Felipe Romero Martinez

Exoskeleton-assisted rehabilitation has emerged as a transformative approach for restoring motor function in individuals with post-traumatic and neurological impairments. This integrative review evaluated 20 international studies involving spinal cord injury, stroke, musculoskeletal trauma, and upper-limb dysfunction to synthesize current evidence on clinical effectiveness, neuromuscular activation, safety, and feasibility of robotic exoskeletons. Most studies focused on lower-limb overground devices, reflecting their central role in gait restoration, while a smaller but growing number explored treadmill-based, hybrid, and upper-limb systems. Findings consistently demonstrated improvements in gait speed, walking distance, symmetry, balance, and muscle activation, supporting the capacity of exoskeletons to promote functional gains through task-specific, repetitive training. Evidence of neuroplastic adaptations was present in several studies, highlighting potential benefits in early and subacute rehabilitation phases. Safety outcomes were favorable across the literature, with no serious adverse events reported and only mild, manageable effects such as fatigue or skin irritation. User acceptance was high, indicating positive psychological and motivational responses to robotic-assisted training. Feasibility was strongest in chronic outpatient settings, though studies in acute care suggest growing opportunities for early mobilization. Training frequency and duration varied widely, underscoring the need for standardized protocols. The review also highlights emerging regional interest in Mexico, Colombia, and Ecuador, where exoskeleton integration may offer scalable solutions for addressing trauma-related disability. Collectively, the evidence supports exoskeletons as effective and well-tolerated tools that enhance modern rehabilitation, while emphasizing the importance of further research on long-term outcomes, implementation strategies, and access in resource-limited health systems.

Artificial intelligence–guided surgery has emerged as one of the most transformative developments in contemporary operative practice, offering new capabilities for precision, personalization, and data-driven decision-making across the surgical continuum. This review synthesizes international evidence on the integration of AI into pre-operative planning, intraoperative navigation, and emerging digital ecosystems, highlighting the contributions of diverse regions including Mexico, Colombia, and Ecuador. The analysis demonstrates that pre-operative applications are the most mature, supported by robust advances in deep learning, computer vision, and predictive modeling that enable high-resolution anatomical reconstruction, improved risk stratification, and more consistent surgical pathway selection. Intraoperative systems, although less prevalent, represent an accelerating frontier. Real-time AI tools are increasingly capable of identifying anatomical structures, recognizing procedural phases, and guiding instrument trajectories, thus enhancing safety and reducing operator variability in complex procedures. Despite these advances, substantial gaps persist in validation maturity; most systems rely on retrospective datasets, with relatively few having undergone multicenter prospective testing or real-time operative deployment. Emerging technologies such as digital twins and extended reality show considerable promise for personalized simulation and dynamic intraoperative adaptation, yet they remain in early stages of clinical translation. Geographic analysis reveals pronounced imbalances in global contributions but also highlights the growing engagement of Latin American institutions in surgical AI research. Overall, the findings indicate that AI-guided surgery is transitioning from experimental innovation to a clinically relevant complement to surgical expertise. Continued interdisciplinary collaboration, rigorous validation, and equitable global participation will be fundamental to advancing safe, effective, and widely accessible AI-enhanced operative care.

Three-dimensional (3D) printing has emerged as an increasingly relevant tool in complex abdominal reconstruction, offering surgeons a tangible means of understanding distorted anatomy and improving surgical planning. This review synthesizes evidence from 23 multidisciplinary studies conducted across diverse healthcare systems, including contributions from Mexico, Colombia, and Ecuador, to evaluate the clinical utility, technical workflows, and operational barriers of patient-specific 3D-printed models. Findings reveal that 3D printing consistently enhances spatial understanding of complex anatomical relationships, supports the selection of resection and reconstruction strategies, and strengthens multidisciplinary communication in high-risk procedures. Pediatric abdominal oncology and abdominal wall reconstruction represent the most robust areas of application, reflecting the need for greater precision in tumor mapping and defect quantification. The technology likewise demonstrates substantial educational value, helping trainees interpret imaging more effectively and develop operative reasoning in a controlled environment. However, the review also identifies persistent challenges that restrict large-scale adoption, including time-intensive segmentation, high operational costs, limited multimaterial printing access, and lack of standardized outcome metrics. Latin American studies highlight that feasibility increases significantly when institutions integrate in-house segmentation and printing units, emphasizing the importance of workflow adaptation in resource-variable settings. Overall, the evidence positions 3D printing as a transformative adjunct that enhances surgical accuracy, safety, and training quality. Its continued growth will depend on improved segmentation automation, cost-efficient production models, interdisciplinary training, and standardized reporting frameworks. As abdominal reconstruction becomes increasingly complex, 3D printing is poised to evolve from an emerging innovation into a routine component of modern surgical practice.