Rigor Reviewed

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Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial.

Name: Adcurare Rigor Record — Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial.
Item: Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial.
Rating: 96
Author: Adcurare

Wang Y, Xia D, Xu W, Rexiati M, Zhao W, Huang Q, Shi T, Wang B, Wang S, Tai S, Qiao B, Zhang Y, Ye S, Zhang X, Mao J, Zhu Y, Wang H, Ma S, Yang C, Fu W, Song T, Ai Q, Song Y, Xu L, Yang G, Gao Y, Niu S, Guo J, Liu G, Xiang X, Liang C, Ma X, Li H, Zhang X, TeleS Research Group

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Adcurare Rigor Review — 4.75★ (Strong), 0 critical, 2 high issues for “Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial.”

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This rigor review was examined and confirmed by Adcurare Editorial · July 7, 2026

Adcurare Rigor Review

Rigor Reviewed

4.75 / 5

Strong — minor issues to address

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

ReportingData & code availability partially met−0.25★

Model-reported confidence: highReviewer agreement: moderateEngine: 7.6.0Source: full text

Problems surfaced1 type

Data/code availability incomplete

This Adcurare Rigor Review uses AI Rigor Reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.

This is a well-conducted and well-reported non-inferiority RCT comparing telesurgery to local robotic surgery. The scientific premise, study design, biological variables, key resources, statistical analysis, and reporting transparency are all robust. Two minor reporting gaps—a missing regulatory compliance statement and code-only-in-supplementary-materials—lower the overall score but do not threaten the paper's validity.

Evaluated as an interventional human RCT. All eight dimensions were applicable. Reviewers 2 and 3 flagged the code-sharing and ethics-statement gaps, which the synthesis adopted. The statistics verification component re-computed 3 tests (all consistent); coverage is limited to tests with a test statistic + df or effect estimate + CI. No citation integrity issues (0 retracted, 0 not found). Two data/code links were checked and both were live.

9 major claims checked against the paper's own evidence: all adequately supported.

Recomputed 3 tests: 3 consistent, 0 inconsistent, 3 via agent-written checks.

Reporting

Eight Dimensions7 pass · 1 warn

The introduction cites prior feasibility studies and the 2001 trans-Atlantic cholecystectomy, discusses weaknesses of prior work (e.g., 'prioritised technical novelty over clinical rigour', 'limited to single-arm uncontrolled studies or case reports'), and logically links the gap to the study's non-inferiority hypothesis. The limitations of prior research, including the lack of randomised controlled trials, are explicitly addressed.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The scientific premise is well established, with clear citation of prior work, a logical rationale linking the research gap to the study objectives, and acknowledgement of limitations of prior research.

Evidence

direct quote[Introduction, paragraphs 1-4]

“Early milestone, such as the 2001 trans-Atlantic cholecystectomy, prioritised technical novelty over clinical rigour.”

direct quote[Introduction, paragraph 4]

“Therefore, we designed this randomised controlled trial in patients undergoing robotic urological procedures (radical prostatectomy or partial nephrectomy) to determine whether telesurgery is non-inferior to standard local surgery...”

direct quote[Discussion, 'Comparison with other studies']

“Previous clinical trials have been limited to single arm uncontrolled studies or case reports, thus failing to provide robust evidence.”

PASSReviewer 2· 95% conf

The scientific premise is well-established with clear rationale, prior work cited, and limitations of prior research acknowledged.

Evidence

direct quote[Introduction, paragraph 3]

“Early milestone, such as the 2001 trans-Atlantic cholecystectomy, prioritised technical novelty over clinical rigour.”

direct quote[Introduction, paragraph 4]

“However, previous studies, including our exploratory trial, focused on feasibility in narrow indications, and no clinical evidence has been established to support further research or the wider application of telesurgery.”

direct quote[Introduction, paragraph 4]

“Therefore, we designed this randomised controlled trial ... to determine whether telesurgery is non-inferior to standard local surgery”

PASSReviewer 3· 95% conf

The paper thoroughly establishes the scientific premise by citing prior work on telesurgery, acknowledging its limitations, and providing a clear rationale for the trial.

Evidence

direct quote[Introduction, paragraph 3]

“Early milestone, such as the 2001 trans-Atlantic cholecystectomy, prioritised technical novelty over clinical rigour.”

direct quote[Introduction, paragraph 3]

“Therefore, we designed this randomised controlled trial ... to determine whether telesurgery is non-inferior to standard local surgery in the probability of achieving surgical success.”

The study reports centralised stratified randomisation with random block sizes, stratification by surgery type, and independent randomisation. Patients, follow-up specialists, and statisticians were masked, with clear rationale for the lack of blinding of the surgical team. A sample size calculation was performed using simulation methods. Inclusion/exclusion criteria are pre-specified and clearly listed. Controls (local surgery) are appropriate. The study is a single-blind non-inferiority RCT. The non-inferiority margin (0.1) and its rationale are described.

Sub-criteria

controlsADEQUATE

power analysisADEQUATE

blinding levelsADEQUATE

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The study design is robust, with clear reporting of randomisation, stratification, blinding of outcome assessors, a pre-specified non-inferiority margin, and a sample size calculation.

Evidence

direct quote[Methods, 'Randomisation and masking', paragraph 1]

“The participants were randomly assigned in a 1:1 ratio to undergo either telesurgery or standard local robotic surgery, using stratified randomisation with random block sizes of four.”

direct quote[Methods, 'Randomisation and masking', paragraph 2]

“Participants, follow-up specialists (independent research nurses or doctors), and independent statisticians were masked to the form of surgery performed (telesurgery or local surgery). As masking of the medical team was not feasible, the determination of surgical success was conducted by the surgical team according to pre-specified criteria to minimise subjectivity.”

direct quote[Methods, 'Sample size calculation', paragraph 1]

“Assuming a 10% attrition rate, we determined that a sample size of 34 participants per group was needed.”

PASSReviewer 2· 95% conf

The study design is rigorous with appropriate randomization, blinding, sample size calculation, and analysis plans.

Evidence

direct quote[Methods: Randomisation and masking, paragraph 1]

“The participants were randomly assigned in a 1:1 ratio to undergo either telesurgery or standard local robotic surgery, using stratified randomisation with random block sizes of four.”

direct quote[Methods: Randomisation and masking, paragraph 2]

“Participants, follow-up specialists (independent research nurses or doctors), and independent statisticians were masked to the form of surgery performed.”

direct quote[Methods: Sample size calculation]

“The unilateral α value was set at 0.025, and the power (1−β) was set at 0.8. ... Assuming a 10% attrition rate, we determined that a sample size of 34 participants per group was needed.”

PASSReviewer 3· 95% conf

The study design is rigorous, with adequate description of randomisation, masking, inclusion/exclusion criteria, outlier handling, controls, and sample size justification. Applicable sub-criteria are adequately reported.

Evidence

direct quote[Methods, Randomisation and masking]

“The participants were randomly assigned in a 1:1 ratio ... using stratified randomisation with random block sizes of four. Stratification was based on the type of surgery ... and randomisation was done separately for each stratum.”

direct quote[Methods, Randomisation and masking]

“Participants, follow-up specialists (independent research nurses or doctors), and independent statisticians were masked to the form of surgery performed ... As masking of the medical team was not feasible, the determination of surgical success was conducted by the surgical team according to pre-specified criteria to minimise subjectivity.”

direct quote[Methods, Inclusion and exclusion criteria]

“The inclusion criteria were age 18-80 years; body mass index 18-30; diagnosis of renal tumour or prostate cancer ...”

Sex, age, height, weight, BMI, and tumour characteristics are reported for both groups. Demographics include patient location. Health status is addressed via inclusion criteria and tumour characteristics. Sex justification is not applicable as both sexes were included.

Sub-criteria

demographicsADEQUATE

sex reportedADEQUATE

sex justifiedN/A

age weight healthADEQUATE

housing conditionsN/A

species strain sourceN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Relevant biological variables for human subjects are well reported, including sex, age, weight, BMI, and disease characteristics.

Evidence

direct quote[Table 1]

“Male sex, total | 28 (78) | 26 (72)”

direct quote[Table 1]

“Median (IQR) age, years | 61.0 (57.5-68.0) | 65.0 (56.5-70.0)”

PASSReviewer 2· 95% conf

Patient demographics, sex, age, weight, and health status are adequately reported in Table 1.

Evidence

direct quote[Table 1]

“Male sex, total | 28 (78) | 26 (72) | 24 (75) | 22 (71)”

direct quote[Table 1]

“Median (IQR) age, years | 61.0 (57.5-68.0) | 65.0 (56.5-70.0)”

direct quote[Table 1]

“Patient location: Beijing | 12 (33) | 12 (33)”

PASSReviewer 3· 90% conf

Key biological variables including sex, age, and health status are reported. Sex is reported for both groups, and since both sexes are included, a separate justification is not required. Race/ethnicity is not reported, but this is a common omission in non-Western settings.

Evidence

direct quote[Table 1]

“Male sex, total: Telesurgery group (n=36) 28 (78); Local surgery group (n=36) 26 (72)”

absence[Table 1]

Race/ethnicity is not reported.

The study was approved by the ethical review committee of Chinese PLA General Hospital (ID:2023-021) and the other four clinical trial sites. Participants signed a surgical informed consent and a separate research consent. Compliance with relevant regulations is implied but not explicitly stated as a separate statement, though the trial registration and ethics approval indicate adherence. The strong evidence of named IRB and consent details supports a 'pass' rating.

Sub-criteria

iacuc statementN/A

informed consentADEQUATE

irb ethics statementADEQUATE

regulatory complianceADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Ethical approvals are clearly documented with named review boards, protocol IDs, and informed consent procedures.

Evidence

direct quote[Ethics statements]

“This study was approved by the ethical review committee of Chinese PLA General Hospital (ID:2023-021) and the other four clinical trial sites.”

direct quote[Ethics statements]

“Participants signed a surgical informed consent and a separate research consent before enrolment.”

WARNReviewer 2· 85% conf

Ethics approval and informed consent are reported, but regulatory compliance (e.g., Declaration of Helsinki) is not explicitly stated.

Evidence

direct quote[Ethics statements]

“This study was approved by the ethical review committee of Chinese PLA General Hospital (ID:2023-021) and the other four clinical trial sites.”

direct quote[Ethics statements]

“Participants signed a surgical informed consent and a separate research consent before enrolment.”

absence[Ethics statements]

No explicit statement of adherence to a regulatory framework (e.g., Declaration of Helsinki) is found.

PASSReviewer 3· 95% conf

Ethics approval from a named body (Chinese PLA General Hospital) with an ID number, informed consent, and regulatory compliance are explicitly stated.

Evidence

direct quote[Ethics statements]

“This study was approved by the ethical review committee of Chinese PLA General Hospital (ID:2023-021) and the other four clinical trial sites.”

direct quote[Ethics statements]

“Participants signed a surgical informed consent and a separate research consent before enrolment.”

The investigational product, the MP1000 Surgical Robotic System, is identified by name, model, and manufacturer. Telecommunication services are identified by provider and network type. Statistical software (SAS, RStudio, GraphPad Prism) is named with versions. No antibodies, cell lines, or animal models are used. The study uses a device and software, both of which are adequately identified.

Sub-criteria

mycoplasma testingN/A

reagents identifiedADEQUATE

organisms identifiedN/A

antibodies identifiedN/A

cell line authenticationN/A

software tools identifiedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Key resources are adequately identified, including the surgical robotic system (MP1000), telecommunication providers, and statistical software.

Evidence

direct quote[Methods, 'Telesurgery system structure']

“We used a four arm, multi-port Surgical Robotic System (MP1000, Edge Medical Co, Shenzhen, China) as the robotic subsystem.”

direct quote[Methods, 'Statistical analysis', last paragraph]

“We used SAS version 9.4 or RStudio for analyses.”

PASSReviewer 2· 90% conf

The investigational product (robotic system) and analysis software are adequately identified.

Evidence

direct quote[Methods: Telesurgery system structure and telesurgery pathways, paragraph 1]

“We used a four arm, multi-port Surgical Robotic System (MP1000, Edge Medical Co, Shenzhen, China) as the robotic subsystem.”

direct quote[Methods: Statistical analysis, paragraph 5]

“We used SAS version 9.4 or RStudio for analyses.”

PASSReviewer 3· 90% conf

The investigational product (Surgical Robotic System MP1000) is identified by name, manufacturer, and relevant technical details. Software tools are identified with versions. Other categories are not applicable.

Evidence

direct quote[Methods, Telesurgery system structure]

“We used a four arm, multi-port Surgical Robotic System (MP1000, Edge Medical Co, Shenzhen, China) as the robotic subsystem.”

direct quote[Methods, Statistical analysis]

“We used SAS version 9.4 or RStudio for analyses. We visualised telesurgery monitoring data by using RStudio or GraphPad Prism 8.0.”

The primary analysis uses Bayesian mixed-effects logistic regression with penalised priors, which is named and described. Secondary analyses use mixed-effects linear regression, Fisher's exact test, and Bayesian logistic regression. Exact p-values and 95% credible/confidence intervals are reported. Assumptions are discussed implicitly through the use of Bayesian methods and penalised priors. Software is identified. Data presentation includes medians with IQRs, tables with group n, and forest plots in supplementary materials. Mathematical plausibility checks were not performed due to the continuous nature of the data and N < 100, but the primary outcome proportions are plausible.

Sub-criteria

tests namedADEQUATE

exact p valuesADEQUATE

effect sizes ciADEQUATE

data presentationADEQUATE

software identifiedADEQUATE

assumptions verifiedADEQUATE

mathematical plausibilityN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 90% conf

Statistical analysis is rigorous with named tests, a pre-specified Bayesian primary analysis, and appropriate handling of data. Some secondary analyses report p-values with wide confidence intervals, but overall the reporting meets standards.

Evidence

direct quote[Methods, 'Statistical analysis', paragraph 2]

“For the primary outcome, we derived the differences in the probability of success between the groups along with their 95% credible interval from the posterior distributions of the bayesian mixed effect logistic regression with penalised priors accounting for clustering by surgeon...”

direct quote[Results, 'Primary outcome' and Table 2]

“the estimated difference in the probability of success in the intention-to-treat and per protocol populations was 0.02 (95% credible interval (CrI) −0.03 to 0.15; bayesian posterior probability 0.99 for non-inferiority)”

direct quote[Methods, 'Statistical analysis', last paragraph]

“We used SAS version 9.4 or RStudio for analyses.”

PASSReviewer 2· 90% conf

Statistical methods are well-described, with named tests, exact p-values, effect sizes, and CIs. Assumption verification is not explicitly addressed but is acceptable for the Bayesian approach.

Evidence

direct quote[Methods: Statistical analysis, paragraphs 1-2]

“For the primary outcome, we derived the differences in the probability of success ... from the posterior distributions of the bayesian mixed effect logistic regression with penalised priors”

direct quote[Table 2]

“Adjusted difference or odds ratio | Adjusted effect size | P (difference in probability of success >−0.1)”

direct quote[Table 2]

“Adjusted mean difference (95% CI) | Adjusted Cohen's d value”

PASSReviewer 3· 90% conf

Statistical tests are named, effect sizes and credible/confidence intervals are reported, software is identified, and individual data points are shown for the primary outcome. Assumptions are addressed via the Bayesian framework.

Evidence

direct quote[Methods, Statistical analysis]

direct quote[Table 2]

“Adjusted difference or odds ratio: 0.02 (95% CrI −0.03 to 0.15); P (difference in probability of success >−0.1): 0.99”

The data availability statement names a concrete repository (Dryad) with a DOI, which is adequate. The code is mentioned as available in supplementary materials, which are not a version-controlled public repository with a permanent identifier. Therefore, code_sharing is reported_but_inadequate. Repository_deposit and accession_numbers are not applicable (no sequencing data).

Sub-criteria

code sharingINADEQUATE

accession numbersN/A

repository depositADEQUATE

data availability statementADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Data and code availability are well addressed: the code is provided in supplementary materials, and the data are deposited in a public repository (Dryad) with a DOI.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at Dryad: https://doi.org/10.5061/dryad.t4b8gtjg8 .”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary materials.”

WARNReviewer 2· 85% conf

Data are deposited in Dryad with a DOI, but the code is only provided in supplementary materials rather than a version-controlled public repository.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at Dryad: https://doi.org/10.5061/dryad.t4b8gtjg8”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary materials.”

WARNReviewer 3· 85% conf

Data are deposited in a public repository (Dryad) with a DOI, and code is available in supplementary materials. However, the code is not in a version-controlled public repository with a permanent identifier, making code_sharing 'reported_but_inadequate'.

Evidence

direct quote[Data availability statement]

“The data underlying the findings in this paper are openly and publicly available and can be found at Dryad: https://doi.org/10.5061/dryad.t4b8gtjg8”

direct quote[Data availability statement]

“The code used to analyse the data in the paper can be found in the supplementary materials.”

The trial is registered at ChiCTR.org (ChiCTR2300077721). Methods are detailed and replicable. All primary and secondary outcomes are reported. Limitations are discussed in a dedicated section. Conclusions are proportional to the evidence, explicitly stating non-inferiority and noting the need for larger studies. Funding sources and competing interests are disclosed.

Sub-criteria

funding coiADEQUATE

trial registrationADEQUATE

reporting guidelineNOT REPORTED

methods completenessADEQUATE

all outcomes reportedADEQUATE

limitations discussedADEQUATE

conclusions proportionalADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

Reporting is transparent, with a clear trial registration, pre-specified outcomes, discussion of limitations, and proportionate conclusions.

Evidence

direct quote[Abstract and Methods]

“Trial registration ChiCTR.org ChiCTR2300077721.”

direct quote[Discussion, 'Strengths and limitations of study']

“Despite the ideal performance of telesurgery in this trial, several concerns and limitations remain.”

direct quote[Funding and Competing interests sections]

“This study was supported by grants from National Natural Science Foundation of China (M-0735)...”

PASSReviewer 2· 90% conf

The manuscript is well-reported with a registered trial, clear methods, and discussion of limitations. The only missing element is a reporting checklist reference.

Evidence

direct quote[Abstract, footnote]

“Trial registration ChiCTR.org ChiCTR2300077721.”

direct quote[Discussion: Strengths and limitations of study]

“Firstly, clinical adoption of telesurgery remains limited, and a notable proportion of trial participants were recruited from non-local regions.”

absence[Methods]

No reporting guideline is referenced.

PASSReviewer 3· 90% conf

Methods are detailed, the trial is registered (ChiCTR2300077721), a reporting guideline is referenced (supplementary materials), all pre-specified outcomes are reported, limitations are discussed, conclusions are proportional, and funding/COI are stated.

Evidence

direct quote[Abstract and main text]

“Trial registration ChiCTR.org ChiCTR2300077721.”

direct quote[Discussion, Strengths and limitations of study]

“Although the sample size was estimated on the basis of the predefined non-inferiority margin, we acknowledge that the relatively small cohort in this trial may have limited the ability to detect statistically significant differences in certain outcomes.”

7 copyedit issues flagged: mostly consistency, typo, grammar.

Checked 34 references: 34 verified.

Reproducibility

2 data/code links checked; 2 live.

Registered (1 ID: Chinese Clinical Trial Registry). No reporting guideline cited.

Adcurare Rigor Action ItemsFinal pass before journal submission

Ready after minor edits. The two 'warn' dimensions (ethical_approvals: add Declaration of Helsinki statement; data_code_availability: deposit code in a public repository) and the copyedit issues are straightforward fixes. Address these before submission to avoid desk rejection or reviewer criticism.

1.
HIGHethics
Add an explicit statement of regulatory compliance in the Ethics section, e.g., 'This study was conducted in accordance with the Declaration of Helsinki.'
Required by most journals; its absence was flagged by one reviewer and constitutes a fixable gap.
2.
HIGHdata code
Deposit the analysis code in a version-controlled public repository (e.g., GitHub, Zenodo) with a permanent DOI and update the Data Availability Statement accordingly.
Code in supplementary materials lacks versioning, discoverability, and a permanent identifier, a common reviewer expectation for open science.
3.
MEDIUMreporting
Add a reference to the CONSORT reporting guideline in the Methods section.
CONSORT is the standard for RCTs; its absence, though minor, is a gap noted by two reviewers.
4.
MEDIUMstatistics
Add a brief statement verifying statistical assumptions for the linear models used in secondary analyses, or clarify that the Bayesian framework is robust to assumption violations.
One reviewer noted assumptions_verified as reported_but_inadequate; a brief note addresses this.
5.
MEDIUMreporting
Add race/ethnicity data to the baseline characteristics table (Table 1) or state why it was not collected.
Race/ethnicity is a standard demographic variable; its omission was noted by one reviewer.
6.
MEDIUMcopyedit
Capitalize 'Bayesian' consistently throughout the manuscript (Methods, Results, Tables).
Inconsistent capitalization (lowercase 'bayesian' in places) is a minor but distracting inconsistency flagged by the copyedit pass.
7.
MEDIUMcopyedit
Use consistent spelling of 'penalized' vs 'penalised' throughout the manuscript.
Flagged by copyedit; choose one spelling (e.g., 'penalised' to match British English used elsewhere) and apply consistently.
8.
LOWcopyedit
In Table 2, 'Perioperative morbidity' row header, remove the extra space before the comma.
Minor typographical inconsistency flagged by copyedit.
9.
LOWcopyedit
In Results, paragraph 2, change 'were' to 'was' for subject-verb agreement ('The probability ... was').
Grammar fix flagged by copyedit.
10.
LOWcopyedit
In Table 2 complications row, specify the denominator for the local surgery group (e.g., 0/31) for consistency.
Denominator is implied but not shown; flagged by copyedit.
11.
LOWcopyedit
In Abstract Conclusions, rewrite for clarity: '...according to the non-inferiority margin of a 0.1 absolute reduction in success probability.'
Minor clarity improvement flagged by copyedit.

Full text (49,881 chars)Analyzed: Jul 7, 2026

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Reliability of urological telesurgery compared with local surgery: multicentre randomised controlled trial.

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Journal

DOI

10.1136/bmj-2024-083588

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