Nelson David Viveros Garcia

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.

Augmented reality (AR) has emerged as a promising adjunct technology in microsurgery, offering new possibilities to enhance three-dimensional visualization and technical precision during vascular anastomosis. Microsurgical procedures are inherently constrained by limited depth perception, narrow fields of view, and high demands on fine motor control, making even minor spatial errors clinically significant. This review synthesizes current evidence on the application of AR-assisted microsurgery, with a particular focus on its impact on precision, spatial orientation, depth perception, procedural efficiency, and educational utility. The analysis integrates findings from experimental validation studies, training-oriented investigations, and early clinical feasibility reports, highlighting consistent patterns across diverse AR platforms. Results indicate that AR most reliably improves precision and alignment during microvascular tasks, especially when visualization cues are tightly integrated into operative microscopy. Depth perception enhancement is frequently reported but remains dependent on overlay design and system stability, while efficiency outcomes show greater variability. In educational settings, AR demonstrates meaningful benefits in skill acquisition and task repeatability among trainees. Nevertheless, persistent technical and workflow-related constraints—such as registration accuracy, interface burden, latency, and setup complexity—continue to limit widespread adoption. Overall, AR should be regarded as a precision-enhancing support tool that complements microsurgical expertise rather than replacing it. Continued refinement in system integration, human–machine interaction, and standardization of outcome metrics will be essential to advance its role in microsurgical vascular anastomosis.