Robotic minimally invasive surgery is an important trend in the modern surgical techniques. The publish of Chinese Expert Consensus on Robotic Surgery for Colorectal Cancer (2015 Edition) has played an important role in the standardization, promotion and application of robotic colorectal cancer surgery. With the concept update and technological progress, robotic colorectal cancer surgery has been further developed. Based on this, on the basis of 2015 expert consensus, the Chinese Expert Consensus on Robotic Surgery for Colorectal Cancer (2020 Edition) is revised and published to supplement, update and improve the theoretical and technical system, so as to better guide clinical practice.

To evaluate the clinical efficacy and safety of robot-assisted retroperitoneal laparoscopic partial nephrectomy using the renal inversion method for tumors located in the dorsal renal hilum.

Clinical data of patients with tumors located in the dorsal renal hilum undergoing robot-assisted retroperitoneal laparoscopic partial nephrectomy using renal inversion method in our hospital from April 2017 to April 2018 were retrospectively analyzed. Surgical procedures and outcomes were summarized. A total of 21 cases were enrolled, including 17 male and 4 female, aged from 26 to 78 years old, (53±14) years old on average. All patients were diagnosed with solitary renal tumors with a diameter of (2.5-8.0) cm, (4.3±1.7) cm on average. The R.E.N.A.L. score ranged from 6 to 12, (9.4±1.5) on average. Patients were placed in a lateral position on the normal side. Intraoperatively, the peritoneum was incised along the fold or thin site (the line of Toldt). It reached the colonic hepatic flexure on the right side, and the trigonal ligament and hepatocolonic ligament were incised when necessary and up to the superior margin of the spleen on the left side, and the ligaments of spleen and kidney and those of spleen and colon were separated when necessary. It reached downwards to the lower pole of the kidney, letting the ascending and colonic liver flexures or the spleen and descending colon shift to the ventral midline. The adipose tissues of the upper and lower poles of the kidney were successively cut off to the blood vessels of the renal pedicle and the ureters, making the affected kidney easily or automatically shift to the ventral side. The tumors and renal hilus could be fully exposed. Conventional partial nephrectomy and suturing were performed.

All patients successfully completed the surgery without conversion to open or radical nephrectomy. The laparoscopic operation time was 30-140 min, (80±24) min on average. The intraoperative bleeding volume was 20-500 ml with an average volume of (104±115) ml. Twelve patients received autologous blood transfusion, and no case received allogeneic blood transfusion. The duration of renal warm ischemia was 8-34 min, (17±7) min on average. The average time of anal exhaust was 35 h after operation. Three patients were administered with analgesics. One case developed urinary fistula and was cured by indwelling double J-tube drainage. No postoperative complications such as abdominal organ injury, infection and secondary hemorrhage occurred. Pathological examination showed 15 cases of clear cell carcinoma, 4 cases of angiomyolipoma, 1 case of papillary carcinoma and 1 case of oncocytoma. No positive margin was detected in the malignant tumors. All patients were subject to postoperative follow-up for 6 to 18 months, with a median time of 12 months. No tumor recurrence or metastasis was observed in all patients.

Robot-assisted retroperitoneal laparoscopic partial nephrectomy using the renal inversion method can fully expose the tumors and blood vessels of patients with tumors in the dorsal renal hilum. It is an efficacious and safe procedure and simple to operate, which can reduce the surgical difficulty.

To present the application value of a three-station advanced model combining vitro model, virtual reality and practical operation together in the training of robot-assisted laparoscopic prostatectomy.

The first station: vitro model training. The trainees were asked to practice end to end anastomosis on vitro models, and were graded on both Test T and Test R evaluation criterion. The second station: robot virtual reality training. The virtual reality technology was used and several parameters were evaluated before and after training. The third station: The trainees and urologists in the control group performed robot-assisted vesicourethral anastomosis, and the reliability of the anastomosis was evaluated by bladder affusion test.

In the first station, the overall scores of six trainees were significantly improved [(50.0±10.5) vs (79.2±9.7), P=0.004] and the anastomosis time was also obviously shortened [(654.5±24.7) s vs (331.0±36.6) s, P<0.001]. The overall scores [(35.3±3.1) vs (86.0±4.2), P<0.001] and the anastomosis time [(345.5±31.2) s vs (170.0±7.4) s, P<0.001] of the trainees significantly improved in the second station as well. In the third station, all the 6 trainees successfully accomplished vesicourethral anastomosis under the guidance of superior doctors, and the average anastomosis time was shortened from (40.7±8.6) min to (27.5±8.4) min compared with the control group (P=0.023). In the bladder affusion test, no leakage was found in the trainee group, while leakage occurred in two cases in the control group, and remedial suture was performed by superior doctors.

The three-station advanced mode could shorten the learning curve of the robot-assisted laparoscopic prostatectomy, which is conducive to the promotion with limited robotic equipment in China.

To explore the clinical utilization value of fluorescent lymphnodes detection with Indocyanine Green (ICG) in robotic prostatectomy and pelvic lymphnode dissection.

In this study, from Jan. 2018 to Dec. 2018, 60 prostate cancer patients, 30 in fluorescence guided surgery group and 30 in control group, who underwent robotic prostatectomy in the First Hospital of Shanxi Medical University. And their clinical data were retrospectively analyzed. Among 30 patients with fluorescence guided surgery, the average age was (62±8) years, BMI was (22.8±1.4) kg/m², PSA level was (81.2±1.2) ng/dl, prostatic volume was(57.5±1.4) ml and 14(46.73%) patients with Gleason score ≤7. In the control group, the average age was (61±7) years, BMI was (22.7±1.3) kg/m², PSA level was (82.4±1.2) ng/dl, prostatic volume was (56.9±1.3) ml and 11(43.30%) patients with Gleason score ≤7. All parameters were comparable between the two groups. Patients in study group, before the prostatectomy, received endorectal ultrasound guided transperineal prostatic injection of ICG (5 mg). Firefly endoscopy were utilized during the fluorescent lymph nodes resection. Resected lymph tissue was marked, counted and sent to pathology. Intraoperative and postoperative data was collected, no significant differences were found in incidence of advert events and biochemical reccurence.

Among patients received endorectal ultrasound guided transperineal prostate ICG injection, one case had leakage. In all 30 patients, it was able to identify fluorescent prostatic capsule which were well distincted from adjacent structures. Fluorescence lymph node (FLN) packets were observed in all 30 patients and fluorescence guided resected tissue was pathologically confirmed lymph tissue. There were total 970 lymph nodes resected in both groups, 526(17.5/person) in study groups, which was significantly more than the control group 444(14.8/person). Total fluorescence rate in study group was 89.6%. Postoperative complications and incidence of reccurence was comparable.

Transperineal injection ICG induced fluorescence guided robotic assisted prostatectomy was proved stable and reliable in this study which could be used as guidance of surgical resection strategy.

To explore the urinary control and oncological prognosis of patients with a modified Robotic intracorporeal orthotopic ileal neobladder.

A group of 10 consecutive patients underwent robot-assisted radical cystectomy and orthotopic ileal neobladder surgery from May 2017 to June 2019, including 9 males and 1 female, average age was (63±11) years, 5 cases with very high risk non-muscle invasive bladder cancer (NMIBC), 5 cases with muscle invasive bladder cancer (MIBC). The postoperative follow-up time was 12-37 months. Record the video of the operation, complications within 90 days after the operation, the patient's urinary control recovery during the follow-up period, renal function, changes in the imaging structure of the upper urinary tract, and oncology prognosis.

All the 10 patients were completed successfully the robot assisted radical cystectomy and intracorporeal orthotopic ileal neobladder, the operation time was (584±56) min, the blood loss was (655±275) ml, and the postoperative feeding time was 1-3 days; 1 patient underwent incisional hernia repair 6 months after operation, and the rest had no grade III or above complications. Some patients underwent urodynamic examination within 6-12 months after surgery, the maximum urine flow rate and average urine flow rate at the last follow-up were (6.3±4.5) ml/s and 1.80(0.30) ml/s, respectively. The postoperative neobladder filling urine volume and residual urine volume were (525±273) ml and 161(227) ml respectively. There were 9 cases (90%) of complete urinary control during the day and 8 cases (80%) of night urinary control. During the follow-up, 4 sides of renal pelvis were slightly dilated, and the monitoring sub-renal eGFR was normal. One patient developed lung metastasis 18 months after surgery, while the remaining patients did not find local recurrence or metastasis.

Our "Teapot type" ileal orthotopic neobladder is a modified intracorporeal orthotopic ileal neobladder on the basis of Student type and VIP type ileal neobladder. The function of new bladder after operation is good, which can effectively protect the structure of upper urinary tract and restore urination function.

To summarize the nursing cooperation of robot assisted laparoscopic partial nephrectomy via transperitoneal and retroperitoneal approach.

The clinical data of 86 cases of robot assisted laparoscopic partial nephrectomy with transperitoneal approach and 128 caseswith retroperitoneal approach were analyzed retrospectively from Jan 2016 to Jan 2020. The time of position placement, nursing potential risk events, preparation time before installation, and doctor satisfaction were recorded in two approaches.

The operations were completed successfully in both groups, and no patient was transferred to open surgery. There were no statistically significant differences between the two groups in position placement time, incidence of nursing potential risk events, duration of renal hot ischemia, and doctor satisfaction (P>0.05). However, the differences in preparation time before installation and operation time were statistically significant (P<0.05) in two groups.

Robot-assisted laparoscopic partial nephrectomy via transperitoneal and retroperitoneal approach have their own characteristics and concerns. Preoperative evaluation and understanding of the surgical plan should be carried out. According to the surgical plan, positioning equipment, safety monitoring, complete intraoperative equipment, skilled coordination, and shortening the duration of renal artery occlusion can ensure the surgical effect.

To compare the perioperative safety and short-term efficacy between robot- and video-assisted thoracoscopic lung cancer surgery based on propensity scores matching.

The clinical data were from 286 patients with primary lung cancer undergoing lobectomy or sublobectomy and lymph node dissection or sampling in the Department of Thoracic Surgery, Qilu Hospital of Shandong University from August 2020 to October 2020. Among them, 130 cases underwent Da Vinci robot-assisted thoracic surgery (RATS) , while 156 cases underwent video-assisted thoracic surgery (VATS) . The perioperative data were compared after controlling confounding factors by propensity score matching.

Eighty-eight cases in each group were successfully matched by propensity score matching analysis. The operational time of the RATS group was slightly longer than that of the VATS group , the difference was not statistically significant (P=0.625) . The intraoperative blood loss in the RATS group was less than that in the VATS group (P<0.001) . The number of lymph node dissection stations (P<0.001) and the number of lymph node dissections (P=0.031) in the RATS group were higher. In terms of hospitalization expenses, the RATS group was higher than that compared with the VATS group (P<0.001) . There was a statistically significant difference in the results of the NRS score after operation (P<0.001) , and the NRS score was higher. There were no statistically significant differences in lymph node ascending rate, time of drainage, drainage, hospital stay after operation, and postoperative complications (P>0.05) .

RATS has similar perioperative safety and short-term efficacy to VATS in resectable lung cancer. RATS has advantages in intraoperative blood loss and lymph node dissection. The disadvantage is the increased hospitalization cost and postoperative pain.

To discuss the feasibility, safety and practicability of da Vinci robot-assisted para-aortic lymphadenectomy in cervical cancer surgical staging.And analysis the risk factors of para-aortic lymph node metastasis.

A retrospective analysis was made on the clinical data of 60 cases of stage ⅢC1r cervical squamous cell carcinoma patients in the gynecologic oncology center of the Chongqing University from Mar. to Jul. 2020 who undergoing para-aortic lymphadenectomy. 25 cases undergoing robot para-aortic lymphadenectomy(robot group)and 35 cases undergoing laparoscopic para-aortic lymphadenectomy(laparoscopic group).

The operation time were(97.60±5.440)min and(168.00±12.394)min, the operation blood loss were(5.88±2.023)ml and(111.70±13.186)ml, the removed lymph nodes numbers were(8.32±1.545)and(7.37±0.897), the time to start radiation and chemotherapy after surgery were(11.08±0.812)d and(13.20±0.711)d, the surgical complication rate were 4.0%, 8.5% in robot group and laparoscopic group.The operation time and the operation blood loss, the differenct was statistically significant(P<0.05). Univariate analysis showed that the clinical stage was associated with para-aortic lymph node metastasis, and the higher the stage, the greater the risk of lymph node metastasis(χ²=11.295, P<0.05).

There are advantages to robot-assisted para-aortic lymphadenectomy for cervical cancer surgical staging. Patients have less bleeding, short operation time, rapid recovery.The higher the clinical stages of cervical cancer, the greater the risk of lymph node metastasis.Surgical staging has clinical significance and provides a basis for the follow-up precise radiotherapy.

To summarize the experience of robot assisted in situ resection of intraductal papillary mucinous adenoma of the pancreas combined with main pancreatic duct bridging.

The clinical data of patients who underwent in situ resection of pancreatic intraductal papillary mucinous adenoma combined with main pancreatic duct bridge repair in May 2020 in the Department of Hepatobiliary Pancreatic surgery, General Hospital of Chinese PLA were retrospectively analyzed.

The patient successfully completed the operation. The operation time was 135 minutes under the microscope, and the blood loss was about 50 ml. the drainage tube was discharged 6 days after the operation, and the drainage tube was removed about 18 days after the operation. Intraductal papillary myxoma with low grade intraepithelial neoplasia was considered pathologically.

In situ resection combined with main pancreatic duct bridge repair is a new surgical method and surgical concept. While protecting the functional organs, more attention should be paid to the protection of physiological and anatomical integrity. Through the main pancreatic duct bridge repair as the core technology of pancreatic plastic repair, the normal anatomical structure of human body can be reduced, and the quality of life of patients can be significantly improved.

To explore the feasibility of using indocyanine green(ICG) visualizing the deep infiltrating endometriosis (DIE) during robotic surgery.

A patient with DIE in Department of Genecology and Obstetrics, Chinese PLA General Hospital was selected and underwent total hysterectomy with bilateral adnexectomy and endometriosis lesion excision with perfect preoperative examination and no surgical contraindication. Near-infrared fluorescence imaging with indocyanine green was used in the operation to visualize the endometriosis lesions.

The location of the lesions were accurate and the patient discharged from hospital successfully.

Near-infrared fluorescence imaging system with indocyanine green may clearly visualize the deep infiltrating endometriosis during robotic surgery. It is characterized by brief operation, accuracy and real time. With this technique, we can comprehensively evaluate the scope of our surgery.

To report the experience of pretreatment-facilitated robot intrathoracic layered anastomosis (PRILA) .

Patients with esophageal cancer proved by biopsy and willing to accept robot-assisted minimally invasive esophagectomy (RAMIE) were included in this study. The pretreatments before anastomosis included the following procedures. Firstly, we used the sternal angle as a marker to confirm the length of the gastric conduit so that we could construct the conduit outside the body. Secondly, cold scissors, rather than the electrocoagulation equipment, were used in making the gastrostomy. Thirdly, the gastric conduit was carefully packaged with single-layered gauze before we move it into the thoracic cavity. Lastly, an intrathoracic clamp was placed on the proximal esophageal stump to reduce the bleeding of the stump. An interview was performed every half-year after the surgery to track the postoperative outcomes.

Between September 2018 and July 2019, 12 patients with esophageal cancer received PRILA for tumor resection and digestive tract reconstruction. All the patients achieved R0 resection, and no patient suffered from an anastomotic leakage. The mean length of postoperative stay was 9.9 day. All patients could receive semiliquid diet when discharged. No relapse or metastasis happened in the first year after the surgery.

PRILA is a safe and feasible procedure with favorable surgical outcomes. The pretreatment procedures provide us a clean surgical field so that the anastomosis could be performed fluently and accurately. It provides surgeons a new strategy to handle the challenges of the intrathoracic robotic anastomosis.

To explore the feasibility of "double-U" three-step pancreaticojejunostomy (PJ) in robot pancreaticoduodenectomy (RPD).

The clincal data of 28 patients who underwent RPD from June 2017 to June 2019 were analyzed retrospectively, and the intraoperative conditions and postoperative complications were analyzed.

All of 28 patients received successful operation. The anastomosis time of "double-U" three-step method ranged from 17 to 35 min, with an average of 23.5 min. The intraoperative blood loss ranged from 50 to 600 ml, with an average of 178.3 ml. Postoperative complications occurred in 5 patients, of which 3 (8.6%) had postoperative pancreatic fistula(POPF) with grade B, which were cured after inhibition of pancreatic juice secretion, prolongation of abdominal drainage time and nutritional support treatment. Two patients developed delayed gastric emptying and were discharged after conservative treatment. The average postoperative hospital stay was 13.9 days (3~63 days), and there was no death during hospitalization.

The "double-U" three-step PJ method is easy to operate, convenient for learning, safe and reliable for ensuring anastomosis quality, with faster recovery and potential wider clinical application. It has certain advantages in reducing complications such as POPF.