Robot-assisted surgery has been increasingly adopted over traditional laparoscopic and open procedures. However, its application in neonates and infants remains limited. Restricted space, delicate tissues, and the need for special instruments complicate its use. This case report describes the application of robot-assisted surgery in an infant with focal congenital hyperinsulinism.

To address the lack of quality and safety evaluation criteria and the inconsistency of testing methods in the clinical application of laparoscopic surgical robots, this study developed a scientific and operable testing method system based on a four-dimensional framework of "device appearance and function-electrical safety-image quality-robotic arm and surgical instruments". By identifying risk points of 21 core indicators, such as leakage current and horizontal/vertical resolution, and referencing standards such as YY/T 1712-2021 to determine the testing principles, the testing tools, operation steps, and limit values for each indicator were clearly defined. Multi-center validation was conducted on seven devices of different brands in three institutions. The validation results showed that the operability of the testing methods across different devices exceeded 90%, and the qualification rate of indicators was over 77%, effectively identifying latent device quality deficiencies. This system addresses a critical gap in the applied quality evaluation of laparoscopic surgical robots, providing standardized tools for hospital acceptance, daily quality control, and health supervision, and promoting the industrialization of medical devices and the standardization of the industry.

Tissue adhesion and thermal injury remain major challenges in high-frequency electrosurgery because carbonized residues can accumulate on the electrode surface and reduce cutting stability. To address this issue, a coating-free bio-inspired electrosurgical knife was designed and fabricated from 316L stainless steel by selective laser melting. Inspired by loach-skin lubrication and anti-fouling characteristics, a porous-groove blade surface was designed for lubricant storage and transport. Inspired by crab-chela serrations, a micro-serrated cutting edge was introduced to reduce cutting resistance. Fluid-flow simulation showed that the porous-groove surface promoted lubricant retention and local recirculation, reducing near-wall resistance by up to 20.73%. Friction tests indicated that Dp = 350 μm and Lp = 800 μm produced the lowest lubricated friction coefficient of 0.362 among the tested porous-groove surfaces. Static cutting simulation and cutting-force tests confirmed that the micro-serrated edge reduced cutting resistance, with the lowest peak cutting force of approximately 0.605 N obtained at H1 = 300 μm. Powered electrosurgical tests showed that the sample with Dp = 350 μm, Lp = 800 μm, and H1 = 300 μm achieved the lowest apparent adhesion mass of 2.07 ± 0.67 mg, corresponding to a 61.5% reduction compared with the DT401 commercial smooth control electrode. The thermal damage areas on the upper and lateral tissue surfaces were reduced by 56.75% and 54.44%, respectively. These results demonstrate an effective engineering strategy for improving the anti-adhesion and thermal-safety performance of electrosurgical knives.

Cancer-related stigma significantly affects breast cancer survivors' quality of life and treatment outcomes. In Indonesia, survivors often face stigmatization, yet evidence on the influence of personal and psychosocial factors remains limited. This study aimed to identify factors associated with stigma among breast cancer survivors. A cross-sectional design was used to recruit 280 female survivors from a tertiary cancer center in Padang, West Sumatra. Data were collected using validated instruments: the Breast Cancer Stigma Assessment Scale (BCSAS), the Body Image Scale (BIS), and the Multidimensional Scale of Perceived Social Support (MSPSS). Guided by a conceptual framework, sociodemographic, clinical, and psychosocial variables were simultaneously entered into a multiple linear regression model. Backward elimination was applied. The analysis revealed that body image (β = -0.593, 95% CI [-1.726, -1.280]), social support (β = -0.258, 95% CI [-0.504, -0.248]), and age (β = -0.161, 95% CI [-0.401, -0.149]) were significantly associated with stigma, together explaining 62% of the variance (Adjusted R[2] = 0.620, p < 0.001). These findings highlight the crucial role of psychosocial factors in shaping stigma experiences. Healthcare providers should incorporate body image enhancement, social support strengthening, and age-sensitive approaches into comprehensive care plans to reduce stigma and improve survivor outcomes.

Minimally invasive cardiac surgery (MICS) has evolved significantly over the past two decades, shifting from conventional median sternotomy toward sternal-sparing approaches that offer reduced surgical trauma, lower complication rates, and faster patient recovery. As incision size has progressively decreased, the field has advanced toward totally endoscopic cardiac surgery (TECS), in which the entire intracardiac procedure is performed exclusively under thoracoscopic visualization. Despite growing adoption, the transition from direct-vision MICS to TECS remains technically demanding and operationally complex. Drawing on our institutional experience at Brigham and Women's Hospital, Harvard Medical School, and a review of the current literature, we provide a comprehensive overview of the key elements required to successfully build and sustain a TECS program. These include a working definition of totally endoscopic surgery, a proposed four-phase surgeon training pathway, simulation-based learning strategies, robotic credentialing, team-based training, technical instrumentation, scope management, patient selection criteria, procedural challenges, and postoperative outcomes. Both non-robotic and robotic-assisted endoscopic platforms are discussed. Large-scale evidence confirms that MICS and TECS achieve outcomes equivalent or superior to sternotomy, with low mortality and stroke rates, and significantly improved health-related quality of life. Notably, non-robotic TECS offers a scalable and cost-effective pathway that does not require an expert bedside assistant, can address multiple pathologies simultaneously, and is feasible across diverse healthcare settings. Emerging technologies-including articulated robotic instruments, artificial intelligence-enhanced imaging, and next-generation robotic platforms-are expected to further expand the reach and safety of fully endoscopic cardiac procedures.

Post-market safety evidence for energy-based surgical devices is fragmented. We characterized adverse-event signals in the FDA MAUDE database, validated them on a third (robotic) platform, and triangulated across regulatory and international sources. Medical Device Reports (2015-2025) under electrosurgical and ultrasonic product codes were analyzed with reporting odds ratios (RORs), stratified by specialty and procedure, with robustness checks. All reports under the robotic-system code were retrieved as a third-platform validation cohort. Signals were triangulated with FDA recalls, 510(k) clearances, the Health Canada and Australian TGA databases, exposure descriptors, and a retrospectively applied Poisson CUSUM feasibility analysis. Among 110,183 deduplicated reports (65.8% electrosurgical, 34.2% ultrasonic), electrosurgical devices showed an electrical-thermal fingerprint (burns ROR 3.84; electric shock ROR 15.34) and ultrasonic devices a mechanical-integrity fingerprint (foreign-body removal ROR 92.74), replicated directionally in Canada and Australia. The fingerprint localized to generator/monopolar components and varied by specialty and procedure. Within the robotic validation cohort, component-stratified analysis partly reproduced these signatures-robot-mounted monopolar instruments retained a burn signal, and robot-mounted ultrasonic instruments carried the highest injury-report share-while cross-platform, same-modality contrasts are reported strictly as report-composition (share-level) comparisons. Reporting artifacts (19.5% placeholder narratives; a 2025 robotic mass-reporting episode comprising 55.8% of the robotic cohort) left fingerprint RORs materially unchanged. A retrospectively applied CUSUM flagged the burn theme more than five years before the 2023-2024 Class I recalls, illustrating-without establishing prospective lead time-the potential of automated monitoring. Energy-modality failure-injury fingerprints were consistent across specialties, delivery platforms, three national databases, and regulatory actions. Automated, artifact-aware surveillance of vigilance databases is a promising complement to pre-market review and warrants prospective evaluation.

Background: Distal radioulnar joint (DRUJ) instability associated with forearm bone deformity is difficult to treat because residual osseous malalignment may impair forearm rotation even after triangular fibrocartilage complex (TFCC) reconstruction. This study evaluated the clinical usefulness of preoperative three-dimensional (3D) computer simulation and patient-matched instruments (PMIs) for corrective osteotomy in deformity-related DRUJ instability. Methods: Three patients with chronic DRUJ instability associated with forearm bone deformity underwent corrective osteotomy based on 3D computer simulation and PMI-assisted surgery. Preoperative simulation was used to determine osteotomy planes, correction angles, and postoperative forearm rotation. Patient-matched surgical guides and plates were manufactured according to the simulation. Corrective osteotomy was combined with TFCC repair or reconstruction. Clinical outcomes were evaluated based on pain, range of motion, grip strength, redislocation and Modified Mayo Wrist Score (MMWS). Results: Bone union was achieved in all patients within 6 months. Postoperative radiographs demonstrated correction of osseous deformity and reduction of the DRUJ. Forearm rotational limitation improved in all cases with fixed dislocation, and dynamic instability resolved in the remaining case. Wrist pain disappeared in all patients, and grip strength and MMWS improved without major complications. Conclusions: Preoperative 3D computer simulation and PMI-assisted corrective osteotomy enabled accurate restoration of osseous alignment and forearm rotation in deformity-related DRUJ instability. Combining corrective osteotomy with TFCC repair or reconstruction may provide stable and functional outcomes. Level of Evidence: Level IV (Therapeutic).

Arthroscopic procedures in the posterior compartment of the knee are technically demanding and present an inherent risk of iatrogenic neurovascular injury because of the close proximity of the popliteal neurovascular bundle. This technical note aims to enhance surgical safety by describing a series of modifications termed the "3D" technique. The technique integrates 3 simple, practical, and reproducible modifications that improve visualization and tunnel accuracy while minimizing the risk of complications using only standard arthroscopic instruments.