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مقالهها، منابع و پژوهشهای تازه حوزه جراحی عمومی
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جستوجوی دقیقجراحی
حوزههای جراحی، بیهوشی و مراقبتهای پیرامون عمل
زیرشاخهها
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ارتوپدی
مقالهها، منابع و پژوهشهای تازه حوزه ارتوپدی
ورود به زیرشاخهجراحی مغز و اعصاب
مقالهها، منابع و پژوهشهای تازه حوزه جراحی مغز و اعصاب
ورود به زیرشاخهجراحی قلب و قفسه سینه
مقالهها، منابع و پژوهشهای تازه حوزه جراحی قلب و قفسه سینه
ورود به زیرشاخهجراحی عروق
مقالهها، منابع و پژوهشهای تازه حوزه جراحی عروق
ورود به زیرشاخهاورولوژی
مقالهها، منابع و پژوهشهای تازه حوزه اورولوژی
ورود به زیرشاخهجراحی پلاستیک و ترمیمی
مقالهها، منابع و پژوهشهای تازه حوزه جراحی پلاستیک و ترمیمی
ورود به زیرشاخهپیوند اعضا
مقالهها، منابع و پژوهشهای تازه حوزه پیوند اعضا
ورود به زیرشاخهبیهوشی
مقالهها، منابع و پژوهشهای تازه حوزه بیهوشی
ورود به زیرشاخهمراقبتهای ویژه
مقالهها، منابع و پژوهشهای تازه حوزه مراقبتهای ویژه
ورود به زیرشاخهطب درد
مقالهها، منابع و پژوهشهای تازه حوزه طب درد
ورود به زیرشاخهتازهترین رکوردها
شواهد جراحی
PubMed2027
Extraperitoneal Single-Port Robotic-Assisted Radical Cystectomy with Orthotopic Ne-obladder: Technique and Surgical Considerations.
INTRODUCTION: Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes. MATERIALS AND METHODS: A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump. RESULTS: Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad. CONCLUSIONS: Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.
PubMed2027
Revisiting the anatomy of the retroperitoneum and renal fascia. Aspects applied to ra-diology, laparoscopic and robotic surgery - a narrative review.
This review aims to provide a comprehensive analysis of the anatomy of the retroperitoneal and abdominal fascias. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the fascias, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. This narrative review addresses the anatomical integration, surgical techniques, and functional importance of the fascias. Renal fascia is a dense connective tissue encasing kidney, perirenal fat, adrenal gland; composed of anterior (Gerota's) and posterior (Zuckerkandl-related/renal) layers that fuse laterally and superiorly. Toldt fascia is a plane formed where the mesocolon (ascending or descending) fuses to the posterior parietal peritoneum / posterior abdominal wall. The lateroconal fascia is a lateral continuation of the renal fascia where anterior and posterior renal layers fuse to form a sheet toward the lateral abdominal wall and Fredet's fascia is a fusion plane between the visceral peritoneum of the hepatic flexure/transverse mesocolon and the anterior surface of the duodenum/pancreatic head (anterior to pancreatic head/duodenum) with a critical landmark in right colectomy.
PubMed2027
Robot-Assisted Partial Nephrectomy in a High-Complexity Renal Tumor in a Horseshoe Kidney.
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
PubMed2026
[The Legal Regulation of Refusal of Medical Organizations and Physicians From Giving Service of Interruption of Pregnancy (Abortion) to Women in Countries of World Community].
The problem of availability of abortion services for women in countries of world community is not only not losing its importance, but is undergoing new stage of actualization, since it has no clear understanding and is often raised in the context of solving demographic problems of aging society. At the same time, analysis reveals vulnerability of position of those using religious context in womans self-determination regarding disposal of her own body and right to refuse compulsion to terminate her pregnancy by physiological childbirth without her psychological, social and economic readiness and public support. Referring to various testimonies and sources, we appeal to necessity of working out common criteria to ensure womens access to medical care related to procedure of abortion in order to reduce mortality from diseases associated with self-abortions menacing live and health of women. The issues considered in the study may affect various spheres of social, medical and legal field and have wide area of practical implementation. The purpose of the study is to identify causes and to establish consequences of womens limited access to abortion services, as well as legal and ethical aspects of overcoming these restrictions.
PubMed2026
Etomidate combined with TAPB in ovarian cancer surgery: A controlled study on hemodynamics and immune response.
BACKGROUND: Selecting appropriate anesthetic agents and techniques that ensure hemodynamic stability and attenuate perioperative stress responses is crucial for ovarian cancer surgery. OBJECTIVES: This study aimed to evaluate the effects of etomidate combined with transversus abdominis plane block (TAPB) on perioperative hemodynamics, inflammatory and oxidative stress responses and immune function in patients undergoing radical resection of ovarian cancer. METHODS: A total of 80 patients were randomly assigned to receive total intravenous anesthesia (TIVA) alone or TIVA combined with TAPB. Hemodynamic parameters, serum inflammatory markers, oxidative stress indicators, pain mediators, immune cell subsets and adverse reactions were compared between the two groups. RESULTS: Perioperative hemodynamic parameters changed dynamically in both groups, with heart rate and mean arterial pressure increasing intraoperatively and decreasing postoperatively. However, the research group had significantly lower heart rate and mean arterial pressure than the control group during the peak intraoperative period (P<0.001), indicating improved hemodynamic stability. Preoperative levels of inflammatory, oxidative stress, pain-related and immune indexes were comparable between groups (P>0.05). At 24 h postoperatively, the research group showed significantly reduced serum levels of high-sensitivity C-reactive protein, tumor necrosis factor-α, malondialdehyde, cortisol, prostaglandin E2 and substance P compared with the control group (all P<0.05), reflecting attenuation of systemic inflammation, oxidative stress and nociceptive activation. Postoperative immune function was better preserved in the research group, as evidenced by higher CD3+ and CD4+ cell counts and CD4+/CD8+ ratio, along with a lower CD8+ level (P<0.05). The overall incidence of adverse reactions was low and did not differ significantly between groups (4.4% vs 8.9%, P>0.05). CONCLUSION: Etomidate combined with transversus abdominis plane block provides stable anesthesia and modulates perioperative inflammatory and immune responses while reducing postoperative biochemical pain mediator levels, thereby supporting a safer and more physiologically balanced recovery following ovarian cancer surgery.
PubMed2026
A Global Bibliometric and Science-Mapping Analysis of Robotic Organ Transplantation (2002-2025).
BACKGROUND: Robotic organ transplantation research remains fragmented and largely kidney-focused, lacking cross-organ synthesis. This study mapped global productivity, thematic evolution, collaboration and intellectual structure through 2025. METHODS: A Scopus-based dataset of 475 original English-language articles (2002-2025) was analysed using Bibliometrix/Biblioshiny and VOSviewer, integrating performance, collaboration, Bradford's law, thematic evolution and source co-citation analyses. RESULTS: The field showed rapid growth (15.94% annual growth rate) with peak productivity in 2025. The United States, Italy, and Japan were leading contributors, whereas Alberto Breda was the most prolific scholar. A 10-journal core accounted for 35.6% of publications. Themes evolved from kidney transplantation and robotic surgery towards broader multiorgan applications, particularly liver and donor surgery, with strong co-citation integration across transplantation, hepatobiliary and robotic surgery domains. CONCLUSION: The field has matured into a multiorgan, outcomes-oriented and transdisciplinary robotic transplantation ecosystem.
PubMed2026
Catheter-Based Therapies for Intermediate-High Risk Pulmonary Embolism: A Protocol for a Systematic Review With Bayesian Pairwise and Network Meta-Analyses.
BACKGROUND: Intermediate-high risk pulmonary embolism (PE) represents a clinically challenging subgroup of acute PE, characterized by right ventricular dysfunction and increased risk of hemodynamic deterioration despite treatment with anticoagulation therapy. Although systemic thrombolysis may provide more rapid reperfusion, its use is limited by an increased risk of major bleeding. Catheter-based treatment strategies have emerged as potential alternatives, but their comparative efficacy and safety remain uncertain. OBJECTIVE: To assess the benefits and harms of catheter-based treatment strategies compared with contemporary control regimens, including standard anticoagulation with or without systemic thrombolysis, in patients with intermediate-high risk PE. METHODS: This protocol outlines a systematic review with Bayesian pairwise meta-analysis and network meta-analysis of randomized clinical trials evaluating catheter-based therapies for hospitalized patients with intermediate-high risk PE. Eligible interventions include catheter-directed thrombolysis, ultrasound-assisted thrombolysis, and catheter-based embolectomy. Comparators may include standard anticoagulation alone or in combination with systemic thrombolysis or other active control regimens reflecting standard of care. Searches will be conducted in relevant databases, supplemented by trial registries. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 tool. Bayesian pairwise meta-analyses and network meta-analysis will be performed using weakly informative priors to synthesize direct and indirect evidence across interventions. Results will be reported as posterior effect estimates with 95% credible intervals. The primary outcome will be all-cause mortality. Secondary and exploratory outcomes include major bleeding as defined according to the criteria of the International Society on Thrombosis and Haemostasis within 7 days, hospital length of stay, and change in RV/LV ratio within 48 h. GRADE assessments will be performed where applicable. DISCUSSION: This review will synthesize direct and indirect randomized evidence on catheter-based treatment strategies for intermediate-high risk PE. The findings may help clarify the role of these interventions in contemporary management, inform future guideline recommendations, and identify persistent evidence gaps requiring further large-scale randomized trials.
PubMed2026
Dual-Modal Safety Framework for Robotic-Assisted Bronchoscopy via Endoscopic Vision and Haptic Feedback.
BACKGROUND: Teleoperated flexible bronchoscopy lacks distal haptic feedback, increasing the risk of unobservable iatrogenic tissue trauma during endoluminal exploration. METHODS: This study proposes a robot-assisted bronchoscopy system integrated with a dual-modal safety framework. A visual module utilises image moments to provide predictive alerts for collision avoidance. Concurrently, a Transformer-based network estimates distal interaction torques from proximal actuation, enabling real-time haptic perception at the leader console. RESULTS: Phantom validations across fragile tissue rupture, sidewall approximation, and luminal exploration tasks demonstrated the framework's efficacy. The visual warnings helped decrease excessive force contacts, while the learning-based estimator delivered reliable distal force perception. CONCLUSIONS: The proposed dual-modal teleoperated safety architecture resolves the trade-off between operational dexterity and safety in flexible bronchoscopy. By integrating predictive visual warnings and real-time haptic feedback, the system improves the operator's situational awareness, decreasing the risk of iatrogenic trauma during the operation.
PubMed2026
Dynamic Metabolic Profiling and Diagnostic Biomarkers of Acute Graft-Versus-Host Disease Based on Metabolomics.
This study utilized LC-MS/MS-based metabolomics to characterize the dynamic metabolic changes associated with the onset and progression of acute graft-versus-host disease (aGVHD), aiming to identify potential noninvasive biomarkers for diagnosis and prognostic assessment. A total of 110 patients with AML who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) were enrolled in the study. Plasma samples from these patients were analyzed using an untargeted metabolomics platform. Differential metabolites and their clinical relevance were investigated using multiple statistical approaches, including pathway enrichment, hierarchical clustering, and ROC curve analysis. The results showed that compared with patients without aGVHD, 36 plasma metabolites were significantly dysregulated in those with aGVHD (VIP > 1, p < 0.05). Among these, six glycerophospholipids-PC(P-16:0/18:1), PC(20:4/20:4), PC(16:0/16:0), PC(18:0/20:3), PE(P-18:0/20:5), and PC(o-16:1/18:0)-exhibited regular alterations across different stages of aGVHD. The combined AUC under the six metabolites was 0.960, highlighting their strong diagnostic potential. Multivariate analysis further indicated that this six-metabolite signature was predictive of 4-year overall survival, with several metabolites serving as independent prognostic factors. In conclusion, these six glycerophospholipid metabolites display dynamic changes during aGVHD progression and hold promise as noninvasive biomarkers for both diagnosis and prognostic stratification. Validation in larger patient cohorts is warranted to confirm these findings.
PubMed2026
Hepatic and Cardiovascular Outcomes in Primary Biliary Cholangitis With Metabolic-Dysfunction Associated Steatotic Liver Disease.
INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in patients with primary biliary cholangitis (PBC). While metabolic comorbidities are expected to worsen outcomes, the clinical impact of MASLD in PBC remains uncertain. We investigated whether concomitant MASLD modifies hepatic and cardiovascular outcomes in patients with PBC. METHODS: We conducted a retrospective international cohort study using de-identified electronic health records from the TriNetX global research network, including 172 healthcare organizations between 2010 and 2025. Adult patients with PBC with and without MASLD were matched using propensity score matching (1:1) to balance baseline characteristics. The primary outcomes were all-cause mortality. Major adverse cardiovascular events (MACE) and hepatic decompensation were evaluated as secondary outcomes. Additional outcomes included hepatocellular carcinoma, liver transplantation, and one-year biochemical response (ALP normalization). RESULTS: Among 30 934 patients with PBC (78.9% female; mean age 68 years), 5955 (19.2%) had concomitant MASLD. After matching, 10 856 patients (5428 per group) were included. Over a mean follow-up of 4 years, patients with PBC-MASLD had a lower risk of all-cause mortality (HR 0.60; 95% CI 0.54-0.67) and hepatic decompensation (HR 0.82; 95% CI 0.71-0.93), but higher risk of MACE (hazard ratio [HR] 1.30; 95% CI 1.14-1.48). One-year biochemical response rates were comparable between groups. Findings remained consistent across multiple sensitivity analyses. CONCLUSION: MASLD identifies a distinct metabolic phenotype of PBC characterized by increased cardiovascular risk but paradoxically lower mortality and hepatic decompensation. These findings highlight the need to integrate cardiovascular risk assessment into the management of patients with PBC.
PubMed2026
Orthodontics-Assisted Autogenous Tooth Transplantation for Maxillary Incisor Injury in Pediatric Patient With Crowding and Class II Malocclusion: A Case Report.
OBJECTIVES: This case report describes orthodontics-assisted autogenous tooth transplantation for a maxillary incisor injury in a pediatric patient with crowding and Class II malocclusion. MATERIAL AND METHODS: A 10-year-old boy presented with a compromised maxillary left central incisor with a periapical lesion after failed endodontic treatment, together with bimaxillary crowding and Class II malocclusion. The mandibular right second premolar was transplanted to replace the maxillary incisor and was integrated with comprehensive orthodontic treatment. RESULTS: After transplantation, endodontic treatment was completed when pulp vitality could not be maintained. During long-term follow-up, the transplanted tooth remained clinically stable, with healthy periodontal tissues and no progressive root resorption or bone loss. Orthodontic treatment achieved stable occlusion, improved function, and satisfactory smile esthetics. CONCLUSIONS: Orthodontics-assisted autogenous tooth transplantation may be a biologically favorable option for replacing a traumatized maxillary incisor in growing patients with crowding and malocclusion. Careful donor selection, coordinated orthodontic timing, and long-term follow-up are essential for stable functional and esthetic outcomes.
PubMed2026
Outcomes in Recurrent Focal Segmental Glomerulosclerosis Post-Kidney Transplantation Treated With Therapeutic Plasma Exchange: A Retrospective Cohort Study.
Recurrence of focal segmental glomerulosclerosis (FSGS) following kidney transplantation remains a significant cause of allograft loss. Much remains unknown about the efficacy of apheresis treatments and the factors that determine favorable treatment outcomes. This retrospective cohort study involved adult patients with pre-transplant diagnosis of FSGS, who developed recurrent FSGS in the post-transplant period over 6 years, from January 1, 2017, to December 31, 2022. Twenty patients with biopsy-confirmed FSGS who received therapeutic plasma exchange (TPE) as part of their treatment regimen were included. Demographic data, transplant characteristics, procedure details, urine protein levels, and other relevant variables were retrieved. Data was compiled in a Microsoft Excel spreadsheet and analyzed using the Statistical Package for the Social Sciences (SPSS, IBM NY, 2023, version 29). A p-value of less than 0.05 was considered statistically significant. Data from 20 patients encompassing 169 TPE sessions were analyzed. Of these, 15 patients (75%) achieved remission of proteinuria, while 5 (25%) did not. The median time to remission was 6 months, and the median number of TPE was 7 (interquartile range [IQR] = 2-13). There was no significant difference in time to remission between patients with complete and partial remission. Receiving more than five TPE sessions (adjusted odds ratio [AOR] = 1.6 (1.01-2.46); p = 0.02) and having lower baseline proteinuria at treatment initiation (AOR = 1.9 (1.03-8.94); p = 0.01) were independent predictors of remission. The complication rate was 10.7%, with hypocalcemia being the most common, occurring in 5.9% of cases. One mortality was recorded during apheresis, yielding a procedure mortality rate of 0.6%. Initiating treatment at lower levels of proteinuria (i.e., earlier in the course of disease recurrence) appear to enhance the likelihood of remission. Our result suggests that a trial of therapy extending beyond the initial induction phase may be necessary to capture late-responding patients. The procedure was generally well tolerated, with few reversible adverse events. However, vigilant monitoring remains essential for optimal management.
PubMed2026
Quantitative Assessment of Myocardial Velocity and Dyssynchrony in Fontan Circulation Using MR Tissue Phase Mapping.
Magnetic resonance tissue phase mapping (TPM) has been used to encode voxel-wise myocardial motion velocity in various cardiac diseases. This study aimed to quantify alterations in myocardial motion velocity in the functional ventricle of Fontan patients using TPM and to investigate the relationship between myocardial motion and cardiac function. We prospectively enrolled 28 Fontan patients and 42 age- and sex-matched normal controls. Myocardial motion velocities were assessed using TPM in the longitudinal (Vz), radial (Vr), and circumferential (Vphi) directions. We evaluated the peak velocities, time-to-peak (TTPz, TTPr), and dyssynchrony index (DIz, DIr). Circumferential motion abnormalities were assessed using peak-to-peak (PTP) values, Vphi inconsistency, and twist. Compared to controls, Fontan patients demonstrated significantly reduced peak Vz and Vr during both systole and diastole (all p < 0.001), as well as prolonged systolic TTPz (p = 0.002) and TTPr (p < 0.001). Diastolic DIz was increased (p < 0.001), whereas systolic DIr was decreased (p = 0.04). In multivariable regression analysis, ejection fraction of Fontan patients positively correlated with peak systolic Vr and negatively correlated with mid Vphi PTP (R2 = 0.639). The cardiac output was positively associated with peak systolic Vr and diastolic DIz (R2 = 0.578). TPM may provide quantitative MR biomarkers for regional myocardial motion abnormalities, including impaired myocardial motion velocities, delayed contraction timing, and altered motion synchronization, in Fontan patients. These findings suggest global ventricular dysfunction and may provide insight into the mechanisms underlying reduced ejection fraction and cardiac output in the functional ventricle physiology in Fontan patients.
PubMed2026
Targeted Neurosurgical Interventions: The Role of Neuroimaging in High-Intensity Focused Ultrasound, Laser Interstitial Thermal Therapy, and Deep Brain Stimulation.
Targeted neurosurgical interventions have evolved substantially during recent decades, with advanced neuroimaging playing a crucial role in their development and clinical implementation. This review is focused on three key minimally invasive neurosurgical techniques-high-intensity focused ultrasound, laser interstitial thermal therapy, and deep brain stimulation-and examines their mechanisms, neuroimaging considerations, anatomic targets, and clinical applications. These techniques represent a paradigm shift from traditional open neurosurgical approaches to more precise, less invasive interventions that target specific anatomic structures or neural circuits. With overlapping clinical applications yet distinct mechanisms, each of these modalities offers unique advantages in the treatment of movement disorders, epilepsy, and other neurologic conditions. This article provides a comprehensive overview of these techniques, with an emphasis on the important role of neuroimaging in planning, guiding, and monitoring these interventions. ©RSNA, 2026 Supplemental material is available for this article. See the invited commentary by Rodriguez and Riascos in this issue.
PubMed2026
Gamma knife thalamotomy for essential tremor in the third era of functional neurosurgery.
We report our experience adopting high angular resolution diffusion imaging (HARDI) tractography to define the target in the Ventralis Intermedius (Vim) nucleus in patients with essential tremor (ET). Retrospective observational cohort study on 18 consecutive Gamma Knife Stereotactic (GKRS)-thalamotomies. Dento-Rubro-Thalamo-Cortical-tract (DRTT), Cortico-spinal tract (CST) and Medial Lemniscus (ML) were reconstructed and used to adjust the coordinates-based target. The DRTT received a median maximum dose of 116 Gy (IQR 92.8-124.2 Gy) and the median volume receiving > 20 Gy (V20) was 154 mm3 (IQR 63.5-190.2 mm3). The maximum dose to the Vim was 126 Gy (IQR 126.2-127 Gy) and the median volume covered by 100 Gy was 25 mm3 (IQR 23-28-2 mm3), corresponding to the 14.5% of the whole volume (IQR 10.7-18.0%). The median Euclidean distance between the indirect (in-Vim) and adjusted Vim (ad-Vim) was 1 mm (IQR 0.7-1.9) and the final position of the ad-Vim was 1 mm cranial compared to the in-Vim (p < 0.001). Tremor improved in 15 of 18 thalamotomies (83.3%) and in all 11 cases with follow-up longer than 12 months, with a median ΔT% of 63.7% (IQR 57.4-72.3). The only prognostic factor was higher dose rate (p = 0.007), associated with faster response. No patients presented adverse radio-induced events during the follow-up. GKRS thalamotomy adopting DRTT projection, as landmark for the Vim in addition to standard coordinates, and maintaining the CST outside the 20 Gy isodose line, is effective and safe in ET.
PubMed2026
Global research trends and clinical theme evolution in robot-assisted nephrectomy with venous tumor thrombectomy for renal cell carcinoma: a bibliometric and visualization analysis.
Robot-assisted nephrectomy with renal vein or inferior vena cava (IVC) tumor thrombectomy is a technically demanding procedure used in selected patients with renal cell carcinoma (RCC) and venous tumor thrombus. The research map of this field has not been clearly described, and recent technical, comparative, and systemic-therapy developments make an updated focused analysis timely. We searched the Science Citation Index Expanded of the Web of Science Core Collection from database inception to 4 May 2026. English articles and reviews about robot-assisted nephrectomy or radical nephrectomy with renal vein or IVC tumor thrombectomy for RCC were included. Titles, abstracts, keywords, authors, affiliations, journals, citations, and cited references were extracted. Python 3.11 was used for descriptive analysis, keyword analysis, co-citation analysis, visualization, and clinical theme coding. We included 51 SCIE publications from 2011 to 2026, including 40 articles and 11 reviews. The papers received 1229 citations, with a mean of 24.10 citations per paper and a median of 12. Annual publications peaked in 2020 with 7 papers. The United States published 24 papers, China published 21, and Italy published 8 when all author affiliations were counted. The Chinese People's Liberation Army General Hospital published 14 papers, and the University of Southern California published 7. Ma X, Zhang X, and Wang BJ were the most productive authors. European Urology, Journal of Urology, and Journal of Endourology were the leading journals. After term cleaning, the most frequent keywords were renal cell carcinoma, tumor thrombus, robotic surgery, experience, inferior vena cava, and thrombectomy. This field has moved from early technical exploration to early evidence building. Future work should use multicenter prospective designs and should study high-level IVC thrombus, long-term oncologic outcomes, perioperative safety after neoadjuvant therapy, robotic training, and multidisciplinary care pathways.
PubMed2026
Global research trends and hotspots in robot-assisted stereotactic neurosurgery: a bibliometric and visualization analysis (2005-2025).
This study systematically assessed the current state of research on robot-assisted stereotactic neurosurgery, identified major research focuses, and investigated evolving trends in this field, with the intention of providing useful guidance for future scientific studies and clinical practice. In this study, publications related to robot-assisted stereotactic neurosurgery published between 2005 and 2025 were retrieved from the Science Citation Index Expanded database within the Web of Science Core Collection. Descriptive and visual bibliometric analyses were conducted to evaluate publication characteristics, including research topics, journals, countries or regions, institutions, authors, and citation performance. A total of 194 publications were ultimately included in the analysis. The yearly publication output demonstrated a general upward trend over time, with a particularly noticeable increase observed after 2018. These studies were published in 88 journals, among which Operative Neurosurgery (16 publications), Acta Neurochirurgica (11 publications), and World Neurosurgery (8 publications) were the most productive journals. The most productive countries were the United States (50 publications, 25.8%), China (35 publications, 18.0%), and Germany (23 publications, 11.9%). Keyword analysis showed that recent research hotspots mainly focused on "safety," "efficacy," and "radiosurgery". Robot-assisted stereotactic neurosurgery has shown a steady increase in research activity over the past two decades and has gradually evolved toward more clinically oriented applications. However, bibliometric indicators primarily reflect publication and citation patterns rather than clinical effectiveness. Further studies based on high-quality clinical evidence are required to better evaluate its practical value and long-term outcomes.
PubMed2026
Global research trends in robotic applications in cardiovascular medicine: a bibliometric analysis.
This study aimed to analyze global research trends in robotic applications in cardiovascular medicine. Robotic technologies have been increasingly integrated into cardiovascular medicine, providing enhanced precision, improved visualization, and reduced operator-related risks. Despite growing interest in this field, comprehensive evaluations of global research trends remain limited. In this bibliometric study, publications indexed in the Web of Science Core Collection between 2019 and 2025 were systematically analyzed, and 261 original articles meeting predefined criteria were included. Bibliometric analyses were carried out using VOSviewer and Biblioshiny to evaluate publication trends, citation dynamics, leading sources, and collaboration patterns. Scientific output showed a steady upward trajectory over time, with a more pronounced increase after 2021 and reaching its peak in 2025. The highest average citation rate was observed in 2024. Journal of Robotic Surgery and Journal of Cardiac Surgery were identified as the most productive journals. The United States was the leading contributor in terms of both publication volume and citation impact and also played a central role in international collaborations. Keyword analysis showed that research activity was primarily focused on robotic surgery, minimally invasive surgery, coronary artery bypass grafting, and percutaneous coronary intervention. Overall, robotic applications in cardiovascular medicine represent a rapidly expanding research area characterized by increasing scientific output and growing international collaboration. The concentration of publications in specific journals and the prominence of leading countries suggest a developing and increasingly structured research landscape.
PubMed2026
Postoperative Seizure Prophylaxis in Intracranial Tumors: Evaluating the Role of Anti-Seizure Medication in Seizure-Naïve Patients.
PURPOSE OF REVIEW: Postoperative seizures occur in up to 20% of seizure-naïve adult patients undergoing craniotomy for tumor resection, contributing to morbidity and readmissions. Yet, routine prophylactic use of anti-seizure medications (ASMs) in this population remains unsupported by current evidence-based guidelines. In this review, we synthesize current evidence on seizure incidence, timing, risk factors, and practical perioperative management strategies. RECENT FINDINGS: Postoperative seizure risk varies by tumor type, cortical involvement, peritumoral edema, hemorrhage, and tumor grade. Across randomized trials and meta-analyses, prophylactic ASM administration has not been shown to consistently reduce postoperative seizure incidence, and older agents can increase toxicity and interaction risk. Some studies suggest a modest reduction of early seizures within the first postoperative week, though this benefit is not sustained long-term. When prophylaxis is employed, second-generation ASMs such as levetiracetam are often favored for their higher tolerability and fewer drug-drug interactions compared to older agents. Emerging evidence has described alternative agents to levetiracetam with greater blood-brain-barrier permeability, but further investigation is required. Routine ASM prophylaxis in seizure-naïve patients undergoing intracranial tumor resection is not supported by current evidence or clinical guidelines. A selective, risk-based approach with short-term prophylaxis may be considered in patients with high-risk features. Future prospective, risk-stratified trials are needed to better define subgroups that may benefit from targeted prophylactic strategies.
PubMed2026
Preliminary translational assessment of robotic surgery skills for vascular dissection: from simulator to in vivo porcine model.
Robotic-assisted surgery (RAS) offers enhanced visualization, precision, and dexterity, but the absence of haptic feedback poses challenges during delicate dissection tasks such as vascular dissection. Simulation-based training has been proposed as a strategy to mitigate these limitations, yet evidence of translational effectiveness into in vivo surgical performance remains limited. We conducted a prospective, controlled feasibility study to evaluate the impact of a structured, simulator-based training program on robotic vascular dissection. Twelve novice surgeons were included in a prospective, controlled, non-randomized feasibility study. Six underwent structured dry-lab training with a sensorized high-fidelity vascular simulator, while six served as untrained controls, no baseline robotic performance assessment was performed before the intervention. Surgical performance was assessed during robotic vascular dissections in anesthetized porcine models using the da Vinci Xi platform. Performance was assessed by a single expert evaluator who was blinded to group allocation using the Global Evaluative Assessment of Robotic Skills (GEARS) and qualitative parameters including tissue handling, vessel exposure, and stapler placement. The trained group achieved significantly higher overall GEARS scores than the control group (25.7 ± 2.9 vs. 21.2 ± 2.4; p = 0.026). Depth perception was significantly improved in trained participants (4.33 ± 0.81 vs. 2.83 ± 0.75; p = 0.028). Trends toward enhanced bimanual dexterity and efficiency were observed but did not reach statistical significance. Qualitative analysis highlighted safer tissue handling, more consistent vessel exposure, and improved stapler positioning in the trained group compared with the controlgroup. Structured training with a sensorized high-fidelity vascular simulator was associated with better performance in selected components of robotic vascular dissection performance in an in vivo porcine model. These preliminary findings support the feasibility of this translational training pathway but require confirmation in larger randomized studies.
PubMed2026
Robert Kennedy (1865-1924) and the first surgical repair of neonatal brachial plexus palsy.
This historical vignette highlights key aspects of the professional life of the Scottish surgeon Robert Kennedy and details the first reported surgical repair cases of brachial plexus birth palsy, which achieved remarkably favorable outcomes. These cases represent the first documented attempt at surgical reconstruction of neonatal brachial plexus palsy and predate the modern era of nerve surgery by several decades.
PubMed2026
Robot-Assisted Mechanical Thrombectomy for Neurointerventional Surgery: An Exploratory Scoping Review.
Robot-assisted endovascular technologies have emerged as a promising innovation in neurointerventional surgery, particularly for mechanical thrombectomy in acute ischemic stroke. This scoping review aims to map and synthesize the current evidence on robot-assisted mechanical thrombectomy, focusing on technical feasibility, preliminary performance outcomes, and existing limitations.A scoping review was conducted following the Joanna Briggs Institute methodology and reported according to PRISMA-ScR guidelines. Searches were performed in PubMed, Embase, Scopus, and Web of Science without date or language restrictions. Studies evaluating robotic assistance in mechanical thrombectomy across preclinical and clinical settings were included.Fourteen studies met the inclusion criteria, including 13 preclinical studies and only 1 clinical study. Robotic systems demonstrated promising technical success and recanalization rates reported in controlled settings, although direct comparisons with conventional manual techniques remain limited. Additional benefits included reduced procedure times, improved navigation precision, decreased operator fatigue, and significant reductions in radiation exposure. However, most evidence remains experimental, with limited clinical validation.Robot-assisted mechanical thrombectomy appears technically feasible in preclinical and early clinical settings, with potential advantages for procedural safety and access to stroke care. However, the current evidence remains limited and predominantly preclinical, and robust clinical trials are required before widespread clinical adoption. These findings should therefore be interpreted as hypothesis-generating.
PubMed2026
Robotic pancreaticoduodenectomy with venous resection and reconstruction: a systematic review of perioperative, vascular, oncological and survival outcomes.
Robotic pancreaticoduodenectomy with venous resection and reconstruction (RPD-VR) is one of the most technically challenging procedures in hepatopancreaticobiliary surgery. While acceptance of robotic pancreaticoduodenectomy is growing, the safety, feasibility, and oncologic adequacy of combined portal vein (PV) and/or superior mesenteric vein (SMV) resection remain incompletely defined. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Scopus and the Cochrane Library were searched from inception of the databases to June 2026. The Newcastle-Ottawa Scale was used to evaluate methodological quality. Twelve retrospective studies involving 202 patients undergoing RPD-VR were included. Indications were predominantly pancreatic ductal adenocarcinoma, but other periampullary and pancreatic malignancies were included. The venous reconstruction techniques were primary venorrhaphy, patch venoplasty, end-to-end anastomosis and interposition graft reconstruction. The conversion rates ranged from 0% to 36.4%. Major postoperative complications (Clavien-Dindo ≥ III) were 0% to 40%, postoperative pancreatic fistula 0% to 20% and mortality 0% to 14.3%. R0 resection rates ranged from 69.2 to 100% and lymph node harvest from 14.3 ± 6.7 to 60.0 ± 13.9 nodes. Limited long-term data suggested vascular patency rates exceeding 90% in the studies reporting follow-up imaging. Overall survival, disease-free survival and recurrence outcomes were, however, reported to a limited extent and heterogeneously across studies. Existing data suggest RPD-VR is technically feasible and may be associated with acceptable perioperative, vascular, and oncologic outcomes in carefully selected patients treated at experienced centers. However, the currently available evidence is limited by the retrospective study designs, small sample sizes, and lack of long-term oncologic follow-up. Standardised reporting and solid long-term outcome assessment in prospective multicenter studies are needed to better define the role of RPD-VR in contemporary pancreatic surgery. Prospero ID: CRD420261417822.
PubMed2026
Comprehensive survey on urological stent practices by the European Association of Urology (EAU) Endourology.
PURPOSE: Ureteral stents are widely used following ureteroscopy (URS), yet several aspects of their management remain non-standardized despite contemporary EAU and AUA guideline recommendations. This study evaluated contemporary international practices and identified gaps in ureteral stent use among endourologists. METHODS: A cross-sectional international survey consisting of 58 items across nine domains was distributed via social media, major urological meetings, and the EAU Endourology Section. Only fully completed responses were analyzed. Descriptive statistics were used, with continuous variables reported as medians and categorical variables as frequencies and percentages. RESULTS: A total of 121 respondents from 48 countries were included. Stent placement remained common after uncomplicated ureteroscopy and was nearly universal in complicated cases. Pre-stenting was applied selectively, most commonly after failed ureteroscopy and for ureteral dilatation. A 6 Fr stent and polyurethane material were the preferred choices. Stent-related symptoms were frequent, with urgency and frequency predominating, followed by hematuria. Pharmacologic management varied, and conservative treatment was commonly used for post-stenting infections. Notably, 45% of respondents did not use a structured stent-tracking system and 71.8% had never used a validated symptom-assessment tool such as the USSQ. Exploratory subgroup analyses identified differences according to geographic region, institution type, and endourological training background in selected aspects of stent management, including pre-stenting duration, long-term stent exchange protocols, pharmacologic management, and follow-up systems. CONCLUSION: International ureteral stent practices show substantial variability. Although core practices were broadly comparable across regions, important gaps remain in stent tracking and symptom assessment, highlighting opportunities to improve patient safety and standardize care.
PubMed2026
Influence of artificial intelligence on xenotransplantation and regenerative medicine on the path toward ending the organ shortage.
The purpose of this review is to summarize the most influential and conceptually significant publications from the past 2 years, including substantial 2026 publications, and to identify emerging directions likely to shape xenotransplantation and regenerative medicine in the near future. Advances in artificial intelligence (AI) now support more structured anticipation of future developments by integrating patterns across experimental, computational, and translational research. The field is approaching a potential inflection point in which increasingly capable AI systems, potentially approaching artificial general intelligence, may accelerate the design of stem-cell-derived tissues and progressively more complex organ constructs. In addition, scientific communication is evolving toward formats that support machine-assisted analysis and AI-driven knowledge synthesis. Multiple developments signal significant expansion across xenotransplantation and regenerative medicine, driven by innovations in gene editing, multimodal data integration, and AI-enabled prediction and decision-support systems. These advances will help to broaden access to transplantable organs and increase the scale and impact of the field across clinical practice, research, and workforce domains. Together, these trends suggest that AI-enabled regenerative and xenogeneic strategies may meaningfully reduce the organ shortage and support future progress toward precision-engineered organ replacement.
PubMed2026
miR-145-5p in predicting caesarean section postoperative complications in scarred uterus cases: a prospective cohort study.
BACKGROUND: To investigate whether serum micro (miR)-145-5p for postoperative complications in patients with scarred uterus undergoing caesarean section, suggesting its potential as an adjunctive molecular biomarker for clinical preoperative risk assessment. METHODS: A total of 198 women were divided into high-expression and low-expression groups based on the mean relative serum miR-145-5p level. Pelvic floor function, vaginal microecology, and abdominal adhesion status were assessed, and postoperative complications were monitored. Spearman's rank correlation was used to analyse the correlation between miR-145-5p expression and scar scores, while Receiver operating characteristic (ROC) curves were employed to evaluate its predictive efficacy for complications. RESULTS: Serum miR-145-5p was negatively correlated with abdominal scar Patient-Observation Scar Assessment Scale (POSAS) scores. The level of miR-145-5p was lower in the moderate-to-severe pelvic floor dysfunction (PFD) group, vaginal microecological disorder group, abdominal adhesion group, and postoperative complication group compared with the corresponding control groups. ROC curve analysis showed that miR-145-5p had good predictive value for these complications. CONCLUSIONS: miR-145-5p is closely correlated with abdominal scar, PFD, vaginal microecological disorders, abdominal adhesions, and other postoperative complications in patients with scarred uterus after caesarean section, which may serve as a potential molecular biomarker for preoperative risk assessment.
PubMed2026
Rotation-traction manipulation versus cervical traction for axial neck pain caused by cervical degenerative disc disease: a multicenter randomized controlled trial.
BACKGROUND: Axial neck pain is a common manifestation of cervical degenerative disc disease (CDD). Rotation-traction manipulation (RTM) is widely used in China, but its comparative effectiveness and safety versus cervical traction remain uncertain. METHODS: In this prospective multicenter randomized controlled trial, 154 adults with CDD-related axial neck pain were randomized 1:1 to receive RTM (7 sessions over 2 weeks) or cervical traction (daily for 2 weeks). Outcomes were assessed at baseline, during treatment, and at 1 and 3 months after treatment. The primary outcome was pain intensity measured by the visual analogue scale (VAS); secondary outcomes were neck tenderness score (NTS) and cervical range of motion (ROM). Intention-to-treat analyses with multiple imputation were performed. RESULTS: All 154 randomized participants were included in the analyses, and 151 completed follow-up. Both groups showed significant improvement over time in VAS and ROM (both P < 0.001). Confirmatory mixed-effects analyses did not demonstrate significant between-group differences in VAS or ROM after adjustment for multiple comparisons. Exploratory analyses suggested that RTM provided faster improvement during the treatment phase and a small cumulative advantage in pain reduction, whereas cumulative ROM improvement did not differ significantly between groups. RTM was also associated with a faster reduction in neck tenderness severity. Adverse events were mild and infrequent, and no treatment-related radiographic deterioration was observed. CONCLUSIONS: Both RTM and cervical traction were associated with clinical improvement in patients with CDD-related axial neck pain. Confirmatory analyses did not demonstrate robust superiority of RTM for pain or cervical ROM, whereas exploratory analyses suggested faster early improvement and a small cumulative pain benefit with RTM. NTS findings should be interpreted cautiously because the tenderness score has not been formally validated. No serious adverse events were observed. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400082667. Registered retrospectively on 4 April 2024.
PubMed2026
Comparison of Procedural Safety and Diagnostic Yield Between Robotic-Assisted Bronchoscopy Platforms.
RATIONALE: Robotic-assisted bronchoscopy platforms are becoming ubiquitous to aid in sampling peripheral pulmonary nodules. A head-to-head performance between the 2 widely available platforms (Ion and Monarch) has not been investigated. OBJECTIVES: To explore differences in diagnostic yield and safety parameters of the Ion and Monarch platforms. A secondary objective was to elucidate radiographic features of nodules that predicted procedural success. METHODS: A retrospective, 2-site cohort study of adult patients scheduled for robotic-assisted bronchoscopy of pulmonary nodules between August 2020 and August 2023. The procedure was performed with either the Ion or Monarch robotic-assisted bronchoscopy platform, depending on the site, with the assistance of standard 2D fluoroscopy. A series of logistic regression models was constructed to explore the effect of platform type on diagnostic yield, after correction of prespecified confounders. We utilized an inferential lasso regression model to explore the predictive properties of nodule radiographic characteristics on yield. RESULTS: A total of 217 cases were analyzed. The median nodule size was 1.4 cm (IQR=1.1 to 2.1), which was similar across both groups. Our parsimonious model suggested no difference in obtaining a positive diagnosis for the Ion platform [OR: 1.5 (0.9-2.7)]. Both nodule size [OR: 1.42 (1.09-1.86)] and presence of a bronchus sign [OR: 2.14 (1.14-4.01)] correlated with diagnostic yield in our inferential model, both in systems and in aggregate. CONCLUSION: Both platforms offer promise in sampling small peripheral nodules. Neither platform appears to improve procedural yield, although caution is advised regarding the generalizability of this finding. Both nodule size and the presence of the bronchus sign may be helpful in preprocedural patient selection.
PubMed2026
Cost-effectiveness of ferumoxtran-enhanced macrophage-specific-MRI and PSMA-PET/CT versus ePLND for nodal staging in primary prostate cancer: a decision analysis based on updated phase-3 trial data.
BACKGROUND AND OBJECTIVE: Accurate nodal staging in intermediate- to high-risk prostate cancer (PCa) is crucial for treatment decisions. While extended pelvic lymph node dissection (ePLND) is the standard, it is invasive and has a low diagnostic yield. A 2019 analysis suggested that non-invasive imaging such as PSMA-PET/CT and ferumoxtran-enhanced macrophage-MRI (m-MRI) is cost-effective, but at the possible expense of a small QALY loss compared to ePLND, based on limited evidence. Recent Phase 3 trials have provided new data, prompting a reevaluation. Therefore, the aim of this article is to update a model with recent trial data to assess the cost-effectiveness of m-MRI and PSMA-PET/CT versus ePLND in Germany. MATERIAL AND METHODS: We adapted a Markov model to simulate lifetime outcomes for men with intermediate- to high-risk PCa from a German insurer's perspective, with costs updated to 2025 level. Diagnostic accuracy data were derived from recent multicenter trials. Costs and QALYs were calculated using a 3% discount rate. Sensitivity analyses tested uncertainties. A practical interactive online-tool is provided for clinical decision-making and research purposes, which can incorporate various input data (https://macrophage-mri.app). RESULTS: Both imaging options were dominant over ePLND (€37,855; 18.11 QALYs). PSMA-PET/CT was €7,869 cheaper and gained 0.800 QALYs; m-MRI was €9,985 cheaper and gained 0.990 QALYs. m-MRI was superior, saving €2,116 and gaining 0.19 QALYs over PSMA-PET/CT. The probabilistic analysis showed that m-MRI was optimal over 95% of the time at an €80,000/QALY threshold; the probability of PSMA-PET/CT being optimal was less than 5%. CONCLUSIONS: An imaging-first approach outperforms routine ePLND, with m-MRI as a cost-effective option. PSMA-PET/CT's low sensitivity limits its usefulness, though it is still cheaper than ePLND. These results support including m-MRI in guidelines for initial staging.
PubMed2026
Effects on mortality of different blood purification techniques in sepsis patients: an umbrella review of systematic reviews and meta-analyses.
Sepsis remains a leading cause of mortality worldwide, and extracorporeal blood purification has been widely implemented despite ongoing uncertainty regarding its survival benefit. We conducted an umbrella review of 42 systematic reviews and meta-analyses evaluating mortality across major extracorporeal blood purification modalities. Mortality estimates generally favored extracorporeal blood purification over conventional care, but effect sizes and consistency varied substantially by modality, and the overall certainty of evidence for mortality was low. At the review level, polymyxin B hemoperfusion showed a relatively consistent direction toward lower mortality, whereas renal replacement therapy-based strategies were typically closer to the null. However, most included reviews were of low or critically low methodological quality, with downgrading driven by risk of bias, inconsistency, and potential publication bias. Therefore, these findings should be interpreted cautiously and should not be considered definitive evidence of survival benefit. They highlight persistent evidentiary fragility and underscore the need for rigorously designed, phenotype-informed trials to clarify modality-specific effects in sepsis.