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Application of 5G-powered robot-assisted teleultrasound diagnostic system in percutaneous nephrolithotomy under the one-to-many mode: ensuring safety, enhancing efficacy, and advancing surgical training #MMPMID41231269
Lu R; Zhou X; Xu Z; Chen S; Wu W; Jiang K; Tian J; Wubuli M; Shao Y; Xie G; Yu Q; Wang F; Zhai R; Yang J; Song N
World J Urol 2025[Nov]; 43 (1): 689 PMID41231269show ga
OBJECTIVE: This study investigates the safety, efficacy, and educational potential of the 5G-powered robot-assisted teleultrasound diagnostic system (RTDS) for guiding percutaneous nephrolithotomy (PCNL) in a one-to-many telemedicine model, addressing medical resource disparities in remote regions. METHODS: Forty-five patients with complex kidney stones (Guy's Stone Scores III-IV) underwent RTDS-assisted PCNL across multiple regions (Xinjiang, Chongqing, Liyang, Suqian), with a maximum distance of 5800 km. Experts from the First Affiliated Hospital of Nanjing Medical University remotely operated the RTDS to assist local surgeons in establishing percutaneous renal access. Primary endpoints included one-session stone-free rate (SFR), first puncture success rate, and Clavien-Dindo complication rate. Secondary endpoints, such as operative time and hemoglobin drop, were also evaluated. Subjective assessments of surgeon workload and emotional state were conducted using the NASA Task Load Index (NASA TLX) and Medical Emotion Scale (MES). For contextual comparison, a systematic review and meta-analysis of published studies on conventional ultrasound-guided PCNL was conducted. RESULTS: The one-session stone-free rate (SFR) reached 80%, with a first-puncture success rate of 76.9%. No complications above grade II were observed, and the complication rate (8.9%) was lower than traditional ultrasound-guided PCNL (16%). Meta-analysis revealed RTDS had comparable SFR but superior safety and first puncture success rates. Surgeons reported reduced intraoperative workload and heightened confidence, underscoring RTDS's educational utility. The one-to-many telemedicine mode exhibited stable performance, facilitating simultaneous real-time guidance for multiple surgeries in geographically dispersed locations. CONCLUSIONS: The 5G-powered RTDS is a safe, effective, and innovative tool for guiding PCNL. It not only bridges healthcare disparities by providing high-quality medical services in remote regions but also enhances the training of junior surgeons, promoting the equitable development of advanced surgical techniques. This study primarily reports original prospective clinical data. The supplementary meta-analysis serves only as contextual reference and should not be interpreted as a substitute for randomized controlled trials.
World+J+Urol 2025 ; 43 (1): 689
