Objective To conduct a systematic bibliometric analysis of recent research on robot-assisted orthopedic surgery, in order to reveal the research trends, hotspots, main contributors, and future development directions in this field. Methods On August 27, 2024, WoSCC (Web of Science Core Collection Database) was searched and relevant literature on robot-assisted orthopedic surgery from 2003 to 2023 was included. Excel 2016, VOSviewer (version 1.6.10), and CiteSpace (version 6.2.R6) were used for data collection and analysis. Results The total citation frequency of 1718 retrieved literature was 28978 times, with an average citation frequency of 16.87 times per article. The total citation frequency of articles in 2019 was the highest (4330 times), and the publication volume in 2023 was the highest (315 articles). Among the top 5 countries in terms of publication volume, the United States had the highest publication volume and total citation frequency, while China ranked second in terms of publication volume, but had the lowest average citation frequency per article. Analysis of cooperation between countries showed that the United States, China, Germany, and other countries had the most cooperation. Babar Kayani’s articles were cited the most frequently. Among the top 10 institutions in terms of publication volume, the Hospital for Special Surgery (United States) had the highest publication volume, the Pennsylvania State System of Higher Education (United States) had the highest total citation frequency for publications, and the average citation frequency of each article published by the University of Pittsburgh (United States) was the highest. The dynamic evolution of research hotspots suggested that early research mainly focused on the combination of traditional surgical techniques and navigation, while in recent years, research had mainly focused on computer-aided surgery, augmented reality, and medical robotics technology. Conclusions In recent years, significant progress has been made in the research of robot-assisted orthopedic surgery, with the United States taking a leading position in this field and having extensive global cooperation. Research hotspots show that with the continuous development of computer-aided surgery, augmented reality, and robotics technology, the field of orthopedic surgery is evolving towards more precise, individualized, and minimally invasive directions.
ObjectiveTo review and evaluate the research progress of the robot-assisted joint arthroplasty.MethodsThe domestic and foreign related research literature on robot-assisted joint arthroplasty was extensively consulted. The advantages, disadvantages, effectiveness, and future prospects were mainly reviewed and summarized.ResultsThe widely recognized advantages of robot-assisted joint arthroplasty are digital and intelligent preoperative planning, accurate intraoperative prosthesis implantation, and quantitative soft tissue balance, as well as good postoperative imaging prosthesis position and alignment. However, the advantages of effectiveness are still controversial. The main disadvantages of robot-assisted joint arthroplasty are the high price of the robot system, the prolonged operation time, and the increased radioactive damage of the imaging-dependent system.ConclusionCompared to traditional arthroplasty, robot-assisted joint arthroplasty can improve the accuracy of the prosthesis position and assist in the quantitative assessment of soft tissue tension, and the repeatability rate is high. In the future, further research is needed to evaluate the clinical function and survival rate of the prosthesis, as well as to optimize the robot system.
Objective To analyze the impact of robot assistance on the restoration of limb length and offset distance in total hip arthroplasty (THA). Methods A retrospective analysis was conducted on the clinical data of 316 patients who underwent unilateral primary THA between September 2019 and August 2023. Among them, 117 patients underwent robot-assisted THA (group A), and 199 patients underwent conventional THA (group B). There was no significant difference between the two groups in the gender, age, or side of the hip replacement (P>0.05); but there was a significant difference in the preoperative diagnosis (P<0.05). The leg length discrepancy (LLD) and global offset (GO) dfference were measured on preoperative anteroposterior pelvic X-ray films, and absolute values were used for comparison between groups. Results The operations in both groups were successfully completed. Postoperative imaging measurements showed that the LLD and GO dfference in group A were significantly lower than those in group B (P<0.05). Among them, group A had 32 cases (27.4%), 5 cases (4.3%), and 0 case (0) of LLD>3 mm, >5 mm, and >10 mm, respectively, while group B had 115 cases (57.8%), 75 cases (37.7%), and 22 cases (11.1%), respectively; and the differences in above indicators between groups were significant (P<0.05). Group A had 40 cases (34.2%), 3 cases (2.6%), and 0 case (0) of GO dfference>5 mm, >10 mm, and >20 mm, respectively; group B had 103 cases (51.8%), 54 cases (27.1%), and 7 cases (3.5%), respectively. There was no significant difference in the proportion of patients with GO>20 mm between groups (P>0.05), while there were significant differences in other indicators between groups (P<0.05). Conclusion Compared with traditional THA, robot assisted THA has more advantages in restoration of limb length and offset distance.
ObjectiveTo investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment.MethodsA total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized.ResultsThere was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments.ConclusionDa Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.
ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
Objective To evaluate the methodological quality of clinical practice guidelines and consensuses of robot-assisted surgery. Methods The guidelines and consensuses were screened according to the inclusion and exclusion criteria by searching the domestic and overseas guidelines network and electronic database from 1 January, 2000 to 29 December, 2021. The Appraisal of Guidelines for Research and EvaluationⅡ (AGREEⅡ) instrument was used independently by two evaluators to evaluate the guidelines and consensuses. The consistency test of intraclass correlation coefficient (ICC) was carried out for two evaluators, and the score of guidelines and consensuses in the six domains of AGREEⅡ were calculated. Results A total of 34 guidelines and consensuses were included, including 10 guidelines and 24 consensuses. The ICC was all greater than 0.75, indicating that the consistency of the two evaluators was high. The average scores of the 34 guidelines and consensuses in the six domains of AGREEⅡ (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence) were 81.0%, 43.5%, 28.2%, 81.5%, 12.7% and 51.7%, respectively. Conclusion These evaluated guidelines and consensuses of robot-assisted surgery still need to be improved in the domains of rigor of development, applicability and editorial independence. With the continuous development of robot-assisted surgery, more guidelines and consensuses based on higher level of evidence will be developed to promote the standardized use of robot-assisted surgery.
ObjectiveThrough comparing the therapeutic efficacy of robot-assisted surgery (RS) and conventional surgery (CS) for mitral valve disease by meta-analysis to guide the choice of clinical operation.MethodsDatabases including The Cochrane Library, PubMed, EMbase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc) and Wanfang Database were searched by computer from inception to June 2020. The literature of efficacy comparison between RS and CS was collected. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted the data, and evaluated the quality of the literature. Meta-analysis was performed using RevMan 5.4 software.ResultsWe identified 11 studies of RS versus CS with 4 330 patients. Among them, 2 212 patients underwent RS and 2 118 underwent CS. Meta-analysis demonstrated that compared with the CS, RS had longer cross-clamp time (MD=25.00, 95%CI 15.04 to 34.95, P<0.000 01), cardiopulmonary bypass time (MD=44.11, 95%CI 29.26 to 58.96, P<0.000 01) and operation time (MD=46.40, 95%CI 31.55 to 61.26, P<0.000 01). However, ICU stay (MD=–22.13, 95%CI –31.88 to –12.38, P<0.000 01) and hospital stay (MD=–1.81, 95%CI –2.69 to –0.92, P<0.000 01) were significantly shorter in the RS group; and the incidences of blood transfusion (OR=0.38, 95%CI 0.16 to 0.89, P=0.03) and complications (OR=0.73, 95%CI 0.57 to 0.94, P=0.01) were significantly lower in the RS group.ConclusionAlthough RS has a longer operation time than CS, it has less damage, less bleeding, faster recovery and better curative efficacy.
Objective To systematically summarize the application and research progress of robot-assisted total knee arthroplasty (TKA) in the treatment of valgus knee from the perspective of precision medicine in recent years, so as to provide a reference for the clinical treatment of valgus knee. Methods Relevant domestic and foreign literature, including clinical studies and evidence-based evaluations regarding robot-assisted TKA versus conventional TKA for valgus knee, was reviewed. A systematic analysis was performed focusing on technical advantages, efficacy differences and existing controversies. Results Conventional TKA is limited by surgeons’ experiences, leading to insufficient accuracy in alignment correction, great challenges in soft tissue balance, and postoperative residual deformity. Robot-assisted TKA is significantly superior to conventional approaches in terms of alignment correction accuracy, joint function improvement, and reduction of postoperative complication rates, with confirmed short-term effectiveness. Nevertheless, controversies remain concerning the limitations of robot applicability, prolonged operation time and uncertain long-term effectiveness. Conclusion Robot-assisted TKA provides a precision-oriented therapeutic option for valgus knee with remarkable short-term effectiveness. Further large-sample studies with long-term follow-up are still required to verify its efficacy and facilitate its clinical popularization.
ObjectiveTo investigate effect of coronal plane alignment of the knee (CPAK) phenotype alteration on patient-reported outcome measures (PROMs) and functional outcomes in patients undergoing robot-assisted total knee arthroplasty (RA-TKA). MethodsThe clinical data of 108 patients who underwent unilateral RA-TKA between December 2024 and June 2025 and met the inclusion criteria were retrospectively analyzed. The cohort included 34 males and 74 females, with an average age of 68.8 years (range, 54-83 years). General data including age, gender, body mass index (BMI), and operative side were collected. PROMs included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Forgotten Joint Score-12 (FJS-12). Functional outcomes included range of motion (ROM) and angle of knee extension lag. Based on full-length lower extremity X-ray films, the mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured, and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated. The CPAK phenotype was determined according to the classification proposed by MacDessi et al. Patients were grouped into a CPAK consistent group and a CPAK changed group based on pre- and post-operative CPAK phenotypes, and the PROMs, functional outcomes, and radiographic parameters were compared. Multiple linear regression analysis was used to examine the independent association between CPAK phenotype change and the improvement in WOMAC scores. Results Among the 108 patients, the CPAK phenotype remained unchanged in 70 cases (64.8%, CPAK consistent group) and changed in 38 cases (35.2%, CPAK changed group). There was no significant difference between the two groups in age, gender, BMI, operative side, or preoperative WOMAC score, KSS score, ROM, and aHKA (P>0.05), whereas preoperative JLO showed a significant difference between groups (P<0.05). Univariate analysis demonstrated significant differences between groups at 3 months postoperatively in WOMAC, KSS, and FJS-12 scores, as well as in the changes of WOMAC score, KSS score, and ROM (P<0.05); moreover, the improvements in these parameters were superior in the consistent group compared to the changed group. There was no significant difference in postoperative ROM, angle of knee extension lag, mLDFA, mMPTA, JLO, aHKA, and the change of aHKA between groups (P>0.05). Multiple linear regression analysis revealed that CPAK phenotype change was a risk factor for improvement in WOMAC scores at short-term stage (P<0.05). ConclusionPreservation of the preoperative CPAK phenotype after RA-TKA is associated with superior improvement in PROMs at short-term stage.
Objective To compare the safety and early effectiveness between conventional manual technique and domestic robot-assisted simultaneous bilateral medial unicompartmental knee arthroplasty (UKA). Methods Clinical data of 59 patients who underwent simultaneous bilateral UKA and met the selection criteria between January 2023 and June 2024 were retrospectively analyzed. Among them, 30 patients received bilateral UKA via conventional surgery with Oxford mobile-bearing unicompartmental knee prosthesis (conventional group); another 29 patients underwent bilateral UKA with LINK SLED fixed-bearing unicompartmental knee prosthesis assisted by the domestic NATON robotic surgical system (robotic group). Baseline data including gender, age, body mass index, disease duration, Kellgren-Lawrence grade, and preoperative American Knee Society Score (KSS) and Oxford Knee Score (OKS) showed no significant intergroup differences (P>0.05). Intraoperative and perioperative indicators including operation time, length of hospital stay, perioperative hemoglobin (Hb) drop (preoperative vs immediate postoperative), and incidence of complications were recorded and compared. KSS and OKS scores were adopted to assess knee functional recovery preoperatively, at 3 months postoperatively, and at last follow-up. KSS satisfaction score was used to evaluate patient satisfaction at 3 months postoperatively and at last follow-up. Radiographic measurements of tibial prosthesis varus-valgus angle and the change in joint line height before and after surgery were performed to evaluate the accuracy of prosthesis implantation. ResultsThe conventional group had significantly shorter operation time than the robotic group (P<0.05). There was no significant difference in length of hospital stay and perioperative Hb drop between the two groups (P>0.05), and no patient required blood transfusion. All patients completed follow-up, the follow-up duration was (12.3±2.3) months for the conventional group and (12.1±2.4) months for the robotic group, with no significant difference (t=0.324, P=0.752). No severe complication including prosthesis loosening, periprosthetic infection, periprosthetic fracture, deep vein thrombosis of lower extremities, pulmonary embolism, knee stiffness, or knee instability occurred in either group. The tibial prosthesis varus-valgus angle and the change in joint line height in the robotic group were significantly smaller than those in the conventional group (P<0.05). No significant intergroup difference was observed in patient satisfaction scores at 3 months postoperatively and at last follow-up (P>0.05). Both KSS and OKS scores significantly improved at 3 months postoperatively and at last follow-up when compared with preoperative scores, with further improvement over time (P<0.05); no significant intergroup difference in these scores was found at any postoperative time point (P>0.05). Conclusion Although robot-assisted simultaneous bilateral UKA requires longer operation time, it achieves comparable early effectiveness and safety to conventional manual simultaneous bilateral UKA, with superior accuracy of prosthesis implantation. The domestic robot-assisted system demonstrates promising clinical application value in simultaneous bilateral UKA.