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Background Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic distal pancreatectomy, has gained widespread acceptance over the last decade owing to its favorable short-term outcomes. However, evidence regarding its oncologic safety is insufficient. In March 2023, a randomized phase III study was launched in Japan to confirm the non-inferiority of overall survival in patients with resectable pancreatic cancer undergoing MIDP compared with that of patients undergoing open distal pancreatectomy (ODP). Methods This is a multi-institutional, randomized, phase III study. A total of 370 patients will be enrolled from 40 institutions within 4 years. The primary endpoint of this study is overall survival, and the secondary endpoints include relapse-free survival, proportion of patients undergoing radical resection, proportion of patients undergoing complete laparoscopic surgery, incidence of adverse surgical events, and length of postoperative hospital stay. Only a credentialed surgeon is eligible to perform both ODP and MIDP. All ODP and MIDP procedures will undergo centralized review using intraoperative photographs. The non-inferiority of MIDP to ODP in terms of overall survival will be statistically analyzed. Only if non-inferiority is confirmed will the analysis assess the superiority of MIDP over ODP. Discussion If our study demonstrates the non-inferiority of MIDP in terms of overall survival, it would validate its short-term advantages and establish its long-term clinical efficacy. Trial registration This trial is registered with the Japan Registry of Clinical Trials as jRCT 1,031,220,705 [ https://jrct.niph.go.jp/en-latest-detail/jRCT1031220705 ].

BackgroundWe have developed the computer-aided detection (CADe) system using an original deep learning algorithm based on a convolutional neural network for assisting endoscopists in detecting colorectal lesions during colonoscopy. The aim of this study was to clarify whether adenoma miss rate (AMR) could be reduced with CADe assistance during screening and surveillance colonoscopy.MethodsThis study was a multicenter randomized controlled trial. Patients aged 40 to 80 years who were referred for colorectal screening or surveillance at four sites in Japan were randomly assigned at a 1:1 ratio to either the “standard colonoscopy (SC)-first group” or the “CADe-first group” to undergo a back-to-back tandem procedure. Tandem colonoscopies were performed on the same day for each participant by the same endoscopist in a preassigned order. All polyps detected in each pass were histopathologically diagnosed after biopsy or resection.ResultsA total of 358 patients were enrolled and 179 patients were assigned to the SC-first group or CADe-first group. The AMR of the CADe-first group was significantly lower than that of the SC-first group (13.8% vs. 36.7%, P < 0.0001). Similar results were observed for the polyp miss rate (14.2% vs. 40.6%, P < 0.0001) and sessile serrated lesion miss rate (13.0% vs. 38.5%, P = 0.03). The adenoma detection rate of CADe-assisted colonoscopy was 64.5%, which was significantly higher than that of standard colonoscopy (53.6%; P = 0.036).ConclusionOur study results first showed a reduction in the AMR when assisting with CADe based on deep learning in a multicenter randomized controlled trial.

Rescue robots are expected to carry out reconnaissance and dexterity operations in unknown environments comprising unstructured obstacles. Although a wide variety of designs and implementations have been presented within the field of rescue robotics, embedding all mobility, dexterity, and reconnaissance capabilities in a single robot remains a challenging problem. This paper explains the design and implementation of Karo, a mobile robot that exhibits a high degree of mobility at the side of maintaining required dexterity and exploration capabilities for urban search and rescue (USAR) missions. We first elicit the system requirements of a standard rescue robot from the frameworks of Rescue Robot League (RRL) of RoboCup and then, propose the conceptual design of Karo by drafting a locomotion and manipulation system. Considering that, this work presents comprehensive design processes along with detail mechanical design of the robot’s platform and its 7-DOF manipulator. Further, we present the design and implementation of the command and control system by discussing the robot’s power system, sensors, and hardware systems. In conjunction with this, we elucidate the way that Karo’s software system and human–robot interface are implemented and employed. Furthermore, we undertake extensive evaluations of Karo’s field performance to investigate whether the principal objective of this work has been satisfied. We demonstrate that Karo has effectively accomplished assigned standardized rescue operations by evaluating all aspects of its capabilities in both RRL’s test suites and training suites of a fire department. Finally, the comprehensiveness of Karo’s capabilities has been verified by drawing quantitative comparisons between Karo’s performance and other leading robots participating in RRL.

BackgroundRobotic pancreaticoduodenectomy (RPD) is technically demanding, and 20–50 cases are required to surpass the learning curve. This study aimed to show our experience of 76 cases from the introduction of RPD and report the changes in surgical results owing to the accumulation of cases and optimization of surgical techniques.MethodsA total of 76 patients who underwent RPD between November 2009 and May 2023 at the Fujita Health University Hospital were divided into three groups: competency (n = 23, Nov 2009–Mar 2020), proficiency (n = 31, Apr 2020–Jun 2022), and mastery (n = 22, Jul 2022–May 2023) phases. In the mastery phase, for the education of new surgeons and maintenance of surgical quality, optimization of the procedure, including hanging maneuver with or without stapling transection of the retropancreatic tissue was implemented. The surgical outcomes were compared between the groups.ResultsThe mean operation time decreased over time despite of the participation of newly started operators in mastery phase [competency: 921.5 min (IQR 775–996 min) vs. proficiency: 802.8 min (IQR 715–887 min) vs. mastery: 609.2 min (IQR 514–699 min), p < 0.001]. Additionally, Clavien–Dindo ≥ grade IIIa complications decreased from 52.2% in competency phase to 35.5% and 9.1% in proficiency and mastery phases, respectively (p = 0.005).ConclusionOperation time and major complications decreased along the learning curve from the introduction of RPD. In addition, optimization of the procedure, including hanging maneuver of the retropancreatic tissue seemed to be effective in reducing operation time and educating new RPD surgeons.

Robots Won't Save Japan addresses the Japanese government's efforts to develop care robots in response to the challenges of an aging population, rising demand for eldercare, and a critical shortage of care workers. Drawing on ethnographic research at key sites of Japanese robot development and implementation, James Wright reveals how such devices are likely to transform the practices, organization, meanings, and ethics of caregiving if implemented at scale. This new form of techno-welfare state that Japan is prototyping involves a reconfiguration of care that deskills and devalues care work and reduces opportunities for human social interaction and relationship building. Moreover, contrary to expectations that care robots will save labor and reduce health care expenditures, robots cost more money and require additional human labor to tend to the machines. As Wright shows, robots alone will not rescue Japan from its care crisis. The attempts to implement robot care instead point to the importance of looking beyond such techno-fixes to consider how to support rather than undermine the human times, spaces, and relationships necessary for sustainably cultivating good care.

Robots Won't Save Japan addresses the Japanese government's efforts to develop care robots in response to the challenges of an aging population, rising demand for eldercare, and a critical shortage of care workers. Drawing on ethnographic research at key sites of Japanese robot development and implementation, James Wright reveals how such devices are likely to transform the practices, organization, meanings, and ethics of caregiving if implemented at scale. This new form of techno-welfare state that Japan is prototyping involves a reconfiguration of care that deskills and devalues care work and reduces opportunities for human social interaction and relationship building. Moreover, contrary to expectations that care robots will save labor and reduce health care expenditures, robots cost more money and require additional human labor to tend to the machines. As Wright shows, robots alone will not rescue Japan from its care crisis. The attempts to implement robot care instead point to the importance of looking beyond such techno-fixes to consider how to support rather than undermine the human times, spaces, and relationships necessary for sustainably cultivating good care.

Objective To investigate the efficacy and safety of robot-assisted radical hysterectomy (RARH) as a minimally invasive procedure in patients with cervical cancer that is curable by surgery. Materials and methods This study was a multicenter, open-label, single-arm clinical trial. The short-term outcome of open radical hysterectomy was used as the historical control. The primary endpoint was successful surgery with minimal blood loss (300 mL or less) and negative surgical margins. Secondary endpoints included surgical outcomes, recurrence-free survival (RFS), and overall survival (OS) rates. Results Overall, 101 cases were enrolled in this study at 10 participating medical institutions and 100 underwent RARH. Among these cases, 89 met the primary endpoint, exceeding the threshold of 0.75 set by the lower limit. At 2 years postoperatively, 17 cases had recurrences, 4 were classified as International federation of Obstetrics and Gynecology Stage IB1 or lower, while 13 as IB2 or higher. There were three deaths, including one in Stage IB1 and two in Stage IIB in the second postoperative year, all of which had lymph node metastasis. The oncological outcomes for all cases showed RFS and OS rates of 82.7% and 96.9%, respectively, over a median observation period of 37 months. For cases with Stage IB1, RFS and OS were 94.1% and 98.5%, respectively. Conclusion RARH demonstrated a significant reduction in blood loss while ensuring radicality, indicating the safety and efficacy of this procedure compared to conventional RH. Although it is conceivable that the results of this oncological analysis could change, as the data collection has not been fully completed, we plan to further evaluate the oncologic outcomes of RARH in future studies. Trial registration UMIN-CTR: UMIN000022278, registered on 11th May 2016.

Background Intracorporeal anastomosis (IA) for colon cancer has garnered attention owing to its minimally invasive nature and compatibility with advanced robot-assisted surgery. IA offers advantages such as smaller incisions, reduced postoperative pain, and quicker recovery. However, concerns persist in basic research regarding the increased risk of tumor cell dissemination due to IA, which may lead to peritoneal recurrence as a result of exposure of the intestinal lumen under high intra-abdominal pressure. Evidence regarding the long-term oncological outcomes of IA is limited, with no randomized controlled trials (RCTs) addressing this issue. Furthermore, no ongoing RCTs focus on long-term outcomes as a primary endpoint regarding two anastomosis techniques, and clinical guidelines do not currently recommend a preferred anastomotic method. This multicenter RCT aims to assess the non-inferiority of IA compared with EA in the surgery of colon cancer. Methods This multicenter, open-label RCT will enroll 1,400 patients with clinical stage II or III colon cancer undergoing laparoscopic or robot-assisted colectomy across 47 institutions in Japan. Eligible patients must have tumors located in the cecum, ascending, transverse, or descending colon. Participants will be randomized to receive either EA or IA. Each participating institution must have a board-certified endoscopic surgeon to ensure surgical quality. Colon resection will include D2 or D3 lymph node dissection, in accordance with the Japanese Classification of Colorectal Carcinoma. The primary endpoint is relapse-free survival, with long-term follow-up planned. Discussion This trial will be the first RCT to evaluate long-term oncological outcomes as the primary endpoint when comparing IA and EA during minimally invasive colon cancer surgery. If IA is non-inferior to EA in relapse-free survival, the choice of anastomotic technique can be tailored to the expertise of individual institutions and surgeons. Conversely, if IA fails to demonstrate non-inferiority, EA will remain the standard treatment. Given the current lack of long-term outcome data comparing IA and EA in colon cancer, this study will provide valuable insights that may influence future surgical standards and guideline recommendations. Trial registration jRCT1032240435.

The country’s automation research might need a renewed focus to rekindle past successes. The country’s automation research might need a renewed focus to rekindle past successes.