Robotic autonomy in endocrine surgery

The focused issue “ The Management of Thyroid Tumors in 2020 and Beyond ” edited by Drs. Jonathon Russell and Jeremy Richmon is going to be released in Annals of Thyroid ( AOT ) in the coming months. This issue aims to review the state-of-art in the management of thyroid pathology, to provide a venue for original research focused on remote access or minimally invasive thyroid management and to review the success at extending proven management strategies into new geographic regions. Taking this opportunity, we have done a series of interviews with the authors discussing the highlights of their articles and sharing their experiences or stories in this field. It is great honor for AOT to interview Dr. Orosco on his stories, recent research, and article “ Robotic autonomy in endocrine surgery ” contributing to the focused issue.

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