strengths and contributed the most papers (n = 793). The Mayo Clinic produced the largest number of papers (n = 85), and Professor Pedro T Ramirez contributed the most papers (n = 36). The number of citations ranged from 0 to 295 with a total sum of 29,103. The Journal of Minimally Invasive Gynecology published the most relevant papers (n = 252). Keywords were classified into six clusters based on co-occurrence data, of which cluster 1, cluster 4 and cluster 6 had more main keywords with the largest average publication year. This is the first VOSviewer-based bibliometric analysis of robotic surgery research in obstetrics and gynecology. The United States was the leading country, and the Journal of Minimally Invasive Gynecology was the most productive journal in the field. Scientists and institutions from around the world should push their boundaries to bring about deep collaboration. The main research topic has always been the use of robotic surgery in the treatment of gynecologic malignancies. More randomized controlled trials need to be conducted to compare surgical outcomes of robotic surgery with other surgical approaches. Robotic sacrocolpopexy for pelvic organ prolapse has become a new research hotspot, and robotic surgery for sentinel lymph node detection in gynecologic malignancies are more potential directions for future research.

Background: Robotic surgery is increasingly used in the treatment of lung disease. Intraoperative catastrophes, despite their low incidence, are currently a critical aspect of this approach. This study aims to identify the incidence and management of catastrophic events in patients who underwent robotic anatomical pulmonary resection; (2) Methods: Data from all patients who underwent robotic anatomical pulmonary resection from 2014 to 2021 for lung disease were collected and analyzed. Catastrophic intraoperative events are defined as events that demanded emergency management for life-threatening bleeding, with or without undocking and thoracotomy; (3) Results: Catastrophic events occurred in seven (1.4%) procedures; all of them consisted of vascular damage during lobectomy. Most of the catastrophic events occurred during left upper lobectomies (57%). Patients in this group had a higher ASA class and a higher pathological stage compared to the control group; (4) Conclusions: Intraoperative catastrophes are unpredictable events which also occur in experienced surgical teams. Given the widespread use of robotic surgery, it is essential to develop well-defined crisis management strategies to better manage catastrophic events in robotic thoracic surgery and improve clinical outcomes.

Mobile robot, especially wheeled mobile robot, with its simple mechanical structure and inherent agility, has attracted significant attentions for dynamic environment applications in the last two decades (Pin et al. 1994 and Purwin 2006). A general mobile robot Guidance, Navigation and Control (GNC) system is illustrated in the following figure. The main function of guidance system is to generate a feasible trajectory command, usually in multiple dimension of freedom (DOF) to achieve a robot task. The objective of control system is to drive the mobile robot following the commanded trajectory with acceptable tracking errors and stability margin. The function of robot navigation system is to provide accurate position, velocity and/or orientation information for the control system and guidance system. A stable and accurate navigation system is the bridge between the guidance system and control system of mobile robots, which ultimately determines the robot performance.

One of the technologies in the industrial world that utilizes robots is the delivery of goods in warehouses, especially in the goods distribution process. This is very useful, especially in terms of resource efficiency and reducing human error. The existing system in this process usually uses the line follower concept on the robot's path with a camera sensor to determine the destination location. If the line and destination are not detected by the sensor or camera, the robot's navigation system will experience an error. it can happen if the sensor is dirty or the track is faded. The aim of this research is to develop a robot navigation system for efficient goods delivery in warehouses by integrating odometry and Dijkstra's algorithm for path planning. Holonomic robot is a robot that moves freely without changing direction to produce motion with high mobility. Dijkstra's algorithm is added to the holonomic robot to obtain the fastest trajectory. by calculating the distance of the node that has not been passed from the initial position, if in the calculation the algorithm finds a shorter distance it will be stored as a new route replacing the previously recorded route. the distance traversed by the djikstra algorithm is 780 mm while a distance of 1100 mm obtains the other routes. The time for using the Djikstra method is proven to be 5.3 seconds faster than the track without the Djikstra method with the same speed. Uneven track terrain can result in a shift in the robot's position so that it can affect the travel data. The conclusion is that odometry and Dijkstra's algorithm as a planning system and finding the shortest path are very efficient for warehouse robots to deliver goods than ordinary line followers without Dijkstra, both in terms of distance and travel time.

In recent years, due to the declining birthrate, there are more and more situations where elderly people need to be cared for. As a result, the burden per caregiver has been increasing. As a technology to solve this problem, indoor robot navigation systems that support indoor mobility of those who need care are attracting attention. A navigation system using a mobile robot has components such as position estimation and movement control. As a conventional technique for location estimation, there is a location estimation method using QR codes. In addition, there is a conventional method of mobile control using RSSI. The proposed method presented in this paper is a robot navigation system that replaces QR codes with RFID tags and uses the RSSI-based mobile control method. In addition, we propose a path recovery system when the mobile robot deviates from the path during navigation. In the performance evaluation of navigation between arbitrary points, the maximum error from the ideal trajectory was found to be 13 cm. We also found that the average error between the destination tag and the stop position was 20 cm, while the maximum error was 51 cm. In the performance evaluation of the path recovery system, the maximum error between the ideal path and the stop position was found to be 30 cm.

BackgroundThe widespread implementation of robotic surgery in the Indian subcontinent has received mixed reactions from residents and mentors alike. To date, however, no study has documented the perception of Indian surgical trainees on the effect of robotic surgery on surgical training. Therefore, we conducted a questionnaire-based study on Indian surgical residents to assess their views about robotic surgery and the effect, they believe, it might have on resident training.Materials and methodsQuestionnaires were distributed to 300 surgical residents from programs that do not have surgical robots. All other residents, faculty, medical students, and interns were excluded from the study. The responses were collected and analyzed using appropriate statistical methods.ResultsOverall, 210 surgical residents responded to the survey. A majority of them (57.72%) reported low levels of knowledge regarding robotic surgery. While 88.10% of the study participants reported that the use of robotic surgery will continue to rise in India, an equal proportion (88%) believed that procuring a robot in their program will impair their training in open and laparoscopic surgeries.ConclusionsThe introduction of robotic surgery into surgical residency programs is seen, by most residents, as a threat to training in traditional surgical methods. This calls for the effective incorporation of robotic training into residency training with equal distribution of resident training cases in programs across the country.

After graduating from Juntendo University in 1984, I joined the First Department of Surgery at Juntendo University in 1986 after two years of surgical training. When I started my career as a gastrointestinal surgeon, the only surgical treatment approach was the “open abdominal method”, which involves making a large incision in the abdomen. At that time, I did not anticipate the development of new techniques. In the late 1980s, “laparoscopic surgery” using a laparoscope and endoscopic forceps with a small wound through a port was introduced. At our hospital, laparoscopic surgery for cholelithiasis and colorectal cancer was introduced in 1991 and 1993, respectively. Laparoscopic cholecystectomy has rapidly become popular worldwide and has become the gold standard surgical procedure in Japan. With improvements in laparoscopic surgical techniques, laparoscopic surgery for colorectal cancer has evolved into a less invasive technique (reduced port surgery) and more complicated procedure.While one would think there would be no further procedural changes in surgical treatment, another wave emerged, that of robotic surgery. A surgically assisted robotic system was approved by the Food and Drug Administration (FDA) in 2001. In Japan, the use of this system was covered by government insurance in 2012 for prostatectomy. Robotic surgery for prostatectomies was initiated at our hospital in 2013. The use of robotic surgery for colorectal cancer surgery was initiated as a clinical trial in 2015. It was covered by government insurance in 2018, and by Mar. 2025, we had performed approximately 270 robotic surgeries. It has been a great asset and very valuable experience for me to be involved in the launch of two minimally invasive surgical techniques, “laparoscopic surgery” and “robotic surgery,” during my 41 years of practice as a surgeon in Juntendo, from the time when only “open surgery” was available.

There is an ever-increasing drive to improve surgical patient outcomes. Given the benefits which robotics has bestowed upon a wide range of industries, from vehicle manufacturing to space exploration, robots have been highlighted by many as essential for continued improvements in surgery. The goal of this review is to outline the history of robotic surgery, and detail the key studies which have investigated its effects on surgical outcomes. Issues of cost-effectiveness and patient acceptability will also be discussed. Robotic surgery has been shown to shorten hospital stays, decrease complication rates and allow surgeons to perform finer tasks, when compared to the traditional laparoscopic and open approaches. These benefits, however, must be balanced against increased intraoperative times, vast financial costs and the increased training burden associated with robotic techniques. The outcome of such a cost-benefit analysis appears to vary depending on the procedure being conducted; indeed the strongest evidence in favour of its use comes from the fields of urology and gynaecology. It is hoped that with the large-scale, randomised, prospective clinical trials underway, and an ever-expanding research base, many of the outstanding questions surrounding robotic surgery will be answered in the near future.