| Objective: To understand the current acceptance of telesurgery and telemedicine by urologists in different regions of China and to analyze the influencing factors,as well as to to obtain suggestions for the current development of telesurgery in China.Methods: A Telesurgery/Telemedicine Awareness,Knowledge,Attitude Questionnaire(TAKA Questionnaire)was designed and distributed to members of the Youth Committee of the Urology Branch of the Chinese Medical Association to design a survey on peer physician recognition of telesurgery/telemedicine services.The internal consistency of the scale was verified using the Cronbach’s alpha reliability coefficient in the scale section.Independent samples t-test was used for comparison between two groups of data;one-way ANOVA analysis was used for comparison between multiple groups of data,followed by LSD and S-N-K test for multiple comparisons.Person correlation analysis was performed between the dimensions;P < 0.05 indicated that the differences were statistically significant.Concerns and suggestions raised in the survey population were summarized and collated.Results: A total of 50 members of the Youth Committee of the Urology Branch of the Chinese Medical Association participated in this questionnaire from urology departments of 50 regional diagnosis and treatment center in 29 provinces,autonomous regions,or municipalities directly under the central government.16(32%)of the physicians indicated that they had participated in training related to telemedicine,while the remaining 34(68%)physicians had not.42(84%)physicians indicated that their medical centers had participated in training related to telemedicine.Forty-two(84%)of the physicians indicated that their medical center had a telemedicine department,and 8(16%)indicated that their medical center did not have a telemedicine department.Thirty-three(66%)physicians expressed a very positive attitude toward future telesurgery-related training;17(34%)physicians expressed no interest in learning more about telesurgery.Those who had participated in previous telemedicine related training,had a telemedicine department at their institution,and were willing to participate in future telesurgery training had higher total scores on the awareness dimension,those who had a telemedicine department at their institution had higher scores on the knowledge dimension,and those who were willing to participate in future telesurgery related training had higher scores on the attitude dimension;both the awareness dimension and the total attitude score were positively correlated(r=0.357,p=0.011).Conclusion: A significant proportion of physicians have not participated in telemedicine related training or even been exposed to telemedicine.And as the least popular form of telemedicine,the recognition of telesurgery in China needs to be improved.Increasing the number of telemedicine departments in medical institutions and conducting training related to telesurgery could help improve the acceptance of telesurgery by urologists in China.Objective: To investigate the feasibility and safety of remote laparoscopic adrenalectomy using a domestic surgical robot based on 5G wireless network communication technology,and to analyze its related influencing factors.Methods: The surgeon in the Affiliated Hospital of Qingdao University operates the “master system” of the "Micro Hand S" surgical robot and remotely controls the“slave system” in different cities in Shandong Province to perform adrenalectomy.The operating and video signals between the two systems are transmitted via a 5G wireless network.General information of patients,Intraoperative network status,and perioperative related information were collected.Correlation analysis was done on the collected data.Results: A total of 15 patients with adrenal tumors were recruited for this study,with a mean age of 58.0 ± 7.9 years;9(60%)undergoing left adrenalectomy and 6(40%)undergoing right adrenalectomy.The network latency for the 15 telesurgeries was 32.53 ± 7.75 ms,and a total of 6 adverse events related to wireless network fluctuations were recorded,but none of them had adverse consequences for the surgery;the teleoperate time was 48.6 ± 18.07 min,the blood loss was 25.63±17.30 ml.The NASA-TLX score of the surgeon was 65±17.65.The VAS score within 24 hours after surgery was 1.73±1.16,the Clavien-Dindo classification were all grade I.The sequence of telesurgery performed by the surgeon was negatively correlated with teleoperate time(r=-0.556,P= 0.031),with blood loss(r=-0.514,P= 0.050),and with the surgeon’s NASA-TLX score(r=-0.598,P= 0.018);There is a positive correlation between the magnitude of the time delay of a 5G wireless network and the network transmission distance.(r= 0.547,P= 0.035)Conclusion: We have demonstrated the feasibility and safety of remote robot-assisted laparoscopic adrenalectomy based on a 5G technology,but this conclusion has some limitations.Key factors affecting remote robot-assisted laparoscopic surgery include the quality of the 5G wireless network,the performance of the surgical robot,and surgical skills of the surgeon. |
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