identified by PROBAST assessment, particularly lack of external inadequate handling of missing data and validation. Fourth, the rapid evolution of ML techniques means that some findings may quickly beco

The gap

Consensus across the literature

Supporting evidence — 5 representative gaps

• Comparative Outcomes of Minimally Invasive Surgical Approaches on Patient Recovery: A Systematic Review (2026) · doi

  The current review has a few limitations. Although the database search was updated through May 2026, no additional studies published during the updated search period met all eligibility criteria for inclusion in the final synthesis. Nevertheless, minimally invasive, robotic-assisted, and AI-supported surgical technologies continue to evolve rapidly. Therefore, studies published after the final May 2026 search date were not captured, and periodic evidence updates will remain necessary. There was substantial heterogeneity in the included studies, including surgical procedure, patient population, outcome definitions, and reporting methods, which made direct comparison difficult and prevented quantitative meta-analysis. The inclusion of both randomized and observational studies may also have introduced variability in methodological quality and risk of bias. English-language restriction may have caused language bias, which is difficult to remove completely because relevant studies published in other languages may not be indexed, accessible, or consistently translated for inclusion in the review process. Differences in surgeon experience, institutional guidelines, infrastructure availability, and implementation of enhanced recovery pathways also affect outcomes and limit generalizability. Another limitation was the inconsistency of statistical reporting across included studies. Not all studies reported comparable effect estimates, confidence intervals, or p-values for the same recovery outcomes, which limited standardized quantitative comparison. To avoid selective or misleading statistical emphasis, this review used narrative SWiM synthesis rather than pooled quantitative reporting. Future procedure-specific reviews with more homogeneous data should consider meta-analysis or subgroup synthesis where appropriate. Altogether, although MIS has demonstrated clear advantages in improving short-term postoperative outcomes, the diversity of existing evidence and inconsistency in outcome reporting suggest the need for additional high-quality and standardized studies [14]. Future research should prioritize well-designed multicenter randomized controlled trials with standardized outcome measures to improve comparability. 2026 Rathod et al. Cureus 18(5): e109163. DOI 10.7759/cureus.109163 11 of 14 Greater focus is also needed on long-term outcomes, complication-specific endpoints, cost-effectiveness, patient-reported measures, and return to work. The use of new technologies, including robotics and AI- assisted surgery, should be evaluated across diverse clinical practices. Standardized reporting frameworks and procedure-specific analyses would strengthen the evidence base and support more precise clinical decision-making.

  Keywords: reporting outcomes standardized review search published inclusion synthesis evidence procedure outcome quantitative specific updated additional
• From data to decisions: machine learning in predicting outcomes of robotic-assisted total knee arthroplasty (2026) · doi

  identified by PROBAST assessment, particularly lack of external inadequate handling of missing data and validation. Fourth, the rapid evolution of ML techniques means that some findings may quickly become outdated. Fifth, publication bias may have favored studies reporting positive results. Finally, the focus on English-language publications may have introduced selection bias. Additionally, no validated prediction model currently incorporates real-time intraoperative data from robotic systems, representing a critical gap that limits the ability to provide dynamic, intraoperative risk assessment during RA-TKA procedures.

  Keywords: assessment bias intraoperative identi probast particularly lack external inadequate handling missing validation fourth rapid evolution
• Diathermy and TECAR Therapy for Lateral Elbow Tendinopathy: A Systematic Review of Randomized Controlled Trials (2026) · doi

  This systematic review has several limitations. Only two randomized controlled trials met the inclusion criteria, lim- iting the strength and generalizability of the findings. The small number of included studies and the relatively limited total sample size reduce the robustness of the conclusions and increase the uncertainty of the evidence. The search strategy was limited to a small number of databases, and additional sources such as Embase, PEDro, and CEN- TRAL were not included, potentially reducing the search’s comprehensiveness. Substantial heterogeneity was observed across studies in intervention protocols, co-interventions, outcome measures, and follow-up durations. This heterogeneity restricts direct comparisons between studies and limits the ability to draw consistent conclusions. The search strategy did not include all major databases, and grey literature was not systematically searched, which may increase the risk of publication bias. Furthermore, only English-language studies were included, potentially intro- ducing language bias. Additionally, the inclusion of studies where diathermy- based interventions were combined with other treatments Page 7 of 8 206 limits the ability to isolate their specific effects. Finally, the absence of protocol registration (e.g., PROSPERO) may increase the risk of reporting bias. The lack of a for- mal GRADE assessment further limits the transparency in evaluating the certainty of the evidence. A formal GRADE assessment of the certainty of evi- dence was not performed, which may limit the transparency of evidence appraisal. However, based on key domains such as risk of bias, inconsistency, and imprecision, the overall certainty of evidence is considered low to very low. Addi- tionally, the limited number of databases searched may have reduced the review’s comprehensiveness and increased the risk of missing relevant studies.

  Keywords: evidence risk bias number included limited increase search databases limits certainty review inclusion small conclusions
• Emerging robotic platforms in partial nephrectomy: a comparative systematic review and network meta-analysis (2026) · doi

  This study is subject to several important limitations that should be considered when interpreting the findings. The overall strength of evidence is limited by the predominance of observational studies and relatively small sample sizes across included reports. Substantial heterogeneity was observed for key outcomes, likely reflecting differences in surgeon experience, tumor complexity, surgical approach, and institutional practices, which reduces the reliability of pooled estimates. In addition, many studies represent early experiences with emerging robotic platforms, introducing potential learning-curve and early adoption bias, as these technologies are often implemented in high-volume centers by experienced surgeons. Follow-up duration was generally short, and important long-term outcomes, including oncologic control and renal functional preservation, were inconsistently reported. Sev- eral clinically relevant endpoints, such as complications and oncologic outcomes, could not be quantitatively syn- thesized due to heterogeneous definitions and reporting practices, and were therefore assessed descriptively. Fur- thermore, the lack of standardized reporting across studies limited the ability to perform subgroup or meta-regression analyses, particularly for factors such as tumor complexity and surgeon expertise. Tumor complexity represents a major determinant of perioperative outcomes in RAPN. Although R.E.N.A.L. nephrometry scores were reported in several included stud- ies, reporting was heterogeneous and incomplete, preventing 1 3Journal of Robotic Surgery (2026) 20:518  518 Page 14 of 15 formal stratified analyses or meta-regression based on tumor complexity. Consequently, differences observed between robotic platforms may partly reflect variation in case mix rather than intrinsic platform-related performance. Finally, cost-effectiveness data were largely unavailable, despite their critical importance in evaluating the broader adoption and sustainability of emerging robotic platforms in clinical practice. Furthermore, the absence of cost-effec- tiveness data highlights an important gap in the available literature. Also, industry-sponsored studies on comparisons between robotic systems may introduce potential biases, as they often favor the sponsor’s platform, limiting the gen- eralizability of our findings. Despite these limitations, our study provides valuable insights into the current and emerg- ing robotic platforms for RAPN and lays the groundwork for future research and clinical practice.

  Keywords: robotic outcomes tumor complexity platforms important reporting several limitations limited across included observed differences surgeon
• Transforaminal Endoscopic Lumbar Discectomy Versus Interlaminar Endoscopic Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review of Clinical Outcomes, Quality of Life, and Surgical Selection Strategies (2026) · doi

  : The Role of Emerging Technolo- gies. The technical barriers identified in this review, such as the “high iliac crest” in TELD, are being addressed by AI- driven navigation and robotic assistance.14 Furthermore, recent protocols suggest that combining TELD for L4-L5 and IELD for L5-S1 in a single session can optimize patient outcomes while minimizing the surgical footprint. Stan- dardized reporting protocols like PRISMA-P will be essen- tial for validating these innovations. Limitations: This review was restricted to four major electronic databases and English-language peer-reviewed articles, which may lead to the omission of relevant grey literature. Our strict inclusion requirement for a minimum of 20 patients per study may have excluded smaller, in- novative trials on endoscopic modifications. Additionally, this review was not prospectively registered (e.g., on PROS- PERO), which may limit initial protocol transparency. a for- mal meta-analysis was not performed. While 31 studies met the inclusion criteria, fewer than 20 reported sufficient sta- tistical information (means, standard deviations, or con- fidence intervals) to enable quantitative synthesis. Addi- tionally, heterogeneity in outcome measurement tools and follow-up durations across studies limited direct compari- son of TELD and IELD. Consequently, only narrative syn- thesis is presented.

  Keywords: review teld protocols ield inclusion role emerging technolo gies technical barriers identified high iliac crest