Most early reports on the Hugo™ Robotic- assisted surgery (RAS) system originated from institutions with concurrent access to established robotic platforms, potentially introducing device selection bias. We conducted a retrospective assessment of 103 patients with localized prostate cancer treated using Hugo™ RAS-assisted robot-assisted radical prostatectomy at a Japanese municipal hospital where no alternative robotic platform was available. The analysis focused on perioperative performance, safety outcomes, and consistency of procedural implementation. A standardized surgical setup, including a W-shaped port configuration and predefined floor-marking-based docking strategy, was applied. Surgery was carried out by six surgeons with different levels of robotic experience, including one surgeon without prior robotic operative experience. Operative, console, and docking durations showed median values of 152 min (IQR 129-218.5), 108 min (IQR 85-174.5), and 5 min (IQR 4-7), respectively. Estimated intraoperative blood loss was 100 mL (IQR 50-214). Neither intraoperative blood transfusion nor conversion to open surgery was necessary in any patient. Postoperative complications occurred in four patients (3.9%), including one major complication (Clavien-Dindo > II; 1.0%). Positive surgical margins were observed in 35 patients (34.0%) and 79.6% achieved urinary continence at 3 months. In this Hugo-exclusive, single-platform environment, RARP using the Hugo™ RAS system was performed without major safety concerns across surgeons with varying experience. Although four independent-arm carts needed to be rolled in, the median docking time was 5 min, possibly facilitated by a standardized floor-marking strategy adopted at our institution.

Metastatic colorectal cancer (mCRC) with microsatellite instability-high or mismatch repair deficiency (MSI-H/dMMR) demonstrates limited responsiveness to conventional cytotoxic chemotherapy but increased susceptibility to immune checkpoint inhibition. Although randomized phase III trials have shown superiority of immune checkpoint inhibitors (ICIs) in the first-line setting, a comprehensive synthesis of survival outcomes across key molecular and clinical subgroups remains warranted.

We conducted a systematic review and meta-analysis of randomized, open-label, phase III trials comparing first-line ICI-based therapy with standard chemotherapy in MSI-H/dMMR mCRC. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Prespecified subgroup analyses evaluated outcomes according to BRAF mutation status, KRAS/NRAS mutation status, and primary tumor location. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using random-effects models. Safety outcomes were analyzed using Mantel-Haenszel fixed-effect models. Statistical heterogeneity was assessed using the I² statistic.

Two phase III trials (KEYNOTE-177 and CheckMate-8HW), including more than 600 patients, were eligible. ICI-based therapy significantly improved PFS compared with chemotherapy (pooled HR 0.61; 95% CI, 0.51-0.73; I²=0%) and demonstrated a significant OS benefit (pooled HR 0.77; 95% CI, 0.63-0.94; I²=0%). Immunotherapy was associated with lower rates of overall and grade ≥ 3 adverse events, despite more frequent immune-related toxicities.

First-line ICI-based therapy provides significant and consistent survival benefits across BRAF-mutated and wild-type tumors, KRAS/NRAS-mutated and wild-type disease, and both right- and left-sided primary tumors, supporting its role as the standard of care for MSI-H/dMMR mCRC.

To evaluate the safety and feasibility of introducing retroperitoneal single-port robot-assisted radical prostatectomy (SP-RARP) by comparing a single surgeon's initial 50 cases with 50 recent transperitoneal multiport RARP (MP-RARP) cases in a Japanese population. Consecutive non-pelvic-lymph-node-dissection RARP performed by one surgeon between December 2022 and January 2026 (50 retroperitoneal SP-RARP, 50 transperitoneal MP-RARP) were analyzed retrospectively using the Mann-Whitney U and Fisher exact tests. Age, body mass index, initial prostate-specific antigen, clinical T stage and nerve-sparing rate were comparable, but high-grade biopsy disease (grade group ≥ 3) was more frequent with SP (50% vs. 28%; P = 0.040). Operative time was 143 vs. 152 min (P = 0.055). There were no transfusions and no Clavien-Dindo grade ≥ II complications or anastomotic leaks. Rescue analgesic doses were fewer with SP (median 0 vs. 1; P = 0.011). Three-month social continence (76.0% vs. 78.0%; P = 1.00) and the positive surgical margin rate (14.0% vs. 24.0%; P = 0.31) did not differ. Length of stay was unchanged (median 9 days). During its introduction phase, the extraperitoneal SP approach was performed safely, with a significantly lower analgesic requirement; margin status and 3-month continence did not differ significantly. Larger studies with longer follow-up are required.

Reduced-port robotic colorectal surgery minimizes trauma but faces technical challenges. We assessed the domestic BMR-5000 system in a standardized "3 + 1" configuration for radical colorectal cancer surgery. This prospective, single-arm trial used objective performance criteria.The surgical non-conversion rate served as the device efficacy endpoint; the primary safety endpoint was device-related Clavien-Dindo grade III or higher complications within 30 days.The technical feasibility and safety of the 3-port BMR-5000 approach served as the primary observational objective in the clinical implementation of this study. Of 60 patients, 40 underwent radical colorectal resections (23 rectal, 7 sigmoid, 6 right colectomy, 4 left colectomy). Non-conversion rate was 100% (95% exact CI 94.0-100.0), exceeding the 90% target. No device-related Clavien-Dindo grade III or higher complications occurred. Mean total operative time was 268.08 ± 84.75 min, mean estimated blood loss was 23.61 ± 27.88 mL, with no intraoperative transfusions. Mean postoperative length of stay was 9.77 ± 4.39 days. Pain scores decreased from 2.72 ± 1.58 perioperatively to 0.22 ± 0.45 by postoperative day 35. In cases requiring lymphadenectomy (n = 40), mean lymph node yield was 13.6 ± 2.97 Overall Clavien-Dindo grade I or higher complications occurred in 5 patients (8.3%); readmission, reoperation, and mortality within 30 days were 0. Reduced-port robot-assisted radical colorectal surgery with the BMR-5000 is feasible and safe, achieving 100% non-conversion, minimal blood loss, and favorable short-term outcomes. Larger comparative studies are warranted.

Robot-assisted radical prostatectomy (RARP) has become a standard procedure for the surgical management of localized and locally advanced prostate cancer (PC). Surgical outcomes are closely linked to the training and experience of the operating surgeon. In 2017, the German Society for Robot-assisted Urology (DGRU) in cooperation with the working group Robotics and laparoscopy of the German Urology Society (DGU) launched a structured national curriculum designed to train new console surgeons through a standardized, competency-based educational program. This study evaluates the first five years of the curriculum, focusing on operative exposure, post-curricular activity, and perceived career impact. A structured electronic survey was distributed to all 48 participants who completed the curriculum between 2017 and 2022. Data were collected from December 2022 to February 2023 using an anonymized online questionnaire. Items included demographics, training conditions, operative volume, outcomes of RARP cases, and professional development. Descriptive statistics were generated from the anonymized dataset. Response rate was 85%, and 93% of respondents had completed the curriculum at the time of data collection. Most trainees reported substantial console exposure and institutional support during training. After graduation, approximately half of the participants had independently performed at least 100 RARPs, while 7.3% reported no complete independent procedures. The majority indicated professional advancement, increased involvement in robotic surgery, and participation in teaching. Functional and oncological outcomes were self-reported by participants and were broadly consistent with published benchmark ranges. Overall satisfaction with the curriculum was high, and participants strongly recommended the program. The first five years of the DGRU RARP curriculum demonstrate successful integration of robotic surgery into clinical practice, substantial operative activity after graduation, and positive participant-reported career development. These findings support the value of structured national training programs in complex urologic surgery.

Partial nephrectomy is the gold standard for clinical stage T1 renal masses when technically feasible. However, real-world adoption may vary according to access to robotic platforms and organizational factors. Multicenter retrospective comparative study using the Spanish National Registry of Localized Renal Cancer during 2024 (30 hospitals). A total of 891 cases were included in the robotic versus laparoscopy/open analysis and 1121 in the dedicated-team analysis. Adults with radiologic cT1 renal masses treated with scheduled surgery and malignant histology were included. Comparisons were robotic-assisted versus laparoscopy/open approaches, and centers with a dedicated kidney surgery team versus those without it. The primary endpoint was the rate of partial nephrectomy (PN) versus radical nephrectomy (RN), analyzed overall T1 and stratified by cT1a/cT1b. Secondary endpoints (among PNs) included ischemia use and ischemia time, and recorded reasons for not performing PN grouped as technical infeasibility versus other reasons. In unadjusted analyses, PN was performed more frequently in the robotic cohort than in the laparoscopy/open cohort for cT1 (88.4% vs. 56.4%, p < 0.001), cT1a (90.2% vs. 68.7%, p < 0.001), and cT1b (84.5% vs. 32.5%, p < 0.001). Ischemia use was similar overall, while ischemia time was shorter in cT1a robotic cases (median 15 vs. 18 min, p = 0.031). Dedicated-team centers did not show higher PN rates after substage stratification; however, technical infeasibility was less frequently recorded than in non-dedicated centers (45.9% vs. 75.7%, p < 0.001). Access to robotic-assisted surgery was associated with markedly higher utilization of PN for cT1 renal masses-especially in cT1b tumors, though residual confounding cannot be excluded given the observational design. Dedicated kidney surgery teams were not associated with higher PN rates after stratification but were associated with fewer cases recorded as technical infeasibility.

Robot-assisted radical prostatectomy (RARP) is widely used for localized prostate cancer, offering enhanced precision and potential preservation of urinary and sexual function. Data on new robotic platforms in Africa are limited. Evaluate the safety, feasibility, and early perioperative, oncological, and functional outcomes of robot-assisted radical prostatectomy performed using the Toumai robotic system and determine whether these outcomes are consistent with those reported for established robotic platforms. We retrospectively analyzed 134 patients who underwent RARP with the Toumai system between May 2024 and November 2025. Preoperative data, perioperative parameters, pathological findings, functional outcomes, and postoperative PSA were collected. Urinary continence and erectile function were assessed at 1, 3, 6, 9, and 12 months postoperatively. The mean age was 67.3 years and mean preoperative PSA was 13.47 ng/mL. Most patients were intermediate risk (52.2%). Mean operative time was 262.8 min, with low blood loss (65.9 mL) and one conversion to open surgery (0.75%). Mean hospital stay was 1.4 days. Postoperative complications were rare (14.9% Clavien-Dindo I-II, 1.5% major), with no mortality. Positive surgical margins occurred in 11.1%, and lymph node involvement in 8%. After a median follow-up of 6 months (IQR: 3-18 months), 19.5% of patients showed biochemical recurrence. Urinary continence improved progressively from 30.6% at 1 month to 60.9% at 9 months and 88.2% at 12 months. Spontaneous erectile function increased from 17.6% at 3 months to 41.2% at 12 months. RARP with the Toumai system is safe and feasible in an African setting, showing acceptable early oncological outcomes with short follow-upand progressive functional recovery. Early biochemical control and continence rates are encouraging, while erectile function recovery remains gradual, highlighting the impact of surgical experience and the need for structured rehabilitation and long-term follow-up.

This study aimed to evaluate whether mitoxantrone hydrochloride injection (MHI) provides lymph node tracing and parathyroid preservation outcomes comparable to those of carbon nanoparticle suspension injection (CNP) during robotic thyroidectomy for papillary thyroid carcinoma (PTC). We conducted a retrospective review of 507 patients with PTC who underwent robotic thyroidectomy from September 2024 to September 2025. Patients were categorized into CNP and MHI groups based on the tracer utilized. After 1:1 propensity score matching, 62 matched pairs were selected for the final analysis. The primary outcomes encompassed the counts of dissected, metastatic, and stained lymph nodes, along with outcomes related to parathyroid preservation. Secondary outcomes included perioperative parameters and postoperative complications. After matching, the baseline characteristics of the two groups were well balanced. There were no notable differences in the counts of total lymph nodes, metastatic lymph nodes, stained level VI lymph nodes, parathyroid autotransplantation, incidental parathyroid resection, or intraoperative parathyroid identification. Preoperative, postoperative day 1, and 6-month postoperative serum calcium and parathyroid hormone (PTH) levels were comparable between the groups. Surgical recovery indicators and postoperative complication rates were also similar between the groups. In this single-center, propensity score-matched retrospective study, MHI showed efficacy and safety similar to those of CNP in lymph node tracing and parathyroid preservation. These findings suggest that MHI may be a practical alternative tracer in robotic thyroid cancer surgery.

Postoperative neurocognitive disorders are clinically relevant, yet longitudinal data in patients undergoing radical prostatectomy are limited. This study aimed to evaluate longitudinal changes in cognitive function and identify factors associated with cognitive trajectories in patients undergoing robotic radical prostatectomy for prostate cancer. The study included 66 patients undergoing robotic radical prostatectomy for prostate cancer. Assessments were performed at baseline (at median 10 days before surgery), 6 months, and 12 months postoperatively. Evaluations included demographic and clinical data, cognitive performance (Neurotest), affective and depressive symptoms (HADS), and affective temperament (TEMPS-A). Global cognitive composite (GCC) scores changed significantly over time (baseline, 6, and 12 months after prostatectomy), while most individual domains remained stable. In the initial model, affective temperament was associated with cognitive change: depressive temperament showed a positive association (β = 0.37, p = 0.017), whereas anxious temperament showed a non-significant negative trend (β = -0.28, p = 0.061). In the adjusted model, baseline GCC was a strong independent predictor (β = -0.63, p < 0.001). Both depressive (β = 0.34, p = 0.009) and anxious temperament (β = -0.31, p = 0.013) remained significantly associated with cognitive trajectories, while physical activity and depressive symptoms (HADS-D) were not. Cognitive trajectories after robotic radical prostatectomy are dynamic may be related to psychological and clinical factors. These findings support longitudinal cognitive monitoring and highlight the potential value of incorporating psychological assessment into perioperative care to identify patients at risk of poorer cognitive outcomes.

Robotic-assisted thoracoscopic surgery (RATS) has increasingly been adopted in thoracic surgery, yet direct comparisons with uniportal video-assisted thoracoscopic surgery (uVATS) for complex segmentectomy remain limited. We compared early perioperative outcomes between RATS and uVATS for complex pulmonary segmentectomy.

Patients undergoing complex segmentectomy between 2023 and 2025 were reviewed. Complex segmentectomy was defined as resection of any segment other than the bilateral superior segment of the lower lobes, lingular, or superior segment of the left upper lobe. After the RATS learning curve, a 1:1 propensity score matching was performed based on age, sex, ASA classification, BMI, and specific segmentectomy procedures, yielding 81 matched pairs in each group.

RATS was associated with a significantly longer skin-to-skin operative time (133 vs. 92 min; P < 0.001) and higher self-paid costs (USD 5,899 vs. 2,557; P < 0.001). Chest drainage duration and length of hospital stay were comparable between the groups. Major morbidity occurred less frequently in the RATS group (0.0% vs. 7.4%; P = 0.031), although prolonged air leak itself did not significantly differ between groups (0.0% vs. 6.2%; P = 0.063). RATS was also associated with greater N2 nodal dissection and a higher number of lymph nodes retrieved (median 7 vs. 2; P < 0.001). No conversions or in-hospital mortality occurred.

RATS provides comparable short-term safety for complex segmentectomy. Although it is associated with longer operative time and increased financial burden, RATS may offer potential advantages in reducing major morbidity. These findings support the selective use of RATS for anatomically complex or high-risk cases. Further studies should assess long-term oncologic outcomes and cost-effectiveness.