Is robotic colorectal surgery worth the cost? An umbrella review integrating clinical outcomes, learning curve, and economic evidence.

In recent decades, veterinary and human medicine have witnessed a remarkable rise in life expectancy, driven by advances in healthcare access, nutrition, diagnostics, and therapeutics (Leulier et al. ). While this progress has greatly improved the quality of life, it has also led to an increased prevalence of chronic, progressive neurodegenerative disorders in humans and companion animals (Van Schependom and D’Haeseleer ). Among companion animals, canine cognitive dysfunction (CCD) is one of the most common age-related neurological conditions (Chapagain et al. ). CCD exhibits several clinically and biologically relevant parallels to Alzheimer’s disease (AD), not only in the clinical signs, but also in neuropathological features. Clinical manifestations of CCD are commonly summarized by the DISHAA acronym and include disorientation, altered social interaction, sleep-wake cycle disturbances, house soiling, changes in activity levels, and anxiety (Landsberg et al. ). Pathological hallmarks include β-amyloid (Aβ) deposition in the brain parenchyma and vasculature, tau hyperphosphorylation and aggregation, synaptic loss, and progressive cognitive impairment (Ruehl et al. ). Importantly, dogs share similar neuroanatomy, comparable environmental exposures, and lifestyle influences with their human caregivers. These characteristics make the aging dog a highly relevant spontaneous translational model for elucidating mechanisms that drive human dementia and for evaluating novel diagnostic and therapeutic strategies (Devinsky et al. ). Epidemiological data indicate substantial variation in CCD prevalence, with estimates ranging from ~ 14% to ~ 65% among older dogs and increasing sharply with age (Figueroa et al. ; Salvin et al. ). This wide range likely reflects differences in study design, populations, and diagnostic approaches, as clinical diagnosis currently relies on behavioral history, neurological examination, and the application of validated instruments such as the Canine Dementia Scale (CADES) (Madari et al. ) and the Canine Cognitive Dysfunction Rating Scale (CCDR) (Salvin et al. ). Complementary assessments, including routine laboratory testing, cerebrospinal fluid (CSF) analysis, and magnetic resonance imaging, help exclude other causes of cognitive decline and detect age-related neuroanatomical alterations (Ehrenzweig and Hunter ).