中国国内手术机器人的发展前景及展望

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Artificial intelligence (AI), first proposed by Prof. John McCarthy in 1956, aims to reproduce human intelligence using computers. Machine learning (ML) is a form of AI that uses computational algorithms that learn and improve with experience.[1] The two main forms of ML are supervised and unsupervised. In supervised ML, algorithms are given labeled data, which is used to predict disease outcomes in a new patient. In contrast, unsupervised ML is used to identify patterns without training; the algorithm learns the inherent structure of the data by searching for common characteristics.[1] AI has gained tremendous popularity in recent years, and some AI techniques such as search engines, voice recognition software, and autonomous driving vehicles are now part of our daily lives. AI research is also being conducted in many medical fields, and shows great promise in promoting practice efficacy, personalizing patient management, and improving research capacity.[2,3] We aimed to outline the current applications and the future perspective of AI in orthopedics. AI techniques have made great improvements in every step of the medical imaging pathway, from acquisition and reconstruction to analysis and interpretation.[4] By incorporating information from the patient's medical records (including symptoms, laboratory results, and physical examination findings), AI identifies the most appropriate patient-specific imaging examination and determines the most appropriate protocol.[5] AI can also potentially increase the speed of magnetic resonance imaging (MRI) data acquisition and decrease the computed tomography (CT) radiation dose.[6] The most popular area of AI research is image interpretation. Rather than replacement of the radiologist, the use of AI helps the radiologist to improve the diagnostic accuracy and prevent errors and observer fatigue. AI algorithms have been applied to various conditions, including the diagnosis of fractures, osteoarthritis, bone age, and bone strength.[4] AI performs as well as or better than orthopedic surgeons in detecting fractures of the proximal humerus, hand, wrist, ankle, and vertebral compression fractures on radiographs.[4,7] AI also has potential applications in the automatic detection of hip or knee osteoarthritis on radiography, with performance comparable to that of an attending radiologist.[8] AI can help automate the grading of lumbar disc pathology on MRI using various classification systems, with an accuracy of 95.6% for disc detection and labeling.[9] Furthermore, AI improves the accuracy of bone age interpretation compared with aging done by a radiologist alone; however, the most accurate values are achieved when AI is used in combination with a radiologist.[10] AI also improves quantitative image analysis by allowing automatic segmentation of the area of interest, and many studies have focused on knee cartilage segmentation, with promising initial results.[11] However, whilst AI-assisted image interpretation can be accurate, it does require large training datasets, which may be costly and attenuate service inequality. With ongoing technological advances, AI in imaging will improve and become more widely applied. Another major potential use for AI in healthcare is in predicting the clinical outcome of patients based on a clinical dataset, genomic information, and medical images. Risk assessment and outcome prediction have always been challenging in clinical medicine. AI offers a new direction that could potentially overcome these challenges. In orthopedics, ML can be used to guide the management of patients by providing a patient-specific predicted rate of post-operative complications following lumbar fusion surgery.[12] In addition, visual and inertial sensor data can be analyzed by ML to predict injury risk patterns associated with dynamic knee valgus.[3] The AI technique can help the doctor to make a diagnosis or decision. In the United States, the IBM Watson Health cognitive computing system (IBM Corp., Armonk, NY, USA) has used ML approaches to create a decision support system for the treatment of cancer, with the intention of improving diagnostic accuracy and reducing costs using large case volumes. Clinical decision support systems also provide recommendations on the diagnosis and treatment of low back pain[13]; these systems can classify subjects, and further progress could enable the combination of AI plus clinician to make more rigorous classifications than human decision-making alone. Thus, AI may enable more accurate allocation to services in the future, whilst increasing the accessibility and speed of self-referral. Orthopedic surgery began to incorporate robotic technology in 1992, with the introduction of the ROBODOC system for the planning and performance of total hip replacement.[14] Substantial progression has been made in the use of robots in the past few years. Most orthopedic robots, such as the Mako system, are used for joint replacements such as unilateral knee arthroplasty, total knee arthroplasty, and total hip arthroplasty.[2] A study has shown that the robots are superior to the conventional technique in achieving limb alignment and reducing operation time and blood loss. Most studies about spine surgery have evaluated the Renaissance robot and the Rosa robot.[15] Several studies have proven that the robots have the advantages of improved pedicle screw accuracy and reduced radiation exposure for patients and clinical staff compared with conventional surgery.[16] However, robotic surgery has low cost-effectiveness and fewer indications, which may limit its widespread clinical application. In 2016, we presented the TianJi Robot, which is a multi-indication orthopedic surgical robot that can be used for all levels of spinal instrumentation and pelvic, acetabular, and limb fracture surgeries.[17–19] The TianJi robot combines a robotic arm with a real-time navigation system and has a high degree of surgical precision. Compared with freehand surgery, the TianJi robot significantly improves the accuracy of instrument placement and improves the clinical results.[17] In July 2019, Prof. Wei Tian performed the world's first multi-center the 5th generation (5G) remote orthopedic surgery using 5G technology. The combination of 5G technology and robotic technology improves the safety and quality of remote surgery, and maybe the future of remote surgery. AI has revolutionized the face of modern orthopedic surgery, but at present, its use is neither universal nor perfect. The limitations of AI are existing. First, the use of AI is limited by the high capital cost, the time needed for its use (both in preparation and intra-operatively), the variable reliability of AI technologies, and the absence of long-term follow-up studies. Therefore, the cost and time of the AI technique needs to be decreased, and more long-term studies are required. Second, there are ethical considerations regarding the use of ML in orthopedic surgery. Working with bulk datasets increases the risks of breaching patient confidentiality and consent unless safeguards are in place, especially where conflicts exist between patient and commercial interests. Furthermore, in cases of misdiagnosis or maloperation, it is unclear whether the doctor or the robot should be held responsible. Thus, it is important that ML is meticulously studied, managed, and appropriately validated. Third, to date, surgical robots and the AI technique can only be used to perform relatively simple procedures, and possess little autonomy and decision-making authority in treatment; these limitations have caused some people to question the usefulness of AI. However, scientists and engineers are making substantial advancements in AI-assisted procedures from non-autonomic robot assistance to task-autonomy or conditional autonomy and, eventually, full automation. Self-learning machines will be able to directly perform independent tasks in the future. However, there may be circumstances where human clinicians are unable to control or override these procedures made by an AI device. Finally, as AI is a new and emerging field in medicine, patient interests may be at risk due to technological advances invariably preceding proper governance and patient-protective legislation. Despite its pitfalls and potential shortcomings, ML provides a unique ability to create meaningful change. Funding This study was supported by the grants from the National Natural Science Foundation of China (No. U1713221), the Beijing Natural Science Foundation (No. Z170001) and Beijing Hospitals Authority Youth Programme (No. QML20170404). Conflicts of interest None.

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As an important branch of medical robots, surgical robots have attracted the attention of studies in China and abroad, and these studies also have carried out many explorations and researches on them. Based on the current research results, this paper summarizes the development status of surgical robots and the development history of four surgical robots which are neurosurgery surgical robots, orthopedic surgical robots, endoscopic surgical robots and vascular intrusive surgical robots. From three aspects which include the structure design, the virtual simulation system and the control factor of the four surgical robots, this paper analyzes the key technology of surgical robots and finally predict and prospect the future development of the surgical robots.

In orthopedic surgery, the accuracy of internal fixation is related to the success of the procedure. In the past, orthopedic surgeons usually placed screws freehand according to anatomical landmarks or fluoroscopy images. Although there are many surgical techniques for inserting screws freehand, the accuracy of freehand screw placement is not high enough, and the results can be unstable. The accuracy of freehand screw placement reported in the literature varies greatly. Particularly in the spine, with its unique anatomy and important adjacent tissues, inaccurate screw placement may lead to serious complications, such as nerve or vessel injury, cerebrospinal fluid leakage, thoracic or abdominal organ injury, and segment instability. Surgeons must undergo extensive professional training and accumulate in-depth surgical experience to reduce the incidence of inaccurate screw placement. Screw fixation usually requires percutaneous access to the bone, followed by insertion of catheters, guidewires, and screw cannulas. Thanks to developments in X-ray and computed tomography (CT) technology, surgeons can delicately plan the path of percutaneous access using personalized preoperative images and three-dimensional (3D) reconstruction images, avoid important tissue features, such as nerves and blood vessels, and select the most appropriate percutaneous entrance and access angle. However, it is difficult to translate well-designed percutaneous access on the image to the actual patient. Additionally, in the absence of a guidance device, percutaneous access established by manual operation will inevitably deviate from the planned path. The limitations of human hands (manipulation) and eyes (positioning) have become increasingly apparent. The limitations of orthopedic surgery are that surgeons cannot see deep structures and cannot directly transfer the preoperative plan to the operation. Additionally, surgeons' hand stability may be insufficient in some sophisticated procedures. Because the clinical use of orthopedic surgical robots requires precise and stable positioning, soft tissue surgical robots, such as the Da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), are unsuitable for use as orthopedic surgical robots. To improve the accuracy of orthopedic surgery, clinicians and researchers have jointly developed a variety of robotic systems. [1] Many robotic systems for orthopedic surgery, such as Renaissance, ROSA Spine, and MAKO, have been used clinically. Robot-assisted orthopedic surgery can improve the accuracy of implant placement and promote computer-assisted minimally invasive surgery; [1] however, these systems also have inherent limitations. Research on orthopedic surgical robots has focused on using robots for a single indication, but not for multiple indications. Additionally, most robots are registered by preoperative CT or intraoperative two-dimensional (2D) fluoroscopy images, but not by intraoperative 3D reconstruction images. During surgery, it is difficult to translate the percutaneous access designed on the image to the patient without intraoperative 3D reconstruction images. Therefore, our work was focused on developing a solution for robot-assisted orthopedic surgery and creating an orthopedic surgical robot system for multiple indications. Here, we describe how our key technologies are applied to our orthopedic surgical robot. Our goal was to build a robotic solution to provide real-time positioning and posture guidance to help surgeons establish percutaneous screw trajectories. The robot determines the planned percutaneous trajectory, places the guide device on the corresponding position on the patient, and holds the device steady. Key operations, such as puncturing, drilling, and screw placement, are manually completed by the surgeon under the guidance of the device. Similar studies have evaluated surgical positioning systems; however, the clinical practicability and versatility of the system are important factors to consider. To achieve these goals, we developed an optical navigation surgical robot system. The operation planning software is specifically designed to adapt to X-ray, cone-beam CT, and other imaging modalities. A custom-designed robot navigation ruler and registration method are used to unify the medical image space and the robot workspace. The motion control strategy of the robot arm is divided into two stages, human–robot cooperation and robot autonomous motion, in which the robot arm can interact safely in the operation room and accurately locate the planned percutaneous access. The robot's end effector, i.e., the guide device, is specifically designed to adapt to different surgical instruments, such as a puncture needle or a bone drill. The surgical robot system consists of an assist-positioning robot arm, an optical navigation unit, and a surgery planning workstation, which are placed on three trolleys with brake casters [Figure 1].Figure 1: The surgical robot system and navigation scheme.To adapt to orthopedic surgery for all parts of the body and different percutaneous access angles, the robot arm has a large working space and flexible working postures. A serial configuration robot arm is used in our system, which has a full length of 850 mm and six degrees of freedom (DOF), with each DOF rotatable to ± 360°. With our specially designed end effectors for various surgical instruments, the robot can be used in orthopedic surgeries for the entire spine, from the cervical spine to the sacrum, as well as in a variety of trauma and joint surgeries. The motion control of the robot arm is achieved by sending the desired pose from the controller, and the clinical positioning accuracy is less than 1 mm. The optical navigation unit is composed of an optical tracker (NDI Polaris Spectra, Waterloo, ON, Canada) and two passive marker brackets. Four infrared reflective balls on each bracket are used to detect and obtain the position and attitude of the rigid body connected to the bracket. One bracket is fixed near the surgical site of the patient, and another is fixed on the flange of the robot's end effector. The typical space layout of the surgical robot system is shown in previous reports. [2] The surgery planning workstation contains a computer equipped with surgery planning software. The patient's intra-operative real-time medical images are transmitted to the computer. Combined with the percutaneous access planned by the surgeons, the expected posture of the robot arm is automatically calculated and sent for execution. In clinical surgery, the calibrator held by the robotic arm is placed just over the skin, as close as possible to the operating area. A set of intraoperative 3D radiographic images is acquired by the C-arm scanner and then transferred to the workstation. Screw trajectory planning is performed by the surgeon, and then the robotic arm moves toward the planned direction of the screw. Guidewires are inserted through the cannula on the robotic arm, which allows for real-time monitoring and adjustment; screws are inserted along the guidewires, and the screw positions are confirmed according to 3D images. The developed system is now being manufactured for commercial use. Hundreds of these orthopedic surgical robots have been deployed across China, and more than 30,000 orthopedic operations have been performed. The orthopedic surgical robot system makes full use of visual image guidance, and it combines the accuracy and stability of robotic surgery with the experienced decision-making ability of surgeons, which greatly improves the accuracy, safety, standardization, operation efficiency, and treatment effect of minimally invasive orthopedic surgery. Numerous clinical studies have confirmed the accuracy and safety of this robot system. Han et al[3] found that 95.3% of 532 thoracolumbar screws were placed perfectly in robot-assisted spinal surgery. Fan et al[4] found that 94.9% of 390 screws were placed acceptably in the cervical vertebrae. In a study by Wang et al, [5] the accuracy of robot-assisted percutaneous sacroiliac screw placement was found to be superior to that of the freehand technique. He et al[6] reported that robot-assisted placement of femoral neck cannulated screws can significantly reduce the duration of intraoperative fluoroscopy, drilling attempts, and operation. Guo et al[7] showed that robot-assisted scaphoid screw fixation improved implantation accuracy and shortened radiation exposure in a randomized controlled trial. In summary, we proposed a robotic solution for multiple orthopedic surgeries and developed a surgical robot system. The robot we studied can be applied to all segments of the spine (cervical spine to the sacrum) and can significantly improve the positioning accuracy of minimally invasive spinal surgery, while also avoiding the physiological shaking of the human hand, with highly repeatable results. Owing to its advantages of precise positioning, stability, and repeatability, robot-assisted spinal surgery can improve the results of clinical surgery. Funding This study was supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (CIFMS) (No. 2021-I2M-5-007), Beijing Natural Science Foundation (No. L212062), Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support (No. 202109), and Beijing Jishuitan Hospital Youth Talent Training Project (No. XKXX202104). Conflicts of interest None.

Robot-assisted surgery has transformed the landscape of genitourinary cancer treatment, offering enhanced precision, reduced morbidity, and improved recovery compared to open or conventional laparoscopic approaches. As the field matures, a new generation of technological innovations is redefining the boundaries of what robotic systems can achieve. This narrative review explores the integration of artificial intelligence, advanced imaging modalities, augmented reality, and connectivity in robotic urologic oncology. The applications of machine learning in surgical skill evaluation and postoperative outcome predictions are discussed, along with AI-enhanced haptic feedback systems that compensate for the lack of tactile sensation. The role of 3D virtual modeling, intraoperative augmented reality, and fluorescence-guided surgery in improving surgical planning and precision is examined for both kidney and prostate procedures. Emerging tools for real-time tissue recognition, including confocal microscopy and Raman spectroscopy, are evaluated for their potential to optimize margin assessment. This review also addresses the shift toward single-port systems and the rise of telesurgery enabled by 5G connectivity, highlighting global efforts to expand expert surgical care across geographic barriers. Collectively, these innovations represent a paradigm shift in robot-assisted urologic oncology, with the potential to enhance functional outcomes, surgical safety, and access to high-quality care.

To report the first experience of performing the single-port robotic-assisted hepatic caudate lobectomy via the da Vinci SP® surgical system and demonstrate the safety and technical feasibility of this platform. A 30-year-old female patient with diagnosis of hepatic hemangioma underwent single-port robotic-assisted caudate lobectomy using the da Vinci SP® system at the Chinese People's Liberation Army (PLA) General Hospital on January 20, 2022. The clinical data, preoperative preparations, surgical procedures, and postoperative recovery of this patient were summarized. The patient underwent single-port robotic-assisted hepatic caudate lobectomy successfully. The intraperitoneal operation time was 97 minutes, and the estimated blood loss was 20 ml. No significant intraoperative complications were observed. The Visual Analogue Scale (VAS) pain intensity score was 3/10 in the immediate postoperative period and 1/10 on postoperative day one. The patient was discharged on postoperative day 2. Herein, we report the first case of single-port robotic-assisted caudate lobectomy using da Vinci SP® system, and this operation in complicated hepatectomy is technically safe and feasible. The present case indicated that the single-port robotic-assisted surgery is expected to further improve the application prospect of single-port surgery.

The da Vinci SP® surgical system offers improvements and refinements for the robotic single-site procedures. Here, we report the first case performing the single-port robotic-assisted left lateral sectionectomy (LLS) for hepatic tumor using the da Vinci SP® surgical system, and demonstrate the safety and technical feasibility of this platform. A 69-year-old female patient with hepatic tumor underwent single-port robotic-assisted LLS using the da Vinci SP® system at the Chinese People's Liberation Army (PLA) General Hospital on December 27, 2021. And the clinical data, preoperative preparations, surgical procedures, and postoperative recovery of this patients were summarized. The patient with hepatic tumor underwent successful single-port robotic-assisted LLS. The intraperitoneal operation time was 49 minutes and the estimated blood loss was 10 ml. No significant intraoperative complications were observed. The Visual Analogue Scale (VAS) pain intensity score was 3/10 in the immediate postoperative period and 1/10 on postoperative day one. The patient was discharged on postoperative day four. Herein, we report the first case of single-port robotic-assisted LLS for hepatic tumor using da Vinci SP® system, and this operation is technically safe and feasible. The present case indicated that the single-port robotic-assisted surgery is expected to further improve the application prospect of single-port surgery.

<p indent="0mm">With the developments of medical artificial intelligence (AI), meta-data analysis, intelligence-aided drug design and discovery, surgical robots and image-navigated precision treatments, intelligent medicine (IM) as a new era evolved from ancient medicine and biomedical medicine, has become an emerging topic and important criteria for clinical applications. It is fully characterized by fundamental research-driven, new-generation technique-directed as well as state-of-the-art paradigms for advanced disease diagnosis and therapy leading to an even broader future of modern medicine. As a fundamental subject and also a practice-oriented field, intelligent medicine is highly trans-disciplinary and cross-developed, which has emerged the knowledge of modern medicine, basic sciences and engineering. Basically, intelligent medicine has three domains of intelligent biomaterials, intelligent devices and intelligent techniques. Intelligent biomaterials derive from traditional biomedical materials, and currently are endowed with multiple functionalities for medical uses. For example, micro-/nanorobots, smart responsive biomaterials and digital drugs are representative intelligent biomaterials which have been already commercialized and applied to clinical uses. Intelligent devices, such as surgical robots, rehabilitation robots and medical powered exoskeleton, are an important majority in the family of intelligent medicine. Intelligent biomaterials and intelligent devices are more and more closely integrated with each other especially on the occasions of intelligence acquisition, remote transmission, AI-aided analysis and management. In comparison, intelligent techniques are internalized in the former two domains and are playing a critical role in the development of intelligent medicine. Representative intelligent techniques of telemedicine, image-navigated surgery, virtual/augmented reality and AI-assisted image analysis for early-stage disease assessments have been employed in nowadays clinical operations which to a large extent relieved medical labors. In the past decades, China has been in the leading groups compared to international colleagues in the arena of intelligent medicine, and a series of eminent research has been clinically translated for practical uses in China. For instance, the first 5G-aided remote surgery has been realized in Fujian Province in January 2019, which for the first time validated their applicability for human uses. The surgical robots have found China as the most vigorous market, and more than 10 famous Chinese companies are developing versatile surgical robots for both Chinese people and people all over the world. China also applied AI techniques to new drug developments especially in early 2020 when COVID-19 epidemic roared, and several active molecules and drug motifs have been discovered for early-stage COVID-19 screening and treatments. Based on the significance of intelligent medicine and its rapid developments in both basic research and industrials, this review summarized the comprehensive viewpoints of the Y6 Xiangshan Science Conferences titled with Fundamental Principles and Key Technologies of Intelligent Medicine, and gave an in-depth discussion on main perspectives of future developments of the integration of biomaterial and devices, the integration of bioinformatics and medical hardware, and the synergy of biotechnology and intelligence information. It is expected that this featuring article will further promote intelligent medicine to an even broader community not only for scientists but also for industrials, and in the long run embrace a perspective future for its blooming and rich contributions in China in the coming <sc>5 years.</sc>

This paper introduces the applications of Computer Assisted Orthopaedic Surgery (CAOS), including pre-operative planner, surgical simulator, intra-operative navigation systems and medical robotics. Basic principals of surgical navigation are also discussed. In view of the high precision requirement for navigation assisted procedures, there exists a definite need for development of medical robotics to carry out these procedures. We have a brief review on the different robot systems and present the surgical navigation arm developed in the Chinese University of Hong Kong. The laboratory test results of navigation guided distal targeting of intramedullary nail with or without surgical navigation arm showed the better repeatability and precision when the robot arm was used. So far the surgical navigation arm has been successfully applied in clinical practice, including distal targeting of intramedullary nailing; percutaneous sacro-iliac screw and percutaneous trans-iliac screw in pelvic fractures and hip screw fixation for fracture of femoral neck. To conclude, medical robotics is an essential component of the future CAOS.

Surgical robots have been widely used in surgery. Currently, the da Vinci Surgical System (Intuitive Surgery, Inc., Sunnyvale, CA, USA) is the most common robotic system used in the clinical setting. This system has proven useful for lesions in occult positions, such as tumors at the base of the tongue, ranulas, and submandibular lithiases. It is less traumatic compared to traditional open surgical procedures; however, its suitability for punctures remains debatable. Remebot (Beijing Baihui Weikang Technology Co., Ltd.; Beijing, China) is a surgical robot that is currently being used for neurosurgical procedures. Based on the intra-operational navigation, it can aid the surgeon with both the direction and depth of puncture, simultaneously. Although it can reportedly achieve an accuracy of 1.330 ± 0.566 mm[1] in biopsy operations, the same has not been reported in the field of oral and maxillofacial surgery. Therefore, in order to verify the feasibility of using a robot in oral and maxillofacial surgery, we chose to puncture the foramen ovale (FO) and foramina stylomastoideum (FS) in the present study. The FO is located in the large wing (near the body) of the sphenoid bone, in front of the spinous foramen, and posterolateral to the foramen rotundum. The mandibular nerve exits the FO and enters the infratemporal fossa. In the clinical setting, the treatment of trigeminal neuralgia often involves a percutaneous puncture of the FO. However, it is difficult to successfully puncture the FO in a single attempt because of its location deep within the human body; moreover, the puncture path faces obstruction from the upper and lower jaws, thereby reducing the actual effective puncture angle. The FS is located on the lateral side of the skull base, between the styloid process and the mastoid process of the temporal bone and behind the root of the styloid process. It acts as the external opening of the facial nerve canal and extends vertically upward to join with the canal. Adenoid cystic carcinoma of the parotid gland can easily develop inside the FS along the facial nerve owing to its neurophilic and fast-growing nature. However, it is sensitive to radiotherapy; brachytherapy seeds implanted into the FS can control tumor progression. Only a few studies have reported the use of a robotic system in the maxillofacial region. Thus, this study aimed to verify the accuracy and feasibility of the application of Remebot in the field of oral and maxillofacial surgery by puncturing the FO and FS. The following materials were used in this study: Remebot, Kirschner wire, and 11 cadaveric heads fixed in 10% buffered formalin. All specimens were from voluntary donation and obtained by Department of Anatomy of Peking Union Medical College. The study protocol was approved by the Institutional Review Board of General Hospital of the People Liberation Army (No. S2018-281-02). The surface of each cadaveric head was cleaned before the surgery. Three fiducial markers containing ceramic balls were pasted onto the frontal and bilateral temporal regions of a cadaveric head. Owing to difficulties in pasting the markers, bone nail markers were used for the remaining specimens. It is important to note that the three points should not be collinear and four points should not be coplanar while placing the markers. The specimen was placed in a supine position. Subsequently, pre-operative volumetric thin-layer computed tomography (CT) scanning of the cadaveric head was performed. Each head was placed in a holder to fix its spatial position. Digital Imaging and Communications in Medicine data were imported to the Remebot-dedicated software and reconstructed. The FO and FS were identified on the base of the skull. The trajectories for bilateral percutaneous puncture of the FO and FS were planned on different views using 3D reconstructed objects. The Hartel anterior approach was used as a reference to design the pathway for the percutaneous puncture of the FO. After the registration of the data, the robotic arm was made to pre-demonstrate the operating path to ensure no obstruction during the procedure [Figure 1A]. During the operative phase, the robotic arm moved to the pre-determined path with an accurate orientation toward the trajectory. The movement could be controlled by the surgeon using three available modes (point-to-point, axial, and free). An optimal-sized Kirschner wire was selected for use during the percutaneous puncture under the guidance of the robotic arm [Figure 1B]. The default puncture depth of the robotic arm was set at 15 cm; hence, the same measurement was used to mark the depth on the Kirschner wire. When the needle was punctured to the pre-determined depth, the split-type manipulator was detached, and the Kirschner wire was left in place. The same method was repeated for the contralateral puncture.Figure 1: Illustration of image-guided, surgical robot-assisted percutaneous puncture of the FO and FS. (A) The layout of robotic arm, a computer, an optical pose tracker, mobile trolley, and specimen. (B) Under the guidance of the robotic arm, the doctor punctured the needle in the direction and depth indicated. (C) Post-operative CT showed the needle had been punctured into FS successfully. (D) Post-operative CT showed the needle had been punctured into FO successfully. CT: Computed tomography; FO: Foramen ovale; FS, Foramina stylomastoideum.The split-type end of the robotic arm was designed to retain the Kirschner wire in place after the puncture. CT scans were taken after completing the percutaneous punctures on both sides and the images were imported into a professional software program to determine the puncture points in the reconstructed objects [Figure 1C, D]. The location errors were calculated by comparing the preoperative plan with the post-actual puncture point. The Euclidean distances between the centers of the FO and FS and the tip of the needle were measured in the IBM SPSS 20 software (IBM Corp., Armonk, NY, USA). Paired t test can be used for investigate the difference of the puncture results between two sides. Twenty-two sides were successfully punctured in the FO. The average accuracy of the FO puncture of left side and right side were 1.49 ± 0.51 mm and 1.31 ± 0.61 mm, respectively (P = 0.445). The errors of the puncture skin point of left side and right side were, respectively, 1.35 ± 0.83 mm and 1.86 ± 0.80 mm (P = 0.230). After preoperative scanning, three of 11 specimens were found to have been destroyed in petrous part and tympanic part of temporal bone. Thus, a total of 16 sides of stylomastoid foramen puncture were performed. The accuracy of the FS puncture target of left side and right side were, respectively, 1.35 ± 0.87 mm and 1.77 ± 1.13 mm (P = 0.105). According to the above three results, there was no significant difference between two sides. Clinically, we attempt to implant the brachytherapy seeds into the facial nerve canal for the limitation of tumor growth. The diameter of the FS decreases from the root of the styloid process to the cranial side on the thin-layer CT. It traverses up vertically into the facial canal and gradually narrows in width. Therefore, it is difficult to puncture the FS in a single attempt. The FO transmits the mandibular division of the trigeminal nerve, the accessory meningeal artery, and the emissary veins between the cavernous sinuses and the pterygoid plexus. The average length and width of the FO are 6.4 and 3.2 mm, respectively.[2] The maximum longitudinal diameter of the FO is the most important factor that contributes to the difficulties during puncture. Currently, the Hartel anterior approach is the most commonly used method to access the FO. However, anatomic variations of the FO can potentially lead to unsuccessful cannulation. FO cannulation using the Hartel approach yields a 5.17% failure rate due to anatomic variations in FO morphology,[3] despite the use of neuro-navigation technology with CT imaging. Generally, percutaneous procedures are “blinded” by definition. Furthermore, CT-guided puncture of the FO is another commonly used method for the accurate percutaneous treatment of the FO.[4] With the help of the navigation system, surgeons could identify the position of the needle through intra-operative CT examination. In a study by Fransen,[5] the mean radiation dose per patient during percutaneous balloon compression of the trigeminal ganglion was reported to be 1137.18 mGy cm2 (range, 639.50–1738.00 mGy cm2). Therefore, the radiation required to perform this procedure might pose a significant risk for both the surgeon and the patient. Compared to the two aforementioned methods, the major advantage of the surgical robot-assisted system is that surgeons can design and navigate the pathway of puncture based on their own CT data. This reduces the risks of a blinded operation during percutaneous puncture. The presence of anatomical variations can be detected before surgery, and a personalized pathway can be designed to improve the success rate of the percutaneous puncture. The depth and direction of the percutaneous puncture can be simultaneously indicated during robotic surgery. The Remebot can locate the end of the robotic arm, which is set at 15 cm away from the target point, with high precision. The surgeon only needs to place the puncture needle through the end of the robotic arm and puncture it along the pre-determined direction. CT guidance requires repeated CT examination intra-operatively to identify the position of the tip of the puncture needle, which increases the risk of radiation exposure. In the case of the Remebot, the patient only needs to undergo a pre-operative CT scan once, on the day of the surgery. By analyzing the experimental results, the Remebot can fulfill the requirements of the FO and FS percutaneous puncture. Furthermore, the robotic-assisted system can greatly lower the skill barrier to perform the percutaneous puncture. Thus, a surgeon with limited experience can accomplish a successful puncture with the assistance of the Remebot. The conventional navigation system requires skin preparation of the whole head followed by its fixation on a holder. It is agonizing for most patients who undergo oral and maxillofacial surgery to have their heads shaved bald. Therefore, we modified the method of registration, wherein only the temporal hair needs to be shaved off, on both sides. The Remebot could identify the markers, which consisted of black and white blocks, through the optical tracking system. However, owing to the invasive nature of this method, we aim to develop a non-invasive method for the fixation and registration of the head in the future. This study has some limitations. Simulating intra-operative bleeding in actual surgical scenes was not possible in the cadaveric specimens used in this study. During cannulation in the Hartel approach, three anatomical structures—the cheek, the pterygomaxillary fossa, and finally the FO—will need to be successively traversed. Thus, the possibility of the needle piercing the internal carotid artery, maxillary artery, middle meningeal artery, or pterygoid venous plexus exists. However, the Remebot could integrate multimodal images, including the magnetic resonance imaging and CT data, to fully design the optimal puncture trajectory in this study. In the future, comparative studies using larger sample sizes are warranted to verify the advantage of a CT-guided, surgical robot-assisted system. This study verifies the feasibility and accuracy of using a robot in the field of oral and maxillofacial surgery. The puncture results of the FO and FS in the cadaveric specimens confirm that this method meets the requirements of clinical surgery. Funding This study was supported by the grants from the National Key Research and Development Plan (No. 2017YFB1304300), the Conversion Fund of PLA General Hospital (2017tm-018), the Clinical Research Support Fund of PLA General Hospital (2017fc-tsys-2013), and the Research on Big Data Sharing Service Platform for Oral Cancer Imaging (2018mbd-13). Conflicts of interest None.

5G remote robot-assisted spinal surgery is accurate and reliable. We conclude that 5G telerobotic spinal surgery is both efficacious and feasible for the management of spinal diseases with safety.

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Minimally Invasive Spine Surgery (MISS) has been defined by McAfee et al. (McAfee PC, 2010) as: “a procedure that by virtue of the extent and means of surgical techniques results in less collateral tissue damage, resulting in measurable decrease in morbidity and more rapid functional recovery than traditional exposures, without differentiation in the intended surgical goal”. Increasingly, minimally invasive surgeries are desirable by both patients and surgeons. In the past few years various minimally invasive spinal surgeries have been developed for, and introduced into, the clinical setting. Procedures may involve one or more of the four “pillars” of MISS (Hartl, 2012), including microsurgical techniques, access strategies to the spine, imaging/navigation techniques, and specialized instruments and implants. The concepts and techniques of MISS have spread throughout China rapidly as a result of direct communication with surgeons worldwide. The first academic society on MISS was established in China in Oct. 2003. Four hundred surgeons participated in the first national meeting on MISS held in Dec. 2004 (YL Chi, 2005). Since then, increased numbers of orthopaedic and neurosurgeons have become interested in MISS. Training courses on special techniques, such as percutaneous vertebroplasty/kyphoplasty, percutaneous pedicle screw instrumentation, and percutaneous endoscopic lumbar discectomy, were held regularly in training centers, promoting the development of MISS in China. With nearly two decades of development, Chinese surgeons have developed MISS instruments and techniques while collecting an extensive amount of clinical data. This special issue includes eight original peer reviewed papers in this field authored by Chinese surgeons. Compared to MISS based on intra-operative radiographs, computer-assisted MISS (CAMISS), in which navigation plays an important role, is a great advance towards more precise and safer surgery. Prof. Wei Tian's team has developed an universal navigation-based robot system which potentially can be used in guiding instrumentation of every part of the body. His team reported the first case of robot-assisted posterior C1-2 transarticular screw fixation for atlantoaxial instability. The details of this new technique was described in this report. Navigation may improve the safety and efficacy of instrumentation by guiding the trajectory of screws in real time but it still cannot overcome the shortcomings of surgeon's skill, requiring repeated adjustments of the trajectories during surgery. Instrumentation of upper cervical spine, especially in deformed spine is still challenging due to the complex anatomy and proximity to important neurovascular structures even with navigation. Navigation-based robot may solve this problem. Several minimally invasive techniques maybe integrated in one operation to achieve better results. Prof. Jian Wang reported his experience of using intraoperative O-arm-based navigation and microendoscopic techniques in direct repair of lumbar pars interarticularis. Dr. Yutong Gu combined percutaneous pedicle screw fixation and vertebroplasty for treatment of thoracic metastatic tumors with neurologic compression. Dr. Changqing Li performed a prospective randomized study on minimally invasive posterior decompression combined with percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures with neurological deficits compared with traditional open posterior surgery. Percutaneous Endoscopic Lumbar Discectomy is becoming increasingly popular in China. Dr. Jiancheng Zeng reported the results of a prospective randomized controlled study comparing interlaminar approach and transforaminal approach for L5-S1 disc herniation. China has a large aging population. Chinese orthopaedic surgeons are facing an increasingly large number of patients with osteoporotic vertebral compression fractures. Prof. Huilin Yang reviewed the history and present use of kyphoplasty and its development in China. The clinical experiences, complications and several studies on technical aspects of PKP were also introduced in this review. MISS has a demanding learning curve, even for highly skilled surgeons. Some MISS has been shown to reduce muscle damage, blood loss, and post-operative pain. The hope is that MISS will also result in quicker recovery, shorter hospital stay and faster return to daily life activity. Further studies are needed to more carefully document the extent of actual, as opposed to perceived or assumed, benefits from MISS, to perform this type of surgery correctly.

Objective: To review and evaluate the technical advantages, disadvantages and research progress of robotic navigation technology in pedicle screw fixation. Methods: An extensive review of domestic and international literature on robotic navigation technology in pedicle screw fixation was conducted to summarize the advantages and disadvantages of this technology and its clinical application, as well as to provide an outlook on its future development. Results: Robotic nailing has the advantages of improved accuracy, reduced intraoperative radiation and minimally invasive surgery compared to freehand nailing. However, as the application of robotic navigation technology is still in its infancy, there are disadvantages in terms of low coverage, high cost, unstable accuracy and long operative time. Conclusion: The application of robotic navigation technology in pedicle screw fixation is a combined solution that requires not only the improvement of robotic shortcomings, but also a good surgical foundation, strict control of the surgical indications and rational selection of the surgical approach in order to adequately ensure the effectiveness and safety of the procedure.

There still remain some problemsin digestive tract reconstruction after robotic radical gastrectomy for gastric cancer at present, such as great surgical difficulties and high technical requirements. Based on the surgical experience of the Gastric Surgery Department of Union Hospital, Fujian Medical University and the literatures at home and abroad, relevant issues are discussed in terms of robotic radical distal gastrectomy (Billroth I, Billroth II, and Roux-en-Y gastrojejunostomy), proximal gastrectomy (double-channel and double-muscle flap anastomosis), and total gastrectomy (Roux-en-Y anastomosis, functional end-to-end anastomosis, FEEA, π-anastomosis, Overlap anastomosis, and modified Overlap anastomosis with delayed amputation of jejunum, i.e. later-cut Overlap). This article mainly includes (1) The principles of digestive tract reconstruction after robotic radical gastrectomy for gastric cancer. (2) Digestive tract reconstruction after robotic radical distal gastrectomy: Aiming at the weakness of traditional triangular anastomosis, we introduce the improvement of the technical difficulty, namely "modified triangular anastomosis", and point out that because Billroth II anastomosis is a common anastomosis method in China at present, manual suture under robot is more convenient and safe, and can effectively avoid anastomotic stenosis. (3) Digestive tract reconstruction after robotic proximal gastrectomy: It mainly includes double channel anastomosis and double muscle flap anastomosis, but these reconstruction methods are relatively complicated, and robotic surgery has not been widely carried out at present. (4) Digestive tract reconstruction after robotic total gastrectomy: The most classic one is Roux-en-Y anastomosis, mainly using circular stapler for end-to-side esophagojejunal anastomosis and linear stapler for side-to-side esophagojejunal anastomosis, for which we discuss the solutions to the existing technical difficulties. With the continuous innovation of robotic surgical system and anastomosis instruments, and with the gradual improvement of anastomosis technology, it is believed that digestive tract reconstruction after robotic radical gastrectomy for gastric cancer will have a good application prospect in gastric cancer surgery.

Robotic-assisted percutaneous coronary intervention (r-PCI) exemplifies the advancement of interventional cardiology by integrating robotics to improve procedural control, operator safety, and potentially patient outcomes. This is a brief history of the development of r-PCI and robotics in cardiac surgery. r-PCI is currently more common in elective PCI cases, where time and precision are prioritized, however, the progress that has been made in surgical robotics allows us to believe in rapid progress of robots dedicated to complex coronary lesions treatment. The successful remote PCI in China highlights the potential of robotic systems to revolutionize interventional cardiology by offering both precision and remote accessibility, particularly in regions with limited access to specialized cardiovascular care.

In China, approximately, 4.41 million individuals sustain fractures every year. With the rapid development of economy, industrialization, and urbanization as well as the aging of the Chinese population, it is predictable that the number of traumatic fractures will inevitably increase dramatically in the near future. According to the nation-wide data on the clinical epidemiology of orthopedic trauma during 2010−2011, fractures occurring in young and mid-aged patients reached 72%, representing the predominant injuries, and the corresponding percentage of fractures in elderly people was 14.7%.[1] Most of the fractures require operative treatment. Open reduction and internal fixation (ORIF) via a large incision was once a commonly used method in the treatment of traumatic fractures, which remains an important choice of treatment algorithm for fractures. However, ORIF is often associated with relatively extensive invasion and increased incidence of infections and nonunion of the fractures. Minimally invasive surgery (MIS) has gained its popularity in many specialties in the last two decades or so, due to its minimal invasion, fewer complications, quick recovery, and the reduced expense.[234] In the field of orthopedic trauma, minimally invasive reduction and fixation, which is the ultimate goal that patients and surgeons have been in persistent pursuit of for a long time, has been achieved, benefiting from sustained attention and the emerging of various new concepts and techniques. Among them, biological osteosynthesis (BO) is one of the currently and widely applied concepts in the management of orthopedic trauma. BO has gained considerable popularity since its advent for fracture management and subsequent successful application in basic research and clinical application. The techniques of less invasive stabilization system for long bone fractures, the internal compression fixation technique via a minimally invasive incision for displaced intra-articular calcaneal fractures,[56] and other percutaneous reduction and fixation techniques,[78] all embody the advantages and successful application in the treatment of traumatic fractures following BO concept. During the procedure of minimally invasive treatment of fractures, the key success factor is minimal or closed reduction, namely ensuring the satisfactory reduction of the fracture before skin incision and fixation. It is impossible to achieve the minimally invasive fixation (MIF) before desired reduction is accomplished. If anatomical or satisfactory alignment could not be achieved before skin incision, limited open reduction and even complete open reduction should be performed in some complex cases. For the pursuit of anatomical or at least satisfactory alignment, Hippocrates invented the famous Hippocrates’ traction table. With societal progress and technological development, especially with the application of X-rays in medical practice, fracture could be reduced accurately and safely with the aid of this revolutionary affordable technique. Afterward, researchers and surgeons continuously invented and developed creative tools for fracture reduction. Currently, the most commonly used tool for fracture reduction is the traction table for fractures of the lower limbs,[9] using a boot as upholder for pulling force and perineal post for resistance. However, there are some weaknesses existing in the traction table-based reduction technique. The biggest limitation is the inconsistency between the direction of generated traction force and that of the muscle contraction in the lower limbs. As a result, in case of young adult patients with significantly displaced or old fracture, a larger force and prolonged traction are required to reduce the fracture, leading to stretch injury of the foot, pudendal nerve trauma, perineal ulcers, peroneal nerve palsy, and even compartment syndrome.[1011] Second, skin traction is performed during fracture reduction procedure by the traction table, which only provides lower traction force of 5–10 kg. Third, traction table could be only indicatively applied in the proximal and shaft fractures of the femur, but not for open fractures, tibial fractures, ankle and foot fractures, or fractures of the amputated limbs. In addition, other disadvantages, including large bulking, heavy weight, and inconvenience for carriage and field application, have been described in detail. Arbeitsgemeinschaftfür Osteosynthesefragen (AO) traction reductor is another fracture reduction instrument applied with Schanz screws stretching the fracture site, which may also lead to an eccentric force for reduction. In addition, application of this instrument occupies a large space, influencing the optimal surgical incision, visualization of anatomic structures around fracture sites, and the placement of osteosynthesis plates or intramedullary nail (IMN) due to Schanz screws placed passing through the medullary canal. To address the above-mentioned technical limitations, various techniques and instruments for fracture reduction in a minimally invasive fashion have been introduced and applied in the clinical application. Our team invented a rapid reductor for the closed reduction of the fractures of all the four extremities.[12] The rapid reductor was designed to combine the advantages of the traction table and AO traction reductor techniques and to simultaneously avoid their potential disadvantages. The main elements include reduction scaffold, traction bow, traction pin, connecting rod, auxiliary reduction pin, and proximal connecting device. The remarkable feature is the application of skeletal traction connecting anterior superior iliac spine through a Schanz pin and the distal end of long bone or calcaneus via its traction bow. The rapid reductor shows obvious advantages in clinical practice, which could provide consistent mechanical axis with muscles’ running, generate enormous force to reduce displaced fractures, and avoid the complications related to skin traction-relating traction table. Furthermore, the rapid reductor is simple and convenient to perform and does not hinder injured limb adduction or abduction when the operative procedures are needed, such as reduction, fluoroscopic examination, and IM nailing (IMN). In addition, this rapid reductor could correct various deformations of overlapping, anterior, posterior, and lateral displacement and rotation. This instrument can be used in the reduction of displaced fractures of the femur, tibia, humerus, and radius and ulna, as well as ampulated limbs. Another trend in the development of MIS technique in orthopedic trauma is to improve the ability of restoring both the anatomical and biomechanical features in the irregular-shaped bones, such as clavicle and spinal vertebrae. Previously, ORIF is commonly used to treat this injury, with subsequent increased complications relating bone, soft tissue, or implant. After continuous struggles and attempts, percutaneous kyphoplasty (PKP) and clavicular closed distractor were invented to solve these issues. PKP was first used in 1998 for the treatment of vertebral compression fractures. With the guidance of intraoperative fluoroscopy, the needle is percutaneously punctured into the compressed vertebrae to make up a work channel. Then, a special balloon was delivered and placed into the center of vertebrae through the channel to inflate the compressed fractures, followed with bone cement injected for maintaining affordable reduction. We creatively applied this technique in the treatment of ischemic necrosis and ganglion cyst of semilunar bone and acquired satisfactory outcomes.[13] Clavicle is characterized by an “S” shape, and a fracture more often in the intermediate third, commonly accompanied by a significant displacement. Dissatisfactory reduction might lead to increased complications such as nonunion, malunion, delayed union, and nerve irritation symptoms. Based on the anatomical research and clinical investigation, we found that posterior extension of the shoulder and upward holding up the back facilitated the distraction of clavicle, and according to this key principle, we developed the closed distractor for clavicular fracture. During the operation, we fix patients’ bilateral shoulder and handle the supporting device placed under the back to push the trunk upward, thereby making the bilateral shoulders extended posteriorly to reduce the overlapped clavicular fractures. Meanwhile, we could reduce the residual lateral displacement by manipulation after distracting the overlapping displacement of clavicle. MIF embodies the core concept of MIS and represents the most important step for successful operation, which emphasizes the stabilization of the fracture until bone union. Based on this theory, a series of MIF devices are developed and widely applied in the management of periarticular, metaphyseal, and diaphyseal fractures. Among them, IMN is the most typical representative device for treating long bone fractures. IMN is inserted into the medullary cavity of the long bones with both ends away from fracture site, therefore avoiding damage in the surrounding soft tissues. During the procedure, it is necessary to insert a guide wire into the distal medullary cavity from the proximal cavity passing the fracture site, prior to implant the IMN. However, there are many troubles in the process of the insertion of the guide wire and subsequent nail fixation when encountering residual displacement after initial closed reduction of fracture or severely comminuted fracture. The commonly used device for guide wire insertion such as “gold finger” often fails to solve this issue in such conditions. A new IM reduction device has been invented, which facilitates the insertion of a guide wire into the distal medullary cavity of the long bones in a closed and controllable manner. The IM reduction device can be used to adjust the direction of the guide wire to facilitate its insertion into the cavity, which can be also applied as a “joystick” to restore the alignment of the long bones before IMN insertion into a proper position.[14] Furthermore, the development of digitalized three-dimensional (3D) navigation techniques, especially novel electromagnetic distal targeting system, greatly facilitates the precise placement of locking screws with reduced time, less attempts, and using fluoroscopy as replacement. From the view of traditional manufacturing industry, it might be difficult to design and produce the implants of complete fitness with bone morphology for individuals. Some implants need to be specifically reshaped in accordance with the anatomical features of bones to facilitate percutaneous insertion to the fracture site. With the advent of computer-assisted and 3D printing technology, personalized customized implants and prosthesis can be expected to be designed and produced, according to the size, configuration, anatomical characteristics, and biomechanical features of the bones of individual patients. In 2014, the world's first artificial customized vertebral body fabricated by 3D printing was applied in the treatment of atlanto-axial tumors in Peking University Third Hospital, giving us more courage and strength on the walking road of MIS. Percutaneous minimally invasive pedicle screw fixation is an ideal treatment method for spinal fractures. However, percutaneous screw placement is a technically challenging procedure with a significant complication profile for misplaced screws. Various recently invented intraoperative image guidance techniques, including computed tomography navigation system, 3D fluoroscopy-based navigation, and O-arm technology, have been shown to provide superior accuracy in the minimally invasive placement of spinal instruments.[15] In 2015, researchers from Peking Jishuitan Hospital have successfully completed the world's first complex thoracolumbar surgery in the minimally invasive fashion assisted by robots and navigation, which will certainly lead the new medical trend in the world. We believe, in the near future, more and more innovative ideas, techniques, implants, and instruments, relating MIS and precise medicine will be proposed, invented, and applied in the minimally invasive management of orthopedic trauma, which will promote the development of Chinese orthopedic trauma and better serve our patients.

This review examines the dichotomy between automatic and autonomous behaviors in surgical robots, maps the possible levels of autonomy of these robots, and describes the primary enabling technologies that are driving research in this field. It is organized in five main sections that cover increasing levels of autonomy. At level 0, where the bulk of commercial platforms are, the robot has no decision autonomy. At level 1, the robot can provide cognitive and physical assistance to the surgeon, while at level 2, it can autonomously perform a surgical task. Level 3 comes with conditional autonomy, enabling the robot to plan a task and update planning during execution. Finally, robots at level 4 can plan and execute a sequence of surgical tasks autonomously.

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The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution.

<ns4:p>Over the last few years, certain areas in the management nasopharyngeal carcinoma (NPC) that have an impact on the care of these patients have evolved, particularly with regard to liquid biopsies, minimally invasive surgery, and advances in chemotherapy and immunotherapy. Beyond its proven role in the diagnostics, surveillance, and treatment of NPC, liquid biopsy with plasma Epstein–Barr virus DNA in the screening of high-risk populations for NPC is strongly supported by recent evidence. Surgery of the nasopharynx is reserved for locally recurrent NPC, and in recent years there have been great strides in minimally invasive techniques with survival rates similar to those of open techniques in treating NPC. Induction chemotherapy in a recent pooled analysis was shown to be superior to concurrent chemotherapy alone for locoregionally advanced NPC. Finally, immunotherapy with a PD-1 inhibitor in NPC has been shown to have 1-year overall survival rates comparable to those of other patients with heavily pre-treated metastatic or recurrent NPC. In this commentary, we discuss these recent advances and their potential in the clinical management of patients with NPC.</ns4:p>

Robot-assisted surgeries have been integrated and leading to a paradigm shift in surgical fields. With the emergence of Minimally Invasive Surgery (MIS), especially Natural Orifice Transluminal Endoscopic Surgery (NOTES), there are various benefits such as a minimization of side effects, enhancement of precise surgical procedures, and faster recovery after the surgery that patients can take from. However, in order to effectively employ and exploit surgical robots, numerous technical challenges need to be addressed. Among these, actuators play a vital role. To provide deeper understanding on current actuators-driven surgical robot, this study will comprehensively review on four main types of transmission systems namely cable-driven mechanism, flexible fluidic actuators, smart material actuators, and magnetic actuators, in terms of conceptual designs, modelling, and control as well as their advantages and disadvantages. Profound discussions and recommendations for the future of actuators-driven surgical robots will be also pointed out to give the roadmap in the surgical field.

No abstract

In the world reference context, although virtual reality, augmented reality and mixed reality have been emerging methodologies for several years, only today technological and scientific advances have made them suitable to revolutionize clinical care and medical contexts through the provision of enhanced functionalities and improved health services. This systematic review provides the state-of-the-art applications of the Microsoft^® HoloLens 2 in a medical and healthcare context. Focusing on the potential that this technology has in providing digitally supported clinical care, also but not only in relation to the COVID-19 pandemic, studies that proved the applicability and feasibility of HoloLens 2 in a medical and healthcare scenario were considered. The review presents a thorough examination of the different studies conducted since 2019, focusing on HoloLens 2 medical sub-field applications, device functionalities provided to users, software/platform/framework used, as well as the study validation. The results provided in this paper could highlight the potential and limitations of the HoloLens 2-based innovative solutions and bring focus to emerging research topics, such as telemedicine, remote control and motor rehabilitation.

No abstract

Medical robotics is a rapidly advancing discipline that is leading the evolution of robot-assisted surgery, personalized rehabilitation and assistance, and hospital automation. In China, both research and commercial developments in medical robotics have undergone exponential growth in recent years. In this review, we first give an overview of the clinical and social demands that motivate the rapid development in medical robotics. For each subdiscipline (surgery, rehabilitation and personal assistance, and hospital automation), we then summarize the major research projects sponsored by National Key Research and Development Programs. The remaining technical, commercial, and regulatory challenges are highlighted. This review also outlines some of the new opportunities in endoluminal and interventional robotics, micro- and nanorobotics, soft exoskeletons, intelligent human–robot interaction, and telemedicine and telesurgery, which may support the general uptake of robotics in medicine.

In recent years, the emergence of digital therapeutics as a novel approach to managing conditions has garnered significant attention. This approach involves using evidence-based therapeutic interventions that are facilitated by high-quality software programs to treat, manage, or prevent medical conditions. The incorporation of digital therapeutics into the Metaverse has increased the feasibility of their implementation and application in all areas of medical services. In urology, substantial digital therapeutics are being produced and researched, including mobile apps, bladder devices, pelvic floor muscle trainers, smart toilet systems, mixed reality-guided training and surgery, and training and telemedicine for urological consultations. The purpose of this review article is to provide a comprehensive overview of the current impact of the Metaverse on the field of digital therapeutics and identify its current trends, applications, and future perspectives in the field of urology.

随着人工智能(Artificial Intelligence, AI)技术的飞速发展，其在骨科学领域的应用范围不断扩大。本文对人工智能在骨科学领域的应用现状展开全面综述，涵盖疾病诊断、治疗、康复指导、医学生教育与培训以及患者沟通等多个方面，并深入探讨其应用前景和面临的挑战。研究结果显示，人工智能在骨科学领域拥有广阔的应用前景，具备提高诊断准确性、制定个性化治疗方案、支持远程医疗和基层医疗、预测疾病风险等诸多优势。不过，其应用过程中也面临着数据隐私和安全保障、算法可解释性提升以及缺乏统一行业标准等挑战。未来，随着技术的持续进步和相关问题的逐步解决，人工智能有望在骨科学领域发挥更为重要的作用。

背景：机器人辅助骨盆骨折复位系统可以潜在地降低感染风险并改善预后，从而带来显著的健康和经济效益。然而，由于尚未解决的困难，这些系统仍处于实验室阶段，尚未准备好商业化。虽然以前的综述侧重于单个技术，系统组成和手术分期，但有必要进行全面的综述，以帮助未来的学者选择适合临床应用的研究方向。方法：使用PubMed检索机器人辅助骨盆骨折复位系统的相关文献。全面搜索“骨盆骨折复位”、“计算机辅助骨盆骨折手术”和“机器人辅助骨盆骨折复位”的结果分别为2222、196和32。选取了约200篇文章，通过对摘要的审阅，选取了10篇高度相关的文章进行深入阅读。结果和结论：螺钉固定在骨盆骨折治疗中的应用，使手术更加微创化，越来越多的辅助技术应用于微创螺钉置入。术前3D打印技术与骨科手术机器人辅助螺钉置入相结合是一种可行的创新辅助技术。通过术前3D打印规划，可以减少骨科手术机器人辅助手术术中螺钉绘制时间，降低螺钉绘制难度。这也使得手术中进入点的选择更有针对性。在不增加术中侵入性操作时间和透视次数的前提下，将术前3D打印技术与机器人完美结合，可以提高螺钉置入精度，实现良好的骨折固定，减少手术并发症。

肺癌作为全球恶性肿瘤相关死亡的首要原因，其外科手术治疗始终是首选方式。达芬奇机器人手术系统作为微创外科技术的革命性平台，近年来在胸外科领域实现了从技术探索到常规应用的跨越式发展。相较于传统胸腔镜手术，机器人辅助胸腔镜手术通过三维高清视野、仿生腕器械及震颤过滤系统进一步优化了肺叶切除术的技术路径。本文系统综述机器人辅助肺叶切除术在肺癌治疗中的临床应用进展，探讨远程手术和远程教育的创新发展，展望机器人胸外科手术在未来发展方向。

近年来，血管机器人技术发展迅速，已被逐步用于疾病诊断、信息采集、血管疏通、药物投放等医疗领域，具有广阔的医学应用前景。本文根据血管机器人的不同驱动方式，对微纳米尺度和毫米尺度的血管机器人结构、驱动方式等进行了分析，综述了国内外血管机器人的不同驱动方式原理及研究现状，包括蠕动驱动，仿生游动，仿细菌鞭毛驱动，螺旋驱动等。探讨了目前血管机器人各类结构的特点，并分析了血管机器人发展的关键技术与发展前景。

近年来，伴随计算机科学的进步，人工智能在多个行业和领域都得到了广泛应用。在关节外科中，人工智能技术可以在疾病的影像学分析及诊断、术前规划、术中操作技术等多方面发挥作用。本研究在查阅大量中外文献的基础上，简要介绍了应用于关节外科中人工智能的技术分类，具体的应用方向及相关局限性，以期为临床工作及未来的研究工作提供参考。

随着信息技术的飞速发展，人工智能(Artificial Intelligence, AI)在医疗领域的应用日益广泛且深入。妇科诊疗作为保障女性健康的关键医疗板块，也逐渐引入AI技术，为疾病的诊断、治疗和管理带来了新的机遇与变革。本文将对AI在妇科诊疗中的应用前景及现状进行综述，旨在全面呈现这一新兴技术在妇科领域的应用情况，分析其优势与挑战，为推动AI在妇科诊疗中的进一步发展提供参考。

先天性畸形是小儿外科最常见的疾病之一，也是世界范围内的公共卫生难题。人工智能目前在小儿先天性畸形诊疗中取得了不错的应用进展。体现在疾病的早期筛查与诊断、治疗方案个性化、手术决策与预后各个方面，随着人工智能技术的发展和规范化，AI有望进一步推动小儿先天性畸形的精准医疗和个性化治疗。

机器人辅助技术在成人脊柱手术中应用广泛，但低龄儿童脊柱特殊的生理及解剖特性，使机器人技术应用的安全性及可行性，仍需进一步证实。本文通过报道一例5岁胸椎爆裂骨折患儿接受天玑机器人辅助下胸椎骨折切开复位内固定术的病例，初步展示了该技术在低龄患者高位胸椎骨折手术中应用的可行性，并获得了满意的早期临床效果，提示该技术在提升此类高风险手术安全性方面具有应用潜力。

随着口腔种植技术的发展，种植体的精准植入逐渐成为口腔种植领域热议的话题。计算机辅助种植(computer-assisted implant surgery, CAIs)技术的出现，从静态导板技术到动态导航技术，再到最近几年兴起的口腔种植机器人，使得种植体的精准植入成为可能。本文就目前存在的三种计算机辅助种植技术在发展分类、操作流程、精度及其影响因素做一综述，并指出了各种技术存在的不足，以期为口腔临床数字化种植的选择提供参考。

目的：通过对比研究达芬奇机器人辅助与常规开胸二尖瓣置换术下患者的临床治疗效果，进一步明确达芬奇机器人手术系统在二尖瓣置换手术中的优缺点，为其在心脏外科手术中的应用提供一定的数据支持及改进方向。方法：收集我院自2018年1月至2022年1月施行的二尖瓣置换手术患者282例，其中达芬奇机器人辅助下二尖瓣置换手术患者70例，命名为达芬奇组；常规开胸二尖瓣置换手术患者212例，命名为常规组。收集两组患者术前基本信息、术中资料及术后并发症的发生率、住院费用等，以及两组病人的症状改善情况，分为改善、无改善、加重。应用SPSS软件及统计学方法分析两组患者以上数据有没有差异，且差异具不具有统计学意义(P值大于或小于0.05)。结果：达芬奇组与常规组患者均顺利完成手术，无院内死亡，康复后出院。达芬奇组(70例)与常规组(212例)在术前基线特征方面无统计学差异(P > 0.05)。达芬奇组患者手术时间、体外循环时间、主动脉阻断时间较常规组明显延长，差异有统计学意义(P 0.05)。达芬奇组及常规组患者术后1个月复查LVEF差异无统计学差异(P = 0.433)，且两组症状较术前均有改善。达芬奇组总住院费用较常规组明显增多(P < 0.001)。结论：达芬奇机器人辅助二尖瓣置换术在手术安全性、可行性上与常规开胸二尖瓣置换术相当，且并不增加术后并发症的发生；此外达芬奇机器人辅助二尖瓣置换术在术后恢复上显著优于常规开胸二尖瓣置换术，但其较长的手术时间、体外循环时间和主动脉阻断时间以及更高的住院费用也值得未来继续改进。

目的：观察快速康复外科(ERAS)理念指导下围手术期护理干预措施对机器人辅助全膝关节置换术患者的临床应用及效果评价。方法：选取新疆医科大学第六附属医院2023年8月至2024年4月在腰硬联合麻醉下行单侧机器人辅助全膝关节置换术的患者75例，分为对照组36例和观察组39例。对照组采用常规围手术期护理干预措施，观察组采用ERAS理念指导下围手术期护理干预措施。比较两组围手术期指标(术后首次下床活动时间、尿管拔除时间)、术后视觉模拟评分法(VAS)评分、美国特种外科医院(HSS)评分、美国膝关节协会(KSS)评分、膝关节主动活动度(ROM)、护理满意度及住院时间。结果：与对照组相比，采取ERAS理念指导下围手术期护理干预措施后，观察组术后首次下床活动时间为(23.06 ± 1.17)小时，尿管拔除时间为(6.82 ± 0.76)小时，均短于对照组，差异具有统计学意义(P < 0.05)；观察组术后第一天VAS评分为(4.46 ± 0.79)分，术后第七天VAS评分为(2.21 ± 0.66)分；术后第七天HSS评分为(59.31 ± 2.36)分，术后第一个月HSS评分为(81.38 ± 2.16)分；术后第一个月KSS评分为(78.38 ± 2.20)分；术后第一个月ROM为(110.00 ± 2.56)；出院时护理满意度评分为(95.79 ± 0.81)分；平均住院天数为(11.15 ± 1.25)天，均优于对照组，差异均具有统计学意义(P < 0.05)。结论：ERAS理念指导下围手术期护理措施对加速机器人全膝关节置换术患者膝关节康复进程有着良好的临床应用价值。

静脉穿刺机器人系统是一种代替人工实行静脉穿刺的医疗辅助系统，在医疗自动化领域具有很重要的实际应用价值。该文结合国内外穿刺机器人系统研究进展，根据功能对整个系统进行了模块化分类，包括静脉成像模块、穿刺执行模块及穿刺反馈模块。然后对各模块分别进行介绍，梳理了各模块的相关研究与应用。最后总结了静脉穿刺机器人系统的优势和存在的问题，并对未来的发展方向提出了展望。

重症膝关节炎患者的最终治疗通常会选择全膝关节置换术，随着我国人口老龄化加重，全膝关节置换术手术量将在未来一段时间持续增加。尽管全膝关节置换术已是一项很成熟的手术，但临床医生始终在追求着更准确的假体位置和更高的患者满意度，并从各方面改进手术的准确性与稳定性。机器人辅助手术系统是一种新兴人工智能技术，目前已有多个类型的机器人辅助系统被应用于临床中，研究表明均可有效帮助临床医生改善假体位置的准确性以及术后下肢力线，但目前缺乏关于长期预后指标的研究。目前，机器人辅助膝关节置换术尚处于发展阶段，机器人系统及其相关手术流程仍存在着巨大的改进和提升空间。

目前针对胃癌患者的外科手术治疗主要有开腹手术(open gastrectomy, OG)，腹腔镜下胃癌切除术(Laparoscopic gastrectomy, LG)，以及机器人胃切除(robotic gastrectomy, RG)。随着外科微创技术的快速发展，开腹手术相对于微创手术有更多的侵入性，伤口疼痛的感受更强，较长恢复排便功能和出院时间等。而在微创技术中，腹腔镜的二维图像应用、不可预防的生理性震颤和触觉下降以及面对一些复杂患者时强加给外科医生不舒服的姿势等情况都极大影响了外科医生操作的准确性与便捷性。因此，开发了机器人系统来解决此类问题。国内外多项研究表明，机器人胃切除术是安全可行的，且短期和长期结果与腹腔镜胃切除术相似。由于5G技术的出现，为机器人平台的发展带来了新的热情，同时使得全智能机器人手术成为可能。此篇文章将主要从手术模式和其他优势阐述机器人手术的临床进展。

低位直肠癌因其解剖位置的特殊性和复杂性，在手术根治性切除、保肛及功能保留等方面面临诸多挑战。近年来随着微创技术的进步以及快速康复外科理念的普及，低位直肠癌的外科治疗取得飞跃性的进展。本文对于低位直肠癌外科治疗的现状进行总结，重点介绍了经肛门内镜显微手术(TEM)、经自然腔道取标本手术(NOSES)、精准功能保肛术以及机器人辅助直肠癌根治术等新一代低位直肠癌外科治疗技术，探讨其在提高手术根治性、保留器官功能和改善患者生活质量方面的优势与挑战。

胆总管结石术后高复发率一直没有得到很好地解决，很多患者一生要进行多次手术治疗，反复复发可能会导致严重的并发症和过高的医疗费用，严重影响了患者的生活质量，随着医疗水平的进步，复发性胆总管结石的患者治疗方式由传统的开腹手术逐渐向微创转变，笔者通过整理归纳相关文章，就传统开腹手术，腹腔镜的应用，内镜治疗，以及机器人技术四个维度治疗复发性胆总管结石作一综述。

随着微创外科的迅猛发展，以及在食管胃结合部癌根治手术中的应用，对于手术医生带来了一些挑战，同时也为患者带来了更多的获益。由于Siewert II食管胃结合部腺癌位置及生物学行为的特殊性，目前对于Siewert II食管胃结合部腺癌的外科治疗方案尚存在较大分歧。本文通过回顾Siewert II食管胃结合部腺癌诊治相关的文献，对Siewert II型食管胃结合部腺癌微创外科治疗的研究进展进行综述。以期为Siewert II型食管胃结合部腺癌的外科治疗方案提供参考。

本研究通过一项回顾性单中心队列研究比较机器人辅助直肠切除术与传统腹腔镜和开放方法的结果，重点关注并发症发生率、转化率、住院时间和肿瘤结局。包括106例因非转移性直肠癌行手术治疗的患者。患者被分配到开放手术(n = 23)、常规腹腔镜手术(n = 55)或机器人辅助手术(n = 28)。与开放手术(17.91 ± 12天)和腹腔镜手术(17.2 ± 14天)相比，机器人手术的转化率显著降低，住院时间更短(11.5 ± 8天，p = 0.001)。与腹腔镜手术(47.83%)相比，机器人(85.71%)和开放(89.09%)病例的标本质量显着更好(p 63岁)在单变量分析中具有更高的转换风险(p = 0.049)。两组间并发症发生率相当(p = 0.131)，吻合口瘘率无显著差异(腹腔镜：18.18%，开放：13.04%，机器人：17.86%)。K-M曲线显示各组总生存率无显著差异。机器人辅助直肠切除术在转化率更低、标本质量更好、住院时间更短方面具有显着优势，同时保持与传统腹腔镜和开放入路相当的并发症发生率和肿瘤学结局。这些发现支持机器人手术作为直肠癌的标准治疗选择。

机器人辅助手术已经成为外科领域的一项革命性技术，与传统的开腹和腹腔镜手术相比具有许多优势。在妇科肿瘤学的背景下，提供了一种治疗复杂妇科肿瘤的微创方法。本文就机器人手术治疗子宫内膜癌的现有文献进行叙述，重点介绍了机器人手术的潜在益处、挑战和未来发展方向。

机器人肝切除术(robotic hepatectomy, RH)随着微创技术的发展而作为一项前沿技术近些年发展极其迅速，也渐渐地推广到了全国各大医院之间。目前研究证明RH是安全有效的，不过相比传统肝切除术也存在着技术较高、手术设备不完善以及较高的医疗费用等问题。但随着未来更加专业、正规的培训，系统的研发以及对于成本的把控，RH也会朝着更标准化的方向迈进，前景可观。本文将就机器人肝切除术的临床进展与未来展望作一综述。

腰椎退行性疾病常见于中老年患者，是导致残疾的常见的原因之一。腰痛退行性疾病常会导致患者出现腰腿部的病理性疼痛，影响患者生活质量。传统腰椎椎体间融合术经过多年临床应用，目前认为已获得满意的临床疗效。然而，近年来微创已成为脊柱手术的发展趋势。脊柱微创手术可明显减少手术创伤、缩短手术时间、减少术中出血、缩短住院时间及患者康复时间。现就关于机器人辅助下内镜下融合内固定的临床应用及相关并发症的研究进行展行综述。

盆腔器官脱垂主要是指子宫、阴道前后壁及其相邻器官(膀胱或直肠)向下移位，其手术方式从经阴道缝合修补发展到经腹骶骨固定术，随着新技术的发展，达芬奇机器人逐渐应用于盆腔器官脱垂的治疗中，相较于传统手术方式，达芬奇机器人可给予术者更稳定的操作系统，更少的手术疲劳以及更加精细的操作，从而降低术中出血量、腹腔引流量等评价手术质量的临床指标，尽管其学习曲线时间较长，但随着术者的手术熟练度的提高，患者手术时间呈逐渐下降的趋势。随着网络技术的不断进步，借助达芬奇操作平台能够突破地域限制，使远程操控成为可能，有助于更好地进行医疗资源的分配。

随着全球人口老龄化加剧，脊柱退行性疾病患者合并骨质疏松症的发病率逐年增高。腰椎皮质骨轨迹置钉技术是解决骨质疏松患者螺钉松动有效方式之一，皮质骨轨迹螺钉比传统的椎弓根螺钉具有更好的生物力学性能。然而由于皮质骨轨迹置钉点偏内和置钉方向外展头倾角度更大缺乏明确解剖置顶点会增加腰椎皮质骨轨迹置钉手术难度。近年来，3D打印技术与骨科机器人辅助置钉技术的应用在提高骨质疏松患者皮质骨轨迹置钉精准度、增加皮质骨接触层数及减少小关节突关节侵犯率等方面发挥重要作用。本研究回顾国内外文献，对两种辅助置钉技术对腰椎皮质骨轨迹置钉的研究进行综述，同时对两种技术有新的认识和思考。

随着人工智能(AI)在医学领域的应用越来越广泛与深入，尤其在骨科领域中，AI通过深度学习后利用已有的医学数据集后再建立训练模型图像解释来提高临床诊断准确性及术前规划、术中实时评估。因此，利用人工智能对骨缺损部分进行骨修复在未来会是一种大趋势。本文就人工智能技术在骨缺损骨修复方面的应用与挑战作一综述，旨在引进国内外先进AI理念及先进技术为骨缺损患者提供精准化、个性化及小创伤治疗。

目的：探讨MAKO机械臂辅助全髋关节置换术在不同类型髋关节疾病中应用的早期疗效。方法：回顾性分析2021年1月至2021年12月因先天性髋关节发育不良(Developmental dysplasia of the hip, DDH)接受MAKO机械臂辅助全髋关节置换术的患者13例为DDH组，因股骨头缺血性坏死(Avascular necrosis, AVN)接受MAKO机械臂辅助全髋关节置换术的患者29例为AVN组。除DDH组女性患者比例偏高外，两组患者年龄、身高、体重、体质指数、术前Harris髋关节评分、西安大略和麦克马斯特大学(Western Ontario and McMaster Universities, WOMAC)骨关节炎指数、术前下肢长度差差异均无统计学意义(P > 0.05)。记录并比较两组患者手术时间、并发症发生率、术后影像学参数(外展角、前倾角、下肢长度差)、术后髋臼假体在Lewinnek安全区和Callanan安全区内的放置率、术后3个月和6个月的Harris评分、WOMAC指数和遗忘关节评分。结果：DDH组手术时间为(101.54 ± 11.79) min，与AVN组手术时间为(97.59 ± 16.88) min相比，手术时间差异无统计学意义(t = 0.762, P = 0.450)。DDH组下肢长度差为(3.95 ± 2.86) mm，与AVN组下肢长度差(3.71 ± 2.71) mm相比，差异无统计学意义(t = 0.263, P = 0.794)。两组患者术后髋臼假体外展角(43.62˚ ± 2.57˚, 41.62˚ ± 4.77˚)差异无统计学意义(t = 1.419, P = 0.164)；术后髋臼假体前倾角(15.41˚ ± 4.67˚, 12.78˚ ± 4.75˚)差异无统计学意义(t = 1.671, P = 0.102)；术后髋臼假体外展角度与术前计划的差值(3.85˚ ± 2.18˚, 3.67˚ ± 2.61˚)差异无统计学意义(t = 0.216, P = 0.830)；术后髋臼假体前倾角度与术前计划的差值(3.17˚ ± 3.32˚, 3.82˚ ± 3.54˚)无统计学意义(t = 0.559, P = 0.579)；术后偏心距差(4.82 ± 2.83, 4.98 ± 3.82) mm，无统计学差异(t = 0.133, P = 0.895)。DDH组髋臼假体在Lewinnek安全区的放置率为90.9%，AVN组为89.7%，组间差异无统计学意义(P = 0.906)。DDH组髋臼假体角度在Callanan安全区的比例为84.62%，AVN组比例为65.52%，差异无统计学意义(P = 0.205)。术后3个月和术后6个月两组患者Harris髋关节功能评分、WOMAC指数、遗忘关节评分的组间差异无统计学意义。DDH组和AVN组术后6个月Harris髋关节功能评分改善值分别为(36.23 ± 5.13)分和(37.14 ± 5.81)分，差异无统计学意义(t = 0.484, P = 0.616)；WOMAC指数改善值分别为(48.62 ± 11.84)分和(45.72 ± 8.94)分，差异无统计学意义(t = 0.875, P = 0.387)。各组患者均无术中及术后并发症发生。结论：MAKO机械臂辅助全髋关节置换术在面对DDH和AVN两种疾病时其操作性、安全性、精准性等表现稳定，具有良好的早期疗效。

以ChatGPT、Gemini、DeepSeek、通义千问等为代表的大语言模型正蓬勃发展，其应用已渗透至医疗实践的各个领域，将深刻改变未来医院的格局。在胸外科、心脏病学、口腔外科、肾脏病学、骨科、胃肠病学和影像科学等领域，变革尤为迅速。大语言模型在辅助医学文档书写、提供临床决策支持、进行医学健康教育及患者围手术期管理等方面展现出巨大的应用潜力。本文综述了大语言模型在电子病例书写、临床辅助诊断、临床决策支持、患者健康管理、医学教育及科研论文撰写等多个外科相关场景的应用。大语言模型能够高效处理与分析大规模数据集，并具备出色的自然语言理解能力。然而，这些技术的应用仍存在局限性，如模型的“幻觉”现象、潜在的学术不端风险、临床过度依赖、误诊与治疗失误的可能性以及责任归属不清等问题。在充分利用大语言模型益处的同时，我们必须认识并解决这些伦理与实践挑战，以确保其在医学领域的应用是负责任且有效的。

目的：研究数字化骨科的发展过程、研究现状、未来趋势。方法：以中国知网(CNKI)为检索库，检索范围为学术期刊，以(篇关摘 = 骨科学 + 骨科 + 骨折 + 骨外科学) AND (篇关摘 = 计算机辅助骨科手术 + 计算机辅助骨科手术系统 + 可视化导航 + CAOS + 3D打印)为检索式，时间限定为：建库——2022年10月14日，学科限定为：外科学 + 临床医学；研究层次限定为：技术研究–临床研究的中文文献。采用EXCEL及可视化分析软件CiteSpace 5.8.R3对所检索文献进行数据处理及可视化分析。结果：共初见文献408篇，纳入文献356篇，时间跨度为2015-06-15至2022-10-14。文献检索结果显示：年发文量整体上呈上升趋势；发文机构以承德医学院附属医院发表数量最多。作者间形成了多个研究团体，但依旧有大量独立研究人员。文献关键词聚类可归纳为数字化骨科具体形式、疾病类型和并发症三大类。结论：数字化骨科是未来骨科的发展方向之一。3D打印、计算机导航、骨科机器人等不同技术根据临床需求及自身特点被广泛应用于骨科临床实践。同时，各医疗机构及科研院所人员之间应加强合作，共同推动我国数字化骨科发展，使其迈上新的台阶。