{
  "abstract": "Abstract Objective To investigate whether the reliability of telesurgery is non-inferior to that of standard local surgery in patients undergoing urological robotic operations.Design Multicentre, non-inferiority, randomised controlled trial.Setting Five hospitals in China from December 2023 to June 2024.Participants Patients scheduled to undergo radical prostatectomy or partial nephrectomy.Interventions Patients were randomly assigned 1:1 to undergo telesurgery or local surgery.Main outcome measures The primary outcome was the probability of success of surgery, determined by the medical team on the basis of pre-established criteria. The pre-specified non-inferiority margin was an absolute reduction in probability of 0.1. Thirteen clinical secondary outcomes were associated with the operation and early recovery, and one secondary outcome related to the workload of the medical team. Four technical secondary outcomes for the surgical system were also explored, including network latency, display latency, frame loss during telesurgery, and system malfunction. The participants were followed up at four and six weeks postoperatively for the secondary outcomes of recovery and complications.Results A total of 72 participants were enrolled in the study and randomised 1:1 to the telesurgery group and the local surgery group for the intention-to-treat set. The median age of patients was 61.0 (interquartile range 57.5-68.0) years in the telesurgery group and 65.0 (56.5-70.0) years in the local surgery group. Telesurgery was not inferior to local surgery in terms of the probability of surgical success in the intention-to-treat population, accounting for clustering by surgeon (success probability difference 0.02 (95% credible interval −0.03 to 0.15) with bayesian posterior probability of 0.99 for non-inferiority). The telesurgery system was stable with a distance from 1000 km to 2800 km, a mean round trip network latency of 20.1-47.5 ms, and frame loss of 0-1.5 per telesurgery. Secondary outcomes, including operative basic data, complications, early recovery, oncological outcome, and medical team workload, did not differ substantially between the two groups.Conclusions The reliability of telesurgery was non-inferior to that of local robotic surgery according to the non-inferiority margin of a 0.1 reduction in success probability.Trial registration ChiCTR.org ChiCTR2300077721.",
  "authors": [
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Ye Wang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"
      ],
      "name": "Dan Xia"
    },
    {
      "affiliations": [
        "Department of Urology, Harbin Medical University Cancer Hospital, Harbin, China"
      ],
      "name": "Wanhai Xu"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"
      ],
      "name": "Mulati Rexiati"
    },
    {
      "affiliations": [
        "Shenzhen Edge Medical Co, Shenzhen, China"
      ],
      "name": "Wuyi Zhao"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Qingbo Huang"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Taoping Shi"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Baojun Wang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"
      ],
      "name": "Shuo Wang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China"
      ],
      "name": "Sheng Tai"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"
      ],
      "name": "Bingzhang Qiao"
    },
    {
      "affiliations": [
        "Department of Urology, Harbin Medical University Cancer Hospital, Harbin, China"
      ],
      "name": "Yubai Zhang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"
      ],
      "name": "Sunyi Ye"
    },
    {
      "affiliations": [
        "Shenzhen Edge Medical Co, Shenzhen, China"
      ],
      "name": "Xiangping Zhang"
    },
    {
      "affiliations": [
        "Shenzhen Edge Medical Co, Shenzhen, China"
      ],
      "name": "Jianle Mao"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"
      ],
      "name": "Yi Zhu"
    },
    {
      "affiliations": [
        "Department of Urology, Harbin Medical University Cancer Hospital, Harbin, China"
      ],
      "name": "Honglei Wang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"
      ],
      "name": "Shuangyu Ma"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China"
      ],
      "name": "Cheng Yang"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Weijun Fu"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Tao Song"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Qing Ai"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Yong Song"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, The Third Center of Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Longhe Xu"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Guoqiang Yang"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Yu Gao"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Shaoxi Niu"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Jing Guo"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Guojun Liu"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Xueyuan Xiang"
    },
    {
      "affiliations": [
        "Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China"
      ],
      "name": "Chaozhao Liang"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Xin Ma"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Hongzhao Li"
    },
    {
      "affiliations": [
        "Department of Urology, Chinese PLA General Hospital, Beijing, China"
      ],
      "name": "Xu Zhang"
    },
    {
      "affiliations": [],
      "name": "on behalf of the TeleS Research Group"
    }
  ],
  "title": "Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial",
  "uid": "674d6b9a-5f32-5ff9-9db3-7ae7aa172f21"
}