Patients
Between October 2023 and April 2024, 201 patients who received urologic surgeries with the KD surgical robot or DV robotic system were included in the study. The inclusion criteria contained: 1) aged over 18 years; 2) received urologic surgeries with KD surgical robot or DV robotic system; 3) American Society of Anesthesiologists (ASA) score of I or II; 4) had complete clinical data for the study analysis. The exclusion criteria contained: 1) previously received abdominal surgery; 2) pregnancy or lactation. The study had the approval from the Ethics Committee. Each patient or his/her family member signed informed consent.
Treatment
Patients received urologic surgeries with a KD surgical robot or DV robotic system according to the actual disease condition, patient willingness, and the surgeon's advice. Then, patients were divided into the KD group and the DV group. The urologic surgeries included nephrectomy, cystectomy, prostatectomy, adrenalectomy, and others. The surgeries were conducted by surgeons who were adequately trained in standardized surgical techniques. The KD surgical robot was shown in Figure 1A-D.
The KD surgical robot was emerging as a promising technology in China, and a KD surgical robot-assisted prostatectomy was described in detail in the following section as an example. The subumbilical incision was made into the rectus sheath, and the extraperitoneal space was extended under the rectus abdominis. Following the incision of the endopelvic fascia, the dorsal venous complex was sutured and ligated (Figure 2A), and the puboprostatic ligaments were suspended. After determining the interface between the prostate and bladder neck, the anterior bladder neck was separated with a monopolar scissor (Figure 2B). The seminal vesicles were then dissected (Figure 2C), exposing the rectoprostatic fascia. The seminal vesicle was retracted, revealing the ipsilateral neurovascular pedicle. The prostatic pedicles were then clipped and detached (Figure 2D). The urethra was subsequently split (Figure 2E), and posterior musculofascial repair was performed. The vesicourethral anastomosis was done using two barbed sutures (Figure 2F). Finally, the decision of lymph node dissection was made based on preoperative magnetic resonance. For other urologic surgeries performed with KD surgical robot assistance, the operations were also conducted and were detailed in previous reports [16]. The detailed elaboration of operations with DV robotic system assistance was not described in the study due to its established use, which could be found in the previously published study [22].
Data collection and assessment
The clinical characteristics of patients were collected, which contained: 1) basic characteristics: age, sex, diagnosis, and surgical type; 2) intraoperative and perioperative parameters: operation time, intraoperative blood loss, intraoperative blood transfusion, drainage volume within 24h after surgery, urine output within 24h after surgery, indwelling time of abdominal drainage tube, time to first flatus, and length of stay; 3) postoperative biochemical indexes: urea nitrogen, serum creatinine, white blood cell, and neutrophil percentage; 4) complications: infection, fever (defined as body temperature >38.5 ℃ for at least 3 days), acute kidney injury, and uracratia; 5) postoperative and follow-up information: time of uracratia improvement, administration of hemostatic, pain numeric rating scale (NRS) score at 1st day after surgery (D1), Barthel's index score at 3rd day after surgery (D3), and patient satisfaction. Pain NRS score ranged from 0-10, with a higher score indicating a higher pain level. Barthel’s index score was used for self-care assessment with a range of 0-100, and a higher score indicated a better self-care ability [23]. Patient satisfaction was assessed with a 5-point Likert scale, including very satisfied, satisfied, neutrality, unsatisfied, and very unsatisfied [24].
Statistics
SPSS v.26.0 (IBM, USA) was used for analyses. The clinical data were shown using mean±standard deviation, median (range), or No. (percentage). The comparisons were analyzed accordingly using a t-test, Wilcoxon rank sum test, or Chi-square test or Fisher’s exact test. P <0.05 indicated statistical significance.