• Ben Challacombe, Alexandru Patriciu, Jonathan Glass, Monish Aron, Tom Jarrett, Fernando Kim, Peter Pinto, Dan Stoianovici, Nigel Smeeton, Richard Tiptaft, Louis Kavoussi, and Prokar Dasgupta.
• Department of Urology, Guy's Hospital, London, UK.
• Comput. Aided Surg. 2005 May 1;10(3):165-71.

ObjectiveWe present results from the first randomized controlled trial of human vs. telerobotic access to the kidney during percutaneous nephrolithotomy.MethodsTo compare (a) human with robotic percutaneous needle access and (b) local robotic with trans-Atlantic robotic percutaneous needle access, we used a validated kidney model into which a needle was inserted 304 times. Half the insertions were performed by a robotic arm and the other half by urological surgeons. Order was decided randomly except for a sub-group of 30 trans-Atlantic robotic procedures that were controlled by a team at Johns Hopkins, Baltimore, via four ISDN lines.ResultsAll attempts were successful within three passes with a median time of 35 s for human attempts compared with a median of 57 s for robotic attempts. The robot was slower than the human to complete insertions (p < 0.001, Mann-Whitney U test), but was more accurate when compared with human operators as it made fewer attempts (88% robotic vs. 79% human first attempt success; p = 0.046, chi-squared test). Times for trans-Atlantic robotic needle insertion (median = 59 s) were comparable to times taken for local robotic needle insertion (median = 56 s) with no difference in accuracy.ConclusionTelerobotics is an accurate and feasible tool for future minimally invasive surgery.

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