Application of 5G robotic telesurgery in urology: a multicenter study in the real world.

Background: The current literature still lacks robust real-life evidence to support the practical implications of telesurgery. We conduct the current study to evaluate the safety and effectiveness of telesurgery over a high-speed remote communication network (the 5G network) in the real world.

Methods: A total of 37 patients were enrolled across the participating hospitals from December 2023 to June 2024. Patients underwent various telesurgeries including radical prostatectomy, partial nephrectomy and other urological surgeries. The primary end point is the success rate of remote surgery. The secondary end points include network transmission status, robot-assisted surgery time, intraoperative blood loss, subjective evaluation of intraoperative experience, postoperative PSA level, positive surgical margin. Other evaluation index includes the surgeon's physiological and psychological stress during surgery, equipment failure and adverse events as postoperative complications.

Results: The overall success rate for remote surgery was 100% [95% confidence interval (CI) 90.5-100, p = 0.019]. The mean network signal delay was 55.30 ± 39.64 ms. The total delay at the local and remote ends were 250.30 ± 39.64 ms and 249.78 ± 40.00 ms, respectively. The average packet loss rate was less than 0.01% at both ends. The evaluation of the remote surgeons' intraoperative experience excellent. A total of 6 adverse events occurred and none were related to the instruments of robot. No postoperative complications of Clavien-Dindo grade III-IV occurred. No serious or repairable equipment failure occurred at either the remote or local end.

Conclusions: It is feasible to perform urological telesurgery over the 5G high-speed remote communication network to overcome geographical barriers and improve patient care.