title: A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy.
abstract: OBJECTIVE
  We present results from the first randomized controlled trial of human vs. telerobotic access to the kidney during percutaneous nephrolithotomy.
  
  
  METHODS
  To 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.
  
  
  RESULTS
  All 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.
  
  
  CONCLUSIONS
  Telerobotics is an accurate and feasible tool for future minimally invasive surgery.
authors.affiliation: Department of Urology, Guy's Hospital, London, UK.
authors.forename: Ben
authors.initials: B
authors.lastname: Challacombe
authors.forename: Alexandru
authors.initials: A
authors.lastname: Patriciu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Glass
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Tom
authors.initials: T
authors.lastname: Jarrett
authors.forename: Fernando
authors.initials: F
authors.lastname: Kim
authors.forename: Peter
authors.initials: P
authors.lastname: Pinto
authors.forename: Dan
authors.initials: D
authors.lastname: Stoianovici
authors.forename: Nigel
authors.initials: N
authors.lastname: Smeeton
authors.forename: Richard
authors.initials: R
authors.lastname: Tiptaft
authors.forename: Louis
authors.initials: L
authors.lastname: Kavoussi
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D002983:Clinical Competence; D006801:Humans; D016014:Linear Models; D009339:Needles; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation*; D012371:Robotics / Q000295:instrumentation*; D018709:Statistics, Nonparametric; D017216:Telemedicine / Q000295:instrumentation*; D016896:Treatment Outcome