Alejandro Cruz Díaz

Advanced cholecystectomy represents a technically and cognitively demanding procedure within general surgery, particularly in cases involving acute inflammation, altered anatomy, or high-risk patient profiles. The emergence of compact fourth-generation surgical robotic systems has introduced new possibilities for minimally invasive management by combining modular design, improved ergonomics, and enhanced visualization. This review analyzes current international evidence on the use of compact robotic platforms in advanced cholecystectomy, integrating clinical outcomes, learning-curve behavior, workflow feasibility, and human-factor considerations. The available literature demonstrates that robotic-assisted cholecystectomy achieves perioperative safety outcomes comparable to conventional laparoscopy, including rates of complications, bile duct injury, and mortality, even in complex disease contexts. Operative efficiency follows a characteristic learning curve, with early increases in operative time that progressively converge toward laparoscopic benchmarks as experience and workflow standardization increase. Importantly, robotic systems appear to reduce physical fatigue, ergonomic strain, and mental workload, factors closely related to stress regulation, cognitive performance, and surgeon well-being. These human-factor effects position robotic surgery at the intersection of technical innovation and psychiatry-adjacent considerations in surgical practice. From a systems perspective, compact robotic platforms demonstrate growing feasibility for integration into mid-resource healthcare settings, including those in Mexico, Colombia, and Ecuador, provided that structured training and governance frameworks are in place. Overall, compact fourth-generation robotic systems represent a safe, feasible, and human-centered advancement in advanced cholecystectomy, with implications for surgical quality, education, and professional sustainability.

Real-time fluorescence-guided surgery has become an increasingly important intraoperative tool in abdominal oncologic surgery, providing surgeons with dynamic visual information that supports critical decision-making during complex procedures. This review analyzes current evidence on fluorescence-guided imaging techniques, with particular emphasis on near-infrared fluorescence using indocyanine green and tumor-targeted probes, and explores their potential integration with assistive surgical technologies such as exoskeleton-based support systems. The available literature demonstrates that fluorescence guidance plays a central role in margin refinement, perfusion assessment, identification of critical anatomy, and detection of occult disease, thereby enhancing intraoperative precision and safety. Furthermore, recent studies highlight the importance of visualization workflows and interface design, underscoring the need to consider how surgeons interpret and act upon fluorescence-derived information in real time. From a workflow-oriented perspective, the combination of advanced imaging and biomechanical support may contribute to more consistent execution of fluorescence-informed decisions, particularly during prolonged and technically demanding oncologic procedures. This review contextualizes these findings within international surgical practice, with specific relevance to educational and clinical settings in Mexico, Colombia, and Ecuador. Overall, the evidence supports a holistic view of precision surgery in which fluorescence-guided imaging and assistive technologies function synergistically to enhance surgical performance, decision-making, and training in abdominal oncologic surgery.

Major surgery induces a complex physiological stress response characterized by metabolic disruption, systemic inflammation, and accelerated protein catabolism, all of which significantly influence perioperative outcomes. Despite advances in surgical and anesthetic techniques, postoperative complications and delayed recovery remain common, particularly among patients with reduced functional reserve, malnutrition, or metabolic vulnerability. In this context, immunometabolic and nutritional prehabilitation has emerged as a proactive strategy aimed at optimizing patients’ physiological condition prior to surgery. This narrative review analyzes current evidence on immunometabolic and nutritional prehabilitation in major surgery, with a specific focus on its relevance to anesthesiology and perioperative medicine. The review synthesizes data related to functional capacity, postoperative morbidity, hospital length of stay, and feasibility of implementation across different healthcare settings. Emphasis is placed on multimodal prehabilitation approaches that integrate structured exercise, nutritional optimization, and immunonutritional principles, as well as their alignment with Enhanced Recovery After Surgery (ERAS) protocols. The findings highlight consistent associations between comprehensive prehabilitation strategies and improved perioperative trajectories, including better preservation of functional capacity, reduced overall postoperative morbidity, and shorter hospitalization. Additionally, the review explores the applicability of these strategies within diverse healthcare systems, with particular consideration of Mexico, Colombia, and Ecuador. By framing prehabilitation as a core component of anesthesiology-led perioperative care, this work supports a shift toward preventive, patient-centered models aimed at enhancing surgical resilience and recovery.