Background. The problem of uneven distribution of quality medical resources and limited access to highly qualified surgical help for patients from distant regions has existed for a long time. 5G-based telesurgery opens up the prospects for overcoming geographical barriers. However, its clinical use is still at the starting stage.

Aim. To analyze perioperative outcomes and safety profile of robot-assisted surgeries performed remotely using 5G-based systems.

Materials and methods. Systematic search of sources in the PubMed, Embase, Web of Science and Cochrane Library databases was performed. The analysis included clinical trials added to the databases since their creation and until April 10, 2026. Special attention was paid to the articles on radical gastrectomy due to stomach cancer, as well as hepatopancreatobiliary and urological surgery. The key limitations of these interventions were identified. Descriptions of single-patient clinical cases were excluded from the analysis.

Results. Oncological gastroenterology: 2 Chinese studies, prospective single-center (n = 27) and retrospective (n = 10), demonstrated that 100 % of resections were R0. Perioperative outcomes were similar to outcomes of non-remote robot-assisted surgery, delay of the roundtrip signal was only 31–91 ms. Hepatopancreatobiliary surgery: 3 studies (n = 5, n = 6, n = 20) confirmed the possibility of remote cholecystectomy and liver resection with delay of 43–126 ms; episodic network disruptions were observed but they did not affect safety of the surgery. Urology: 5 studies (between 6 and 37 patients) involving radical prostatectomy, nephrectomy, adrenalectomy, and other interventions with success rates up to 100 % and identical perioperative outcomes as in non-remote surgeries (delay varied between 29.1 and 129.6 ms). All studies share the same limitations of small sample sizes, absence of data on long-term oncological outcomes, variability of network characteristics, absence of tactile feedback in robotized systems, absence of ethical and legal base, and uncertain economic efficiency.

Conclusion. Feasibility and safety of robot-assisted surgeries performed remotely using 5G networks was demonstrated in cases of carefully selected patients. Perioperative outcomes of remote and non-remote robot-assisted surgeries are similar. However, telesurgery is still at the early stage of validation and carries many uncertainties and limitations; currently, it cannot replace non-remote robot-assisted surgery.

Background. Expansion of the surgical platform market due to rapid introduction and clinical implementation of new robotic systems necessitates an objective assessment of efficacy and safety of the new robotic platforms in comparison with the established platforms. The Edge Medical MP1000 multi-port surgical robotic system is a modern platform featuring 3D high-definition visualization and a reported latency of ≤40 ms. The MP1000 surgical platform has been used successfully for more than 6,000 procedures in urology, gynecology, general surgery, and thoracic surgery demonstrating high technological maturity and versatility of this surgical platform. MP1000 robotic system was successfully installed at the Moscow Multidisciplinary Research and Clinical Center named after S.P. Botkin in October 2025, expanding the institution’s surgical capabilities and opening new prospects for the adoption of innovative approaches in robotic urological surgery.

Aim. To assess the feasibility and safety of robot-assisted radical prostatectomy (RARP) performed using the Edge Medical MP1000 multi-port surgical system, and to analyze early oncological and functional outcomes of the procedure, to describe the technical features of the MP1000 platform relevant to surgical performance (docking, ergonomics, visualization, and usability for both the surgeon and the assistant).

Materials and methods. We conducted a single-center prospective cohort study of 8 patients with localized prostate cancer who underwent RARP using the Edge Medical MP1000 multi-port surgical system. One patient also underwent pelvic lymph node dissection. The primary endpoint was the rate of conversion to open surgery. Secondary endpoints included docking time, operative time, intraoperative blood loss, the incidence and nature of intraoperative and postoperative complications according to the Clavien–Dindo classification, surgical margin status, length of hospital stay, duration of bladder catheterization, early urinary continence and erectile function outcomes, as well as the surgeon’s subjective assessment of ergonomics and console comfort.

Results. All procedures were successfully completed without the need for conversion to open surgery. Mean docking time was 17.3 (11–25) minutes, and mean operative time was 197.7 minutes. Estimated intraoperative blood loss ranged from 5 to 200 mL (median 88.1 mL). Positive surgical margins were observed in 4 patients. The mean length of hospital stay was 10.5 (7–16) days. Following urethral catheter removal, all patients regained spontaneous voiding, with postvoid residual urine volume not exceeding 50 mL. Early continence (the use of one pad per day) had been achieved in 7 patients by postoperative day 30; there were no cases of severe urinary incontinence. The ergonomic characteristics of the MP1000 were comparable to those of the benchmark platform under similar conditions. No major intraoperative complications were recorded. One patient developed ureteral orifice edema requiring percutaneous nephrostomy.

Conclusion. Robot-assisted radical prostatectomy performed using the Edge Medical MP1000 multi-port surgical system is a safe procedure. The early functional outcomes obtained in this series are comparable to those reported for the benchmark robotic platform (da Vinci Xi). Technical features of the system, including high-definition 3D visualization, minimal response latency, precise motion, and convenient positioning, may broaden its potential applications in urological practice. However, the study is limited by the small sample size. Multicenter studies with larger patient cohorts and longer follow-up are required to provide a definitive assessment of efficacy and reproducibility.

Background. In the last 30 years, minimally invasive interventions have served as the priority treatment for hiatal hernias complicated by gastroesophageal reflux disease. Laparoscopic fundoplication is considered the “gold standard” of anti-reflux therapy, but the number of robotassisted surgeries has been growing since 2018, which necessitates comparison of these approaches.

Aim. Comparative evaluation of efficacy and safety of laparoscopic and robot-assisted accesses during fundoplications to treat hiatal hernias.

Materials and methods. Retrospective single-center study of treatment results of 270 patients who underwent surgery due to hiatal hernia at the S.P. Botkin Moscow Multidisciplinary Scientific and Clinical Center of the Moscow Healthcare Department between 2018 and 2025 was performed. Type I hernia per the SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) classification was observed in 7 (2.6 %) patients, type II – in 25 (9.3 %), type III – in 141 (52.2 %), type IV – in 97 (35.9 %). Laparoscopic fundoplication was performed in 109 (40.4 %) cases, robotassisted – in 161 (59.6 %).

Results. Among 32 patients with type I and II hernias, laparoscopic surgery was performed in 14 (5.2 %), robot-assisted fundoplication – in 18 (6.7 %); among 141 patients with type III hernias – in 63 (23.3 %) and 78 (28.9 %), respectively. In the patient group with type IV hernias, laparoscopic access was used in 32 (11.9 %) cases, robot-assisted – in 67 (24 %). Nissen fundoplication was performed in 259 (95.9 %) patients, Chernousov fundoplication – in 11 (4.1 %) cases. Mean operative time for laparoscopic access was 155 min, for robot-assisted access – 122 min. Grade I–II postoperative complications per the Clavien–Dindo classification were reported in the laparoscopic fundoplication group in 8 (7.3 %) cases, in the robot-assisted group – in 7 (4.3 %). Hiatal hernia recurrence was observed in 5 (4.6 %) cases after laparoscopic fundoplication and in 3 (1.8 %) cases after robotassisted surgery.

Conclusion. While the identified differences were not statistically significant, robot-assisted surgeries for larger hernias have clinical and intraoperative benefits and therefore should be preferred in cases with high risk of postoperative complications.

Introduction. Obesity is one of the major risk factors for endometrial cancer and significantly complicates surgical treatment due to technical challenges, limited visualization of the operative field, and an increased risk of perioperative complications. Robotic-assisted surgery has emerged as a promising minimally invasive approach capable to overcome these limitations.

Aim. To evaluate the impact of obesity severity on perioperative outcomes of robotic-assisted surgery in patients with endometrial cancer.

Materials and methods. This retrospective single-center study included 102 patients with endometrial cancer and class I–III obesity who underwent robotic-assisted surgery. Patients were stratified into three groups according to class of obesity. The operative time, estimated blood loss, length of postoperative hospital stay, and perioperative complications were assessed.

Results. No statistically significant differences in operative time were observed among the BMI groups (p >0.05). Patients with class III obesity had higher intraoperative blood loss compared with those with class I and II obesity; however, the absolute blood loss remained low. In addition, morbidly obese patients had a significantly longer postoperative hospital stay, with a median of 4 days versus 2 days in the other groups. Perioperative complications occurred in 2 patients (1.96 %) and did not require reoperation.

Conclusion. Robotic-assisted surgery is a safe and effective treatment modality for endometrial cancer in patients with varying class of obesity.

Background. Retzius-sparing robot-assisted radical prostatectomy is a modification of robot-assisted radical prostatectomy in which the prostate is removed through a posterior approach without entering the cave of Retzius. This technique is aimed at preserving the puboprostatic ligaments, dorsal venous complex, endopelvic fascia, and other structures involved in the support of the urethrovesical segment, and is associated with early recovery of urinary continence. Due to the specific surgical anatomy of this approach, standardization of the main operative steps and assessment of its reproducibility in clinical practice are required.

Aim. To analyze experience with Retzius-sparing robot-assisted radical prostatectomy at the University Urology Clinic of the the Moscow Multidisciplinary Clinical Centre “Kommunarka”, Moscow Healthcare Department, and to demonstrate key steps of the surgical technique.

Materials and methods. Between 2025 and the present, 30 Retzius-sparing robot-assisted radical prostatectomies have been performed at the University Urology Clinic using the da Vinci Xi robotic surgical system. Intraoperative parameters, early postoperative course, pathological findings, and continence recovery dynamics were analyzed.

Results. Mean operative time was 187.71 ± 32.66 min, and median blood loss was 30 mL. Median durations of urethral catheter drainage and postoperative hospital stay were 6 days. Pathological examination revealed pT2 disease in 92.9 % of cases and pT3a disease in 7.1 %. Gleason scores of 3 + 3 and 3 + 4 were identified with equal frequency, each accounting for 50.0 % of cases. The positive surgical margin rate was 28.6 %. Complete recovery of urinary continence was observed in 86 % of patients at 1 month and in 98 % at 3 months. The article also presents a step-by-step description of the surgical technique, including trocar placement, posterior access to the prostate, mobilization of the seminal vesicles, bladder neck dissection, urethral mobilization, and urethrovesical anastomosis formation.

Conclusion. The initial experience with Retzius-sparing robot-assisted radical prostatectomy at the University Urology Clinic confirms its technical feasibility and efficacy (achieving favorable early functional outcomes). At the same time, the positive surgical margin rate indicates the need for careful patient selection, standardization of key operative steps, and further assessment of the oncological safety of this approach in larger case series.

Background. Radical cystectomy (RC) is a key method of treatment of muscle-invasive bladder cancer. Laparoscopic and robot-assisted approaches allow to achieve good oncological results while minimizing injury and thus improving functional results.

Aim. To describe the technique of robot-assisted RC developed and validated at the “Kommunarka” Moscow Multidisciplinary Clinical Center, Moscow Healthcare Department.

Description of the technique. Robot-assisted RC is performed with intracorporeal formation of an ileal conduit per Bricker without intubation of the ureter. After standard installation of the ports, mobilization of the ureter with sparing of the periureteral cellular tissue is performed. Extended pelvic lymph node dissection is performed. Distal parts of the ureters are clipped and dissected. After complete en bloc mobilization of the bladder and prostate with seminal vesicles, umbilical ligaments and puboprostatic ligaments are dissected, and endopelvic fascia is opened. After completion of dissection of the apical part of the prostate, a clamp is placed on the urethra, and it is dissected. The system is de-docked, the angle of the operating table is changed from 45° to 15°, and an accurate aiming of surgical instruments at the ileocecal angle is performed. After mobilization of the left ureter, it is moved from left to right through the previously formed tunnel in the sigmoid mesocolon. At the distance of 15–20 cm from the ileocecal angle, part of the ilium with mesentery is mobilized. Mesentery is dissected and intestine is resected. Side-to-side intestinal anastomosis is formed. Intestinal segment is placed isoperistaltically, and mesentery “window” is sutured. Distal parts of the ureters are dissected, and end-to-side uretero-enteric anastomosis is formed (per Nesbit technique). Ileal conduit is moved to the anterior abdominal wall. The surgery ends with draining of the pelvis.

Discussion. According to literature data, not performing upper urinary tract draining using external ureteral stents does not increase the rate of complications. Prospective study of safety and efficacy of cystectomy without ureter intubation has been ongoing at the “Kommunarka” Moscow Multidisciplinary Clinical Center, Moscow Healthcare Department since 2024.

Conclusion. The described robot-assisted RC technique with intracorporeal formation of Bricker ileal conduit without placing stents in the ureters can be considered a standard of bladder cancer treatment in conditions of availability of a highly qualified surgical brigade. The article presents a step-by-step description which will help practicing doctors to learn the technique of this complicated intervention.

Background. In the last decade, robot-assisted technologies became an important part of development of microinvasive surgery, especially colorectal surgery which requires high accuracy of manipulations and sparing of functionally significant anatomical structures.

Aim. To analyze experience of robot-assisted interventions in patients with tumors of the rectum and sigmoid colon accumulated in a large medical center.

Materials and methods. Between December 2023 and April 2026 at the Moscow Multidisciplinary Clinical Centre “Kommunarka”, Moscow Healthcare Department, 535 patients with colorectal cancer underwent surgery using a robotic surgical platform. Among them, 384 patients were diagnosed with tumors of the colon, 151 – with tumors of the rectum.

Results. Conversion was required in 6 cases: in 3 into laparoscopy, in 3 into laparotomy. In 12 cases grade I–II postoperative complications per the Clavien–Dindo classification were reported; in 7 cases – grade II; in 2 cases – grade IV, in 4 cases – grade V. Comparison of characteristics of the first 10 and last 10 robot-assisted interventions due to colorectal cancer showed that while complexity of surgical situations increased, results remained high, and mean operative time decreased to 241 min.

Conclusion. Results of the analysis show that with accumulation of experience, efficacy of interactions between team members and their adaptation to the features of the robotic system improved, including during complex clinical situations. This confirms that robot-assisted surgery is a growingly important part of modern colorectal surgery.

Background. Treatment of low tumors of the rectum remains one of the most complex oncological problems. If a tumor is ultra-low and specific anatomical characteristics of the pelvis are identified, organ-sparing surgery in the framework of the standard laparoscopic access becomes exacting due to rigidity of the instruments, while combined abdominoperineal resection is associated with additional risks. In robot-assisted access, the instruments have much higher motion degrees of freedom which allows to overcome difficulties caused by complex anatomy, size and site of the tumor.

Aim. To demonstrate benefits of organ-sparing robot-assisted antegrade intersphincteric resection in patients with narrow and deep pelvis using a real clinical case.

Clinical case. A 50‑year-old patient was admitted to the Oncological Proctology Division of the Moscow City Oncology Hospital No. 62 with adenocarcinoma of the lower rectal ampulla (cT3N1M0). Magnetic resonance imaging showed features of the pelvis making standard intervention difficult. Following neoadjuvant chemoradiotherapy without a significant pathological response, a fully transabdominal robot-assisted (da Vinci Xi) intersphincteric rectal resection was performed. Distinctive features of the procedure were absence of the perineal stage, colonic pull-through and delayed (on day 7) coloanal anastomosis formation without a temporary stoma. This technique allowed the avoid extirpation while achieving oncological radicality (ypT3N0R0). Functional outcomes at 6 months corresponded to a Wexner score of 12.

Conclusion. This approach, based on strict magnetic resonance imaging data on the features of the pelvis allows to spare the anal sphincter preservation in patients with ultra-low tumors in the setting of challenging pelvic anatomy.