Telesurgery vs. Robotic Surgery: Innovations in Urologic Oncology

A randomized, multicenter non-inferiority trial found remote telesurgery to be non-inferior to local robotic surgery for radical prostatectomy and partial nephrectomy, with a point-estimate difference in surgical success probability of 0.02.

These findings indicate comparable short-term procedural success, complication rates, early recovery, and short-term oncological outcomes between groups, while longer-term oncologic outcomes, cost-effectiveness, training, and sociological impacts were not assessed.

The trial randomly assigned patients undergoing radical prostatectomy or partial nephrectomy to remote telesurgery or standard local robotic surgery. Its protocol included a clearly prespecified non-inferiority margin of an absolute 0.1 reduction in surgical success probability, supporting the primary comparative finding.

System testing spanned distances of approximately 1,000 km to 2,800 km and monitored network latency, display latency, and frame loss alongside operative metrics. Platform stability, low frame loss, and consistent performance were observed during procedures, supporting technical feasibility of telesurgery over distances up to 2,800 km on dedicated, well-provisioned networks.

Key limitations persist: absence of long-term oncologic outcome data beyond six weeks; uncertain cost-effectiveness and broader health-economic impact; workforce training and competency maintenance requirements; undefined credentialing pathways; and unresolved medico-legal and regulatory considerations. Each area requires targeted study and multidisciplinary policy development before widespread implementation.

For health systems and surgical programs, priorities include establishing clear credentialing and training standards, staged implementation with monitored rollout, and structured outcome tracking to evaluate longer-term clinical, economic, and system-level effects alongside patient safety.

Key Takeaways:

• What’s new? A randomized, multicenter comparison found telesurgery non-inferior to local robotic surgery for radical prostatectomy and partial nephrectomy.
• Who’s affected? Patients served by tertiary urology programs and surgical teams responsible for remote case selection, credentialing, and oversight.
• What changes next? Hospitals should prioritize infrastructure, credentialing, staged rollouts, and ongoing outcome monitoring to assess long-term outcomes and cost implications.