Background: Robot-assisted laparoscopic surgery robot-assisted surgical system has gained significant popularity over open and laparoscopic interventions. However, given its high costs, it remains unclear what clinical advantages robot-assisted laparoscopic surgery offers over conventional laparoscopic surgery. Objective: This umbrella review aims to synthesize and compare the clinical outcomes of robot-assisted laparoscopic surgery versus conventional laparoscopic surgery for five surgical procedures. Inclusion criteria: All systematic reviews and meta-analyses published in the past five years that compared the clinical outcomes of conventional laparoscopic surgery and robot-assisted laparoscopic surgery for cholecystectomy, colectomy, hysterectomy, nephrectomy and/or prostatectomy were included. Methods: A systematic literature search was conducted in PubMed and Scopus. The quality of all included reviews was assessed with the AMSTAR 2 quality assessment tool. Each review’s study characteristics (and a list of primary sources) were extracted, along with the quantitative and qualitative data for the following ten clinical outcomes: blood loss, rate of conversion to open surgery, hospitalization costs, incisional hernia rate, intraoperative complication rate, postoperative complication rate, length of hospital stay, operative time, readmission rate and wound infection rate. Results: Fifty-two systematic reviews and (network) meta-analyses were included in this umbrella review, covering more than 1,288,425 patients from 1046 primary sources published between 1996 and 2022. The overall quality of the included reviews was assessed to be low or critically low. Robot-assisted laparoscopic surgery yielded comparable results as conventional laparoscopic surgery in terms of blood loss, conversion to open surgery rate, intraoperative complication rate, postoperative complication rate, readmission rate and wound infection rate for most surgical procedures. While the hospitalization costs of robot-assisted laparoscopic surgery were higher and the operative times of robot-assisted laparoscopic surgery were longer than conventional laparoscopic surgery, robot-assisted laparoscopic surgery reduced the length of hospital stay of patients in nearly all cases. Conclusion: Robot-assisted laparoscopic surgery achieved comparable results with conventional laparoscopic surgery for cholecystectomy, colectomy, hysterectomy, nephrectomy and prostatectomy based on ten clinical outcomes. Further research is needed to prove that robot-assisted laparoscopy is as safe and reliable as conventional laparoscopic surgery.

The success of total hip arthroplasty depends on the experience of the surgeon, and one of the ways the surgeon currently determines the final implant insertion depth is to listen to the change in audible pitch of the hammering sound. We investigated the use of acoustic vibration emissions as a novel method for insertion quality assessment. A non-invasive contact microphone-based measurement system for insertion depth estimation, fixation and fracture detection was developed using a simplified in vitro bone/implant (n=5). 2583 audio recordings were analysed in vitro to obtain energy spectral density functions. Out of the four main resonant peaks under in vitro conditions, broach insertion depth statistically correlates to increasing 3rd and 4th peak frequencies. Degree of fixation was also observed as higher goodness of fit (0.26-0.78 vs. 0.12-0.51 between two broach sizes, the latter undersized). Finally, however, the moment of fracture could not be predicted. A cadaver in situ pilot study suggests comparable resonant frequencies in the same order of magnitudes with the bone model. Further understanding of the signal patterns are needed for an early warning system diagnostic system for imminent fractures, bone damage, improving accuracy and quality of future procedures.