Safety and feasibility of telesurgical robot assisted radical prostatectomy: prospective pilot study

OBJECTIVES: Our objective was to evaluate the feasibility, safety, and operational reliability of a standardized telesurgical robot-assisted radical prostatectomy (RARP) programme performed between two Belgian institutions. MATERIALS AND METHODS: This prospective pilot study included 20 patients undergoing RARP (10 telesurgical and 10 contemporaneous matched on-site reference procedures) performed between two Belgian institutions, AZORG Hospital and Orsi Academy. The primary endpoint was intraoperative safety, assessed using the European Association of Urology intraoperative adverse incident classification. Secondary endpoints included perioperative outcomes; postoperative recovery; pathological, biochemical, and functional outcomes; and telesurgery-specific technical parameters (network latency, system reliability, and surgeon-reported usability and workload). RESULTS: All telesurgical procedures were completed successfully without intraoperative adverse events or local takeover. Median operative time was 155 (interquartile range 140-180) min, and median estimated blood loss was 325 (interquartile range 200-400) mL. No major postoperative complications (Clavien-Dindo ≥3) occurred. Pathological, biochemical, and early functional outcomes following telesurgical RARP were within the range observed in the contemporaneous reference cohort. Mean network latency was 10.7 ± 5.3 ms, mean jitter was 4 ms, and packet loss remained below 0.05% throughout all procedures. One transient connection interruption occurred, without clinical consequences, and all procedures were completed successfully. Surgeon-reported usability and workload scores were favourable. CONCLUSION: This prospective pilot study provides early clinical evidence that telesurgical RARP can be safely implemented under stable low-latency conditions. These findings support the clinical applicability of telesurgery, providing a framework for larger-scale evaluations.