Safety and feasibility of robotic telesurgery in urological procedures: a systematic review and meta-analysis of clinical data

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Pooled proportion: 0.92 for procedural success; 0.12 for complication rate; 123.30 ms for mean round-trip latency

• Primary Outcome: Pooled procedural success rate (completion without conversion to local surgeon or alternative surgical approach): 0.92

• Nnt Or Sensitivity: No NNT calculable (no comparator group). RTL heterogeneity I² = 99.99%, indicating near-total between-study variance. No conversion to open or laparoscopic surgery reported across any included study.

• Confidence Interval: Procedural success: 95% CI 0.86–0.96; Complication rate: 95% CI 0.07–0.20; RTL: 95% CI 81.76–164.83 ms

Clinical Application

Technically feasible in controlled research and pilot clinical settings based on available evidence. Operational requirements — including dedicated fibre-optic or 5G network infrastructure, specialised robotic platforms (e.g., da Vinci, MUSA, or purpose-built telesurgery systems), trained bedside surgical teams, and regulatory frameworks for remote surgical practice — represent substantial barriers to routine implementation. The pooled RTL of 123.30 ms, while within proposed safety thresholds for some procedures, demonstrates extreme variability (I² = 99.99%), indicating that network performance cannot be assumed to be consistently safe across real-world deployment contexts. Robotic telesurgery is not currently approved or routinely practised in Australian clinical settings. The TGA has not issued specific guidance on telesurgery platforms as a distinct regulatory category, though robotic surgical systems (e.g., da Vinci) are TGA-registered medical devices. The PBS does not currently fund telesurgery-specific procedural items. RACGP and relevant specialist colleges (Urological Society of Australia and New Zealand, USANZ) have not issued clinical guidelines on telesurgery adoption. Australia's geographic context — with large rural and remote populations experiencing documented inequity in access to specialist urological care — makes telesurgery a theoretically compelling solution. However, the current evidence base is insufficient to support TGA regulatory submissions, PBS funding applications, or USANZ clinical guideline development. Australia's National Broadband Network (NBN) infrastructure variability and the emerging 5G rollout in regional areas are relevant technical considerations for future feasibility studies in the Australian context. Highly selected patients undergoing urological procedures at specialised centres with established robotic telesurgery infrastructure, experienced remote surgeons, and reliable high-bandwidth low-latency network connectivity. Not currently applicable to general urological practice populations.

Abstract

Robotic telesurgery has emerged as a potential solution to expand access to specialized surgical care; however, clinical evidence remains fragmented across procedures and robotic platforms. We conducted this meta-analysis to assess the feasibility and safety of robotic telesurgery across urological procedures. An electronic search was conducted on PubMed, Scopus, Web of Science (WoS) and the Cochrane Library from inception through April 2026 according to PRISMA guidelines. Clinical studies reporting robotic telesurgery in urology were included regardless of study design. The primary outcome of interest was procedural success, defined as completion without conversion to a local surgeon or an alternative surgical approach. Secondary outcomes included complication rates and round-trip latency (RTL). Nineteen studies involving 164 patients were included. The pooled procedural success rate was 0.92 (95% CI: 0.86-0.96). No conversions to open or laparoscopic surgery were reported across the included studies. The pooled complication rate was 0.12 (95% CI: 0.07-0.20), with events occurring in a limited number of studies. RTL data were available from 14 studies, with a pooled mean latency of 123.30 milliseconds (ms) (95% CI: 81.76-164.83) demonstrating substantial heterogeneity (I² = 99.99%). Robotic telesurgery in urology demonstrates excellent technical feasibility and a favorable short-term safety profile in carefully selected cases. However, variability in network performance and procedure-specific requirements remain important considerations. Further prospective studies with standardized reporting and long-term outcome assessment are needed before widespread clinical adoption can be recommended.

References

1. 1.Almazeedi, A. H., Abdelaziz, A., & Aldousari, S. (2026). Safety and feasibility of robotic telesurgery in urological procedures: a systematic review and meta-analysis of clinical data. Journal of Robotic Surgery. https://doi.org/10.1016/j.clineuro.2020.106152