{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T08:24:46Z","timestamp":1787214286995,"version":"build-2736575974"},"reference-count":100,"publisher":"American Association for the Advancement of Science (AAAS)","funder":[{"DOI":"10.13039\/501100012165","name":"Key Technologies Research and Development Program","doi-asserted-by":"publisher","award":["No. 2024YFB4709903"],"award-info":[{"award-number":["No. 2024YFB4709903"]}],"id":[{"id":"10.13039\/501100012165","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["92248304, 52435005, 5187522,U22A20249"],"award-info":[{"award-number":["92248304, 52435005, 5187522,U22A20249"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100015286","name":"Hebei Provincial Key Research Projects","doi-asserted-by":"publisher","award":["2023BCB152, 2024BCA004"],"award-info":[{"award-number":["2023BCB152, 2024BCA004"]}],"id":[{"id":"10.13039\/501100015286","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Interdisciplinary Research Program of Huazhong University of Science and Technology","award":["2024JCYJ010, 2024JCYJ043, 2025JCYJ062"],"award-info":[{"award-number":["2024JCYJ010, 2024JCYJ043, 2025JCYJ062"]}]}],"content-domain":{"domain":["spj.science.org"],"crossmark-restriction":true},"short-container-title":["Research"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:p>Uterine fibroids pose a major global health burden, affecting approximately 120 million women worldwide. While minimally invasive surgeries, such as electromechanical morcellation, preserve fertility, they are severely hampered by the risk of unpredictable tissue dissemination\u2014a hazard that prompted a U.S. Food and Drug Administration black-box warning. Resolving this clinical dilemma requires a paradigm shift in instrument design. This review identifies a persistent \u201cmechanical blind spot\u201d: Current surgical tools operate with static parameters that fundamentally clash with the profound multi-scale mechanical heterogeneity of fibroids. Driven by FIGO-defined microenvironments and degeneration-driven remodeling, this extreme variability in tissue stiffness shapes the dynamic\u2014and often hazardous\u2014cutting challenges during surgery. To bridge this critical gap, we review the mechanobiological origins of this heterogeneity and analyze its direct impact on morcellation-induced fragmentation. We then synthesize multiscale mechanical quantification methods (ex vivo and in\u00a0vivo) and evaluate the evolution of instrument-optimization strategies. Moving beyond conventional structural refinements, we highlight the potential of bio-inspired end-effectors for safe tissue interaction. Crucially, we propose a technological roadmap integrating these physical mechanisms with artificial intelligence\u2014enabling preoperative \u201cmechanical mapping\u201d and real-time adaptive control. Taken together, this work offers new perspectives for the clinical management of this prevalent condition and provides a comprehensive theoretical framework for developing next-generation, mechanics-aware surgical ecosystems.<\/jats:p>","DOI":"10.34133\/research.1385","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T08:26:23Z","timestamp":1784103983000},"update-policy":"https:\/\/doi.org\/10.34133\/aaas_crossmark_01","source":"Crossref","is-referenced-by-count":0,"title":["Overcoming Mechanical Blindness: Adaptive Surgical Instrument Design for the Heterogeneous Landscape of Uterine Fibroids"],"prefix":"10.34133","volume":"9","author":[{"given":"Jixuan","family":"Liu","sequence":"first","affiliation":[{"name":"Institute of Medical Equipment Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."},{"name":"School of Mechanical Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, 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China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuwen","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Medical Equipment Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."},{"name":"School of Mechanical Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbin","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Medical Equipment Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."},{"name":"School of Mechanical Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukun","family":"Liu","sequence":"additional","affiliation":[{"name":"Institute of Medical Equipment Science and Engineering, \rHuazhong University of Science and Technology, Wuhan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyi","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, \rHuazhong University of Science and Technology, Wuhan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuidi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, \rHuazhong University of Science and Technology, Wuhan, China."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2469-1638","authenticated-orcid":true,"given":"Chaoyang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, \rHuazhong University of Science and Technology, Wuhan, 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