Autonomous Robotic Surgery: Has the Future Arrived?

Autonomous robotic surgery represents a pioneering field dedicated to the integration of robotic systems with varying degrees of autonomy for the execution of surgical procedures. This paradigm shift is made possible by the progressive integration of artificial intelligence (AI) and machine learning (ML) into the realm of surgical interventions. While the majority of autonomous robotic systems remain in the experimental phase, a notable subset has successfully transitioned into clinical applications. Noteworthy procedures, such as venipuncture, hair implantations, intestinal anastomosis, total knee replacement, cochlear implant, radiosurgery, and knot tying, among others, exemplify the current capabilities of autonomous surgical systems. This review endeavors to comprehensively address facets of autonomous robotic surgery, commencing with a concise elucidation of fundamental concepts and traversing the pivotal milestones in the historical evolution of robotic surgery. This historical trajectory underscores the incremental assimilation of autonomous systems into surgical practices. This review aims to address topics related to autonomous robotic surgery, starting with a description of fundamental concepts and going through the milestones in robotic surgery history that also show the gradual incorporations of autonomous systems. It also includes a discussion of the key benefits and risks of this technology, the degrees of autonomy in surgical robots, their limitations, the current legal regulations governing their usage, and the main ethical concerns inherent to their nature.

Enhancing Quality of Life: Pre- and Postoperative Assessment in Idiopathic Hyperhidrosis Patients.

OBJECTIVE: This study aimed to characterize patients, describe surgical complications, and evaluate the pre- and postoperative quality of life (QOL) of individuals who underwent surgery for primary hyperhidrosis (PHH). METHODS: A prospective, non-randomized, uncontrolled study was conducted, documenting cases of patients undergoing surgery for PHH at a reference center in La Habana, Cuba, from January 2016 to December 2022. RESULTS: A total of 49 cases were described, with a median age of 16 years; 59.1% were female. The most common presentation was palmar-plantar-axillary, observed in 53% of cases. The palmar presentation was more frequent in female patients (p<0.05). Within 24 hours post-procedure, 85.7% of patients showed dryness in the palmar and axillary areas, with surgical complications occurring in 14.3% of cases (intercostal neuritis, pneumothorax, and hemothorax). CH of some form was recorded in 89.8% of cases. At least 30 days after the surgery, 95.9% of the patients reported a significant improvement in their QOL. CONCLUSION: Thoracic sympathectomy is an efficient and safe method for treating hyperhidrosis in adolescents, leading to an enhanced QOL. However, this study reported a higher incidence of complications, particularly CH, compared to previous national and international studies.

Robotic Surgery: A Comprehensive Review of the Literature and Current Trends.

Robotic surgery (RS) is an evolution of minimally invasive surgery that combines medical science, robotics, and engineering. The first robots approved by the Food and Drug Administration (FDA) were the Da Vinci Surgical System and the ZEUS Robotic Surgical System, which have been improving over time. Through the decades, the equipment applied to RS had undergone a wide transformation as a response to the development of new techniques and facilities for the assembly and implementation of the own. RS has revolutionized the field of urology, enabling surgeons to perform complex procedures with greater precision and accuracy, and many other surgical specialties such as gynecology, general surgery, otolaryngology, cardiothoracic surgery, and neurosurgery. Several benefits, such as a better approach to the surgical site, a three-dimensional image that improves depth perception, and smaller scars, enhance range of motion, allowing the surgeon to conduct more complicated surgical operations, and reduced postoperative complications have made robotic-assisted surgery an increasingly popular approach. However, some points like the cost of surgical procedures, equipment-instrument, and maintenance are important aspects to consider. Machine learning will likely have a role to play in surgical training shortly through "automated performance metrics," where algorithms observe and "learn" individual surgeons' techniques, assess performance, and anticipate surgical outcomes with the potential to individualize surgical training and aid decision-making in real time.