To further standardize the application of robotic assisted single-port surgery in gynecology and enhance its operational safety and clinical outcomes, this expert consensus systematically summarizes the current technological status, indications, contradiction and operational protocols. In recent years, with advancements in endoscopic technology, robot-assisted laparoendoscopic single-site surgery (R-LESS) has significantly improved operational flexibility, precision, and surgeon comfort in gynecological procedures within confined spaces. The consensus elaborates on the technical features and clinical applications of multi-arm and single-arm robotic systems (such as da Vinci Si/Xi/SP, and domestically developed Shurui SR-ENS-600 and Jingfeng SP1000), defines the indications and contraindications including adnexal surgery, hysterectomy, and early-stage malignant tumor surgery, and standardizes key aspects of preoperative assessment, patient preparation, surgical steps, and complication management. Finally, it outlines future directions for R-LESS in AI-assisted planning, 5G remote operation, force feedback technology, and standardized training.

Robotic surgery has demonstrated obvious advantages in precise and complex operations, and its application in urology, gastrointestinal surgery and obstetrics and gynecology has gradually become widespread. However, its development in pancreatic surgery has been relatively slow. From 2011 to 2025, the author′s team completed a total of 5, 500 robotic pancreatic surgeries. Based on the summary of the above-mentioned surgical experiences, the author proposed new technologies, new concepts, and new sub-specialties. Among them, the new technologies include standardized port placement, the application of L-hole and R-hole, 301 pancreaticojejunostomy, robotic radical antegrade modular pancreatosplenectomy using the flip-up approach, and Rong′s surgery. The new concepts include: circumferential vessel resection techniques and low-tension and low-stress anastomosis; New Sub-specialty: Pancreatic Duct (Repair) Surgery. These experiences and concepts can help robotic pancreatic surgeons shorten their learning curve, promote the adoption of robotic pancreatic surgery in primary care settings, advance the development of robotic pancreatic surgery in China, and enable more patients to benefit from the progress of minimally invasive techniques.

To compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) in elderly patients.

Clinical and follow-up data of elderly patients (> 65 years) who underwent LPD or OPD between Jan. 2015 and Dec. 2022 were retrospectively analyzed. A 1∶1 propensity score-matching (PSM) analysis was performed to minimize differences between groups. Univariate and multivariate logistic regression analysis were used to select independent prognostic factors for 90-day mortality.

Of the 410 elderly patients, 236 underwent LPD and 174 OPD. After PSM, the LPD group had a less estimated blood loss (EBL) (100 ml vs. 200 ml, P<0.001), lower rates of intraoperative transfusion (10.4% vs. 19.0%, P=0.029), more lymph node harvest (11.0 vs. 10.0, P=0.014) and shorter postoperative length of stay (LOS) (13.0 days vs. 16.0 days, P=0.013). There were no significant differences in serious complications, reoperation, 90-day readmission and mortality rates (all P>0.05). Multivariate logistic regression analysis showed that post-pancreatectomy hemorrhage (PPH) was an independent risk factor for 90-day mortality. Elderly patients with pancreatic ductal adenocarcinoma (PDAC) who underwent LPD or OPD had similar overall survival (OS) (22.5 months vs. 20.4 months, P=0.672) after PSM.

It is safe and feasible for elderly patients to undergo LPD with less EBL and a shorter postoperative LOS.

To observe the application scope and experience of thoracoscopic diaphragmatic fold surgery in the treatment or prevention of complications of diaphragmatic nerve injury (tumor invasion or intraoperative injury).

After phrenic nerve injury, the therapeutic effects were compared between patients with and without diaphragmatic plication. Therapeutic versus prophylactic diaphragmatic plication of the treatment course was compared. The symptoms and imaging were observed.

In the period from Jan. 2022 to Jul. 2024, a total of 445 mediastinal tumor surgeries were performed, of which 49 involved the folding of the diaphragm. Among these, 5 patients underwent total thymectomy and diaphragm folding via minimally invasive surgery. Comparing the symptoms and imaging observations before and after surgery in patients with diaphragmatic nerve injury treated by thoracoscopic diaphragm folding, it was found that patients with improved symptoms of chest tightness; in patients with preventive diaphragm folding, no respiratory difficulty due to diaphragmatic bulging occurred after surgery, recovery was fast, and postoperative effects were good.

In mediastinal tumor resection without lung resection, thoracoscopic diaphragmatic folding surgery can treat or prevent complications of phrenic nerve injury in patients with phrenic nerve invasion or intraoperative injury, achieving satisfactory treatment results.

To explore the effectiveness, safety and feasibility of mesh repair in the treatment of abdominal wall fascia defect after laparoendoscopic single-site surgery for abdominal wall endometriosis (AWE) resection.

The clinical data of 5 patients who underwent laparoendoscopic single-site surgery AWE lesion resection and 6 patients who underwent AWE lesion resection via the original cesarean section incision with intraoperative mesh repair of fascia defects from Jun. 2023 to Dec. 2024 in the First Affiliated Hospital of Nanjing Medical University were collected. The AWE lesions were completely resected using either the laparoendoscopic single-site surgery or the original cesarean section incision. Preoperative ultrasound and MRI were performed to evaluate the size and location of the AWE. The location of the AWE, the extent of the fascia defect after resection, the adverse reactions related to mesh placement, the pathological results of the lesion and the perioperative complications were compared between the two groups of patients.

All the 5 patients who underwent laparoendoscopic single-site surgery and 6 patients who underwent surgery through the original cesarean section had successful surgeries. There was less bleeding during the laparoendoscopic single-site surgery, and the postoperative pathology showed endometriosis and negative surgical margins. All incisions healed well with grade A, and no adverse reactions related to mesh placement occurred.

After minimally invasive radical resection of AWE, the fascia defect is too large to be sutured. Mesh can be used to fill and repair the fascia defect to ensure the original tension of the abdominal wall. Compared with the conventional surgery through the original cesarean section incision, laparoendoscopic single-site surgery has the advantages of smaller incision and faster postoperative recovery. This technique is safe and feasible for clinical application.

To explore the clinical analysis of laparoscopic total hysterectomy in patients with complete obliterated Cul-de-sac due to endometriosis.

A retrospective analysis was conducted on the general clinical and pathological data of 115 cases of endometriosis diagnosed by postoperative pathology after laparoscopic total hysterectomy from Jun. 2022 to Aug. 2024.Among them, 54 cases had complete obliterated Cul-de-Sac, and 61 cases had incomplete obliterated.The general clinical data and perioperative situation of the two groups were compared.

Both groups did not experience serious complications such as major bleeding, conversion to open surgery, or organ damage.They all recovered well at the 3-month follow-up after surgery. There were more recurrent patients in the completely obliterated group[16 (29.6%) vs. 6 (9.8%), P=0.007], more dysmenorrhea[46(85.2%) vs. 38(62.3%), P=0.006], and younger patients undergoing hysterectomy[45.61±3.96 years vs. 47.41±3.81 years, P=0.015]. The EM resection of ovaries, sacral ligaments, and rectovaginal septum was performed more frequently in the fully obliterated group than in the incompletely obliterated group[35(64.8%) vs.18(29.5%), P<0.001; 42(77.8%) vs.26(42.6%), P<0.001; 46(85.2%) vs. 8(13.1%), P<0.001]; The group with incomplete obliterated of peritoneal EM resection had more cases [22(40.7%) vs. 45(73.8%), P<0.001]. The completely obliterated group had more operation time, intraoperative bleeding, ureteral dissociation and postoperative hospital stay than the incompletely obliterated group 147.00(114.75176.75)min vs. 95.00(81.00117.00)min, P<0.001; 50.00(20.00100.00)ml vs. 20.00(10.00, 20.00)ml, P<0.001; [44(81.5%) vs.15(24.6%), P<0.001; 4.00(3.00, 5.00)d vs. 3.00(2.00, 4.00)d, P<0.001]; There was no significant difference in uterine weight, perioperative ureteral stent placement, postoperative fever, and other complications between the two groups(P>0.05).

Laparoscopic total hysterectomy was performed in patients with endometriosis and complete obliterated Cul-de-Sac, and there were no serious complications occurred during and after the operation, and the postoperative recovery was good, which is a safe, effective and feasible treatment method.

To summarize the application value and initial experience of CT-based 3D surgical model reconstruction technology(CT-3D surgical modeling technology) in pediatric robotic abdominal surgery.

For five pediatric patients from Oct. 2023 to Feb. 2025, we performed robotic surgery following the construction of surgical models and preoperative simulation via CT-3D surgical modeling technology. Among the surgeries, there was one case of robotic-assisted hepatic resection for hepatoblastoma; one case of robotic-assisted emergency surgery, including duodenal repair, central pancreatectomy, and pancreatic body-jejunal anastomosis; one case of robotic-assisted pancreaticoduodenectomy (Whipple procedure); one case of robotic-assisted intra-abdominal lymphangioma resection; and one case of robotic-assisted retroperitoneal lymphangioma resection. Subsequently, we summarized the application value and our initial experience of CT-3D surgical modeling technology in pediatric robotic abdominal surgery for complex anatomies.

A total of five patients (three males and two females) aged 10.0±2.45 years underwent the procedure. The mean surgical time was 475.6±280.03 minutes, and intraoperative bleeding: median 50 ml (range 10-300). These surgical models accurately reflected the intraoperative anatomy, and preoperative simulation with them reduced unnecessary intraoperative manipulations and significantly improved surgical efficiency.

CT-3D surgical modeling technology enhances the predictability of robotic surgical steps and holds positive implications for broadening the indications for pediatric robotic abdominal surgery.

By reviewing the diagnostic and therapeutic process of laparoscopic surgery for patients with primary intrahepatic cholangiocarcinoma (ICC) in our center, this study summarizes and discusses minimally invasive techniques combining Glissonian sheath anatomical dissection with a dorsal approach for ICC treatment.

A patient admitted to the Hepatobiliary Surgery Department of Wuxi Xishan People′s Hospital in Mar. 2025 with cholecystolithiasis and acute cholecystitis was subsequently found to have a left hepatic lobe mass adjacent to the portal fissure (sagittal part). Clinical diagnosis confirmed ICC, cholecystolithiasis, and acute cholecystitis. After systematic evaluations including cardiopulmonary function, hepatic functional reserve, and tumor staging, a laparoscopic surgical strategy was formulated.

The patient successfully underwent an enlarged left hemihepatectomy via the Laennec approach (laparoscopic intra-glissonian anatomical dorsal approach) combined with hepatic hilar lymph node dissection and cholecystectomy. The procedure was performed with minimal intraoperative blood loss. No postoperative complications such as infection, hemorrhage, bile leakage, or portal vein thrombosis occurred, and the patient recovered smoothly. The postoperative pathological diagnosis confirmed ICC.

Surgery is the most effective strategy for treating ICC. In cases where the tumor is adjacent to the sagittal section of the hepatic portal, the Laennec approach (intra-glissonian dissection) combined with a dorsal approach for hepatectomy can be employed following a systematic and comprehensive preoperative evaluation. This combined approach ensures adequate surgical margins, minimizes intraoperative bleeding, and ultimately improves patient outcomes.

To explore the feasibility of bilateral endoscopic parathyroidectomy via subclavian approach in patients with secondary hyperparathyroidism.

One patient with secondary hyperparathyroidism in the Thyroid and Breast Surgery Department of the General Surgery Center of Tai′an 88th Hospital was selected. The preoperative examination was completed and there were no surgical contraindications. The patient was scheduled to undergo bilateral subclavicular approach and endoscopic parathyroidectomy.

The patient′s operation was successfully completed without complications such as postoperative bleeding, incision infection, hoarseness, or choking when drinking water. The patient was discharged smoothly after the operation and was satisfied with the aesthetic appearance of the incision.

Transsupraclavicular approach bilateral endoscopic parathyroidectomy provides a new endoscopic surgical approach for patients with secondary hyperparathyroidism.

The arc of Bühler(AOB), as a rare anatomical variation, can provide important collateral circulation for the abdominal trunk and superior mesenteric arteries, and can compensate for blood supply when the abdominal trunk/superior mesenteric arteries are occluded. This article reports a 60-year-old male patient with common bile duct adenocarcinoma. Preoperative three-dimensional reconstruction revealed an AOB with a diameter of 5.51 mm running between the common hepatic artery and the superior mesenteric artery. During the operation, this variant vessel was retained without ligation or dissection. Preoperative three-dimensional reconstruction technology can accurately identify vascular variations and optimize surgical decisions. Especially for patients who need complex surgeries such as pancreaticoduodenectomy, it can significantly reduce the risk of iatrogenic injury.

This study aims to assess the feasibility of utilizing the da Vinci robotic system for assisting in pediatric parathyroidectomy.

A retrospective analysis was performed on the clinical data of a child diagnosed with primary hyperparathyroidism, treated at No.960 Hospital of People′s Liberation Army. Preoperative evaluations were completed, and contraindications for surgery were excluded. In May 2024, a da Vinci robotic-assisted parathyroidectomy was carried out. The surgical procedure and long-term symptom relief were monitored.

The surgery lasted approximately 95 minutes, with intraoperative blood loss of 10 ml. Ten minutes after the removal of the target parathyroid gland, the parathyroid hormone (PTH) level had decreased by more than 50% compared to preoperative values. The drainage tube was removed on postoperative day 4, with no complications. At the 12-month follow-up, thyroid and urinary system ultrasounds showed no significant abnormalities. Blood calcium was 2.36 mmol/L, phosphate was 1.53 mmol/L, PTH was 40.30 pg/ml, 25(OH)D was 27.42 ng/mL, calcitonin (CT) was 1.50 pg/ml, and thyroid function was normal. The cosmetic result was satisfactory.

Da Vinci robotic-assisted parathyroidectomy in pediatric patients is both safe and feasible. However, additional clinical cases are required to validate these findings.

In recent years, significant progress has been made in the surgical treatment of gastrointestinal tumors. The innovation of minimally invasive techniques has become a key development direction. Laparoscopic techniques have been widely used in colorectal cancer and gastric cancer, and their short-term efficacy and safety have been confirmed by multiple studies.Laparoscopic colorectal cancer surgery significantly shortens the recovery time and reduces complications by reducing incision trauma and improving operational accuracy. In addition, robotic surgery, with the advantages of highly flexible instruments and three-dimensional field of vision, demonstrates higher flexibility and accuracy in complex anatomical areas. However, it still has problems such as high cost, long operation time and lack of tactile feedback. For emerging technologies, nano-carbon tracer technology improves the accuracy of lymph node dissection for gastric cancer by precisely locating sentinel lymph nodes. Photodynamic therapy provides a non-invasive treatment option for patients with early gastric cancer by selectively killing tumor cells. In the future, minimally invasive techniques and artificial intelligence will be further integrated to promote personalized and precise treatment. Strengthen the multidisciplinary collaboration model and integrate surgery, immunotherapy and gene-targeted therapy; Optimize diagnosis and treatment strategies by leveraging big data and enhance service accessibility through telemedicine. Overall, surgical treatment of gastrointestinal tumors is moving towards an era that is more minimally invasive, precise and individualized.

Significant progress has been made in intelligent laparoscopic surgical robotics over the past decade. This review summarizes the latest advancements in the field. Clinical studies have demonstrated that robot-assisted surgery offers distinct advantages over conventional laparoscopic techniques, including reduced intraoperative blood loss, shorter operative time, and decreased hospital stays. Commercially, although Intuitive Da Vinci Robotic Surgical Systems remains dominant, the competitive landscape is gradually diversifying. Academic research has primarily focused on open platforms, surgical automation, navigation and intraoperative imaging, force sensing and control, single-port laparoscopic robots, and modular surgical robotic systems. Additionally, emerging technologies such as MRI-compatible robots and cellular-level interaction show promising potential. In the future, laparoscopic surgical robots will evolve toward miniaturization, intelligence, and customization, while human-robot interaction modes will transform with increasing autonomy. However, clinical translation still faces challenges, including regulatory approval, development processes, and clinical validation. Innovations in intelligent surgical technology must remain patient-centered, prioritizing safety and efficiency, to fully realize their potential to transform medicine.