A randomized controlled trial of human versus robotic and telerobotic access to the kidney as the first step in percutaneous nephrolithotomy

Figures & data

Figure 1 The model.

Figure 2 The PAKY-RCM courtesy of the Urobotics laboratory, Johns Hopkins University, Baltimore.

Figure 3 Trial design.

Figure 4 Robot and model.

Table I.  Phantom validation: scored 1–10.

Feature/operator	US 1	US 2	US 3	UK 1	UK 2	UK 3	Median
Authenticity: general	8	9	6	9	9	8	8.5
Authenticity: macroscopic	7	8	5	8	8	8	8
Authenticity: radiographic	9	9	7	10	8	9	9
Authenticity: computerized	9	8	7	8	8	8	8
Feel: general	8	7	6	8	8	7	7.5
Feel: texture	8	7	4	8	7	8	7.5
Feel: resistance	8	7	4	8	8	8	8
Feel: entry into calyx	8	7	8	8	8	7	8
Degree of difficulty: Ease for human	9	8	5	8	7	7	7.5
Degree of difficulty: Ease for robot	9	8	9	8	7	8	8
Potential future use as a training tool	9	9	10	10	9	9	9
Recommendation to trainees	9	9	10	10	9	9	9
Median score for user	8.5	8	7	8	8	8	8

Table II.  Results for human against robot.

Operator	Number of human attempts	Median human insertion time (s) [95% CI]	First attempt success: human passes (%) [95% CI]	Number of robot attempts	Median robot insertion time (s) [95% CI]	First attempt success: robot passes (%) [95% CI]
1	20	63 [40, 80]	85 [62, 97]	20	48 [40, 60]	90 [68, 99]
2	40	33 [28, 38]	75 [59, 87]	40	55 [44, 63]	90 [76, 97]
3	40	30 [27, 38]	80 [64, 91]	40	59 [47, 65]	93 [80, 98]
4	20	43 [34, 79]	75 [51, 91]	20	61 [40, 90]	75 [51, 91]
5	2	98 [00, 00]	50 [00, 00]	2	96 [00, 00]	100 [00, 00]
Trans-Atlantic	30*	28 [24, 36]	77 [58, 90]	30	59 [48, 60]	83 [65, 94]
Total	N = 152	35 [31, 38]	79 [72, 85]	N = 152	57 [48, 60]	88 [81, 92]

*Human insertions: acting as the control for the trans-Atlantic robotic group, performed by a urologist in London.