Performance and safety of Kangduo surgical robot versus da Vinci robotic system for urologic surgeries

Performance and safety of Kangduo surgical robot versus da Vinci robotic system for urologic surgeries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Performance and safety of Kangduo surgical robot versus da Vinci robotic system for urologic surgeries XUEXIN LI, fengjiao wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4587270/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Kangduo (KD) surgical robot is a novel robotic system in China, and some animal experiments and single-arm clinical trials have indicated its effectiveness, feasibility, and safety for urologic surgeries. This study intended to compare the performance and safety of the KD surgical robot with the da Vinci (DV) robotic system in patients who received urologic surgeries. Methods: A total of 201 patients who received urologic surgeries were divided into the KD group (N=60) and the DV group (N=141) according to the actual surgical methods. Results: The median (range) operation time [180.0 (30.0-540.0) minutes vs. 130.0 (70.0-360.0) minutes] ( P <0.001) and indwelling time of abdominal drainage tube [5.0 (2.0-14.0) days vs. 3.0 (2.0-18.0) days] ( P <0.001) were longer, but the intraoperative blood loss [50.0 (10.0-200.0) mL vs. 50.0 (10.0-400.0) mL] ( P <0.001) was less in the KD group than the DV group. The median values of white blood cells at the 1 st ( P =0.032) and 3 rd ( P =0.022) day after surgery were decreased in the KD group compared to the DV group. The incidence of infection (11.7% vs. 29.1%) ( P =0.008) and fever (15.0% vs. 30.5%) ( P =0.023) was lower in the KD group compared to the DV group. Postoperative and follow-up parameters, including time of uracratia improvement, administration of hemostatic, pain numeric rating scale score, Barthel’s index score, and patient satisfaction, were not different between the two groups (all P >0.05). Conclusion: The KD surgical robot unveils satisfactory surgical performance compared to the DV robotic system in patients receiving urologic surgeries. Urologic surgeries Kangduo surgical robot da Vinci robotic system performance complications Figures Figure 1 Figure 2 Introduction Robotic systems for urologic surgeries, such as nephrectomy, prostatectomy, and pyeloplasty, have improved surgical outcomes in patients with urologic diseases [ 1 – 3 ]. The da Vinci (DV) robotic system is the most widely used surgical robot worldwide, dominating the market for nearly two decades, with the advantages of magnified stereoscopic vision, minimal invasion, and good accuracy and dexterity [ 4 – 6 ]. Despite its various benefits, there are still some concerns regarding the DV robotic system, such as high costs, which hinder its application [ 7 , 8 ]. Furthermore, the occurrence of surgical complications is also a concern of the DV robotic system, which prolongs hospitalization and reduces the quality of life in patients with urologic diseases [ 9 , 10 ]. Therefore, exploring potential robotic surgical systems for urologic surgeries is meaningful to improve the management of patients with urologic diseases. The Kangduo (KD) surgical robot is a recently developed robotic system in China, which is a master-slave system and consists of a surgeon console, patient cart, and vision cart [ 11 ]. Currently, some animal experiments [ 12 – 14 ] and single-arm clinical trials [ 15 – 18 ] have suggested that the KD surgical robot is effective, feasible, and safe for urologic surgeries. Moreover, a few studies have compared the performance and safety of the KD surgical robot and the DV robotic system in patients who receive urologic surgeries [ 19 – 21 ]. For instance, one study discovered that operation time was longer in patients who received the KD surgical robot-assisted radical prostatectomy than those who received the DV robotic system-assisted radical prostatectomy; however, other factors, such as neurovascular bundle sparing, blood loss, and complications were not affected [ 19 ]. Another study reported that operation time and time per stitch were longer in patients receiving the KD surgical robot-assisted pyeloplasty compared with those receiving the DV robotic system-assisted pyeloplasty, but the blood loss, the postoperative length of hospitalization, and complications were not different [ 21 ]. Nevertheless, the sample size was small in the previous studies (N = 16 in both arms in two previous studies; N = 49 in the KD surgical robot arm and N = 50 in the DV robotic system arm in one previous study) [ 19 – 21 ]. Therefore, a large-scale study is required to further assess the performance of the KD surgical robot in patients who receive urologic surgeries. Accordingly, the current study enrolled 201 patients and aimed to compare the performance and safety of the KD surgical robot and the DV robotic system in these patients. Methods 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 1 st day after surgery (D1), Barthel's index score at 3 rd 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. Results Clinical features in the KD and DV groups The mean age was 63.0 (32.0–82.0) years in the KD group and 61.0 (21.0–92.0) years in the DV group ( P = 0.494). There were 19 (31.7%) females and 41 (68.3%) males in the KD group as well as 45 (31.9%) females and 96 (68.1%) males in the DV group ( P = 0.972). The disease types and surgical types were different between the two groups (both P < 0.001). The detailed clinical information of the two groups is shown in Table 1 . Table 1 Basic characteristics. Items DV group (N = 141) KD group (N = 60) P value Age (years) 61.0 (21.0–92.0) 63.0 (32.0–82.0) 0.494 Sex 0.972 Female 45 (31.9) 19 (31.7) Male 96 (68.1) 41 (68.3) Diagnosis < 0.001 Kidney cancer 97 (68.8) 35 (58.3) Bladder cancer 1 (0.7) 11 (18.3) Prostatic cancer 29 (20.6) 5 (8.3) Adrenal cancer 10 (7.1) 2 (3.3) Others 4 (2.8) 7 (11.7) Surgical type < 0.001 Nephrectomy 100 (70.9) 34 (56.7) Cystectomy 1 (0.7) 10 (16.7) Prostatectomy 29 (20.6) 5 (8.3) Adrenalectomy 7 (5.0) 1 (1.7) Others 4 (2.8) 10 (16.7) Age was shown using median (range) and analyzed using Wilcoxon rank sum test; other characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher’s exact test. DV, Da Vinci; KD, KangDuo. Comparison of intraoperative and perioperative parameters between the KD and DV groups Operation time [median (range): 180.0 (30.0-540.0) minutes vs. 130.0 (70.0-360.0) minutes] ( P < 0.001) and indwelling time of abdominal drainage tube [median (range): 5.0 (2.0–14.0) days vs. 3.0 (2.0–18.0) days] ( P < 0.001) were longer in the KD group than in the DV group. Intraoperative blood loss was decreased in the KD group compared to the DV group [median (range): 50.0 (10.0-200.0) mL vs. 50.0 (10.0-400.0) mL] ( P 0.05) (Table 2 ). Table 2 Intraoperative and perioperative parameters. Items DV group (N = 141) KD group (N = 60) P value Operation time (minutes) < 0.001 Mean ± standard deviation 142.0 ± 50.1 197.1 ± 103.4 Median (range) 130.0 (70.0-360.0) 180.0 (30.0-540.0) Intraoperative blood loss (mL) < 0.001 Mean ± standard deviation 78.2 ± 60.9 48.7 ± 38.4 Median (range) 50.0 (10.0-400.0) 50.0 (10.0-200.0) Intraoperative blood transfusion (mL) 0.609 Mean ± standard deviation 22.7 ± 68.0 16.7 ± 55.7 Median (range) 0.0 (0.0-400.0) 0.0 (0.0-200.0) Drainage volume within 24h after surgery (mL) 0.278 Mean ± standard deviation 77.2 ± 58.9 78.9 ± 50.8 Median (range) 67.0 (21.0-455.0) 75.0 (9.0-400.0) Urine output within 24h after surgery (mL) 0.767 Mean ± standard deviation 1916.4 ± 511.7 1940.6 ± 541.8 Median (range) 2000.0 (150.0-3000.0) 1900.0 (200.0-3100.0) Indwelling time of abdominal drainage tube (days) < 0.001 Mean ± standard deviation 4.8 ± 3.8 5.5 ± 3.1 Median (range) 3.0 (2.0–18.0) 5.0 (2.0–14.0) Time to first flatus (days) 0.253 Mean ± standard deviation 3.0 ± 0.7 2.9 ± 1.0 Median (range) 3.0 (2.0–5.0) 3.0 (1.0–5.0) Length of stay (days) 0.813 Mean ± standard deviation 9.3 ± 3.3 9.0 ± 3.1 Median (range) 8.0 (5.0–18.0) 8.0 (5.0–20.0) All characteristics were shown using mean ± standard deviation and median (range), and analyzed using Wilcoxon rank sum test. DV, Da Vinci; KD, KangDuo. Comparison of postoperative biochemical indexes and complications between the KD and DV groups White blood cells at D1 [median (range): 7.4 (4.5–14.5)×10 9 /L vs. 8.1 (4.5–17.8)×10 9 /L] ( P = 0.032) and D3 [median (range): 6.5 (3.6–11.3)×10 9 /L vs. 7.5 (4.4–15.7)×10 9 /L] ( P = 0.022) were lower in the KD group than in the DV group. Other postoperative biochemical indexes were not different between the two groups (all P > 0.05) (Table 3 ). Table 3 Postoperative biochemical indexes. Items DV group (N = 141) KD group (N = 60) P value Urea nitrogen at D1 (mmol/L) 0.860 Mean ± standard deviation 6.0 ± 1.3 5.9 ± 1.5 Median (range) 6.3 (2.7–8.7) 5.9 (2.8–8.9) Serum creatinine at D1 (µmoI/L) 0.818 Mean ± standard deviation 81.7 ± 16.3 81.7 ± 16.4 Median (range) 78.8 (46.0-101.7) 78.7 (56.3-134.7) White blood cell at D1 (10 9 /L) 0.032 Mean ± standard deviation 9.5 ± 3.5 8.3 ± 2.7 Median (range) 8.1 (4.5–17.8) 7.4 (4.5–14.5) Neutrophil percentage at D1 (%) 0.353 Mean ± standard deviation 71.8 ± 13.6 69.2 ± 14.2 Median (range) 67.9 (45.7-134.7) 67.6 (34.2–99.0) White blood cell at D3 (10 9 /L) 0.022 Mean ± standard deviation 8.2 ± 2.7 7.1 ± 1.9 Median (range) 7.5 (4.4–15.7) 6.5 (3.6–11.3) Neutrophil percentage at D3 (%) 0.082 Mean ± standard deviation 64.4 ± 14.4 60.7 ± 11.4 Median (range) 64.3 (34.2-113.1) 60.2 (34.8–86.5) All characteristics were shown using mean ± standard deviation and median (range), and analyzed using Wilcoxon rank sum test DV, Da Vinci; KD, KangDuo; D1, 1st day after surgery; D3, 3rd day after surgery. Regarding complications, the rates of infection (11.7% vs. 29.1%) ( P = 0.008) and fever (15.0% vs. 30.5%) ( P = 0.023) were decreased in the KD group compared to the DV group. However, the rates of acute kidney injury and uracratia were not different between the two groups (both P > 0.05) (Table 4 ). Table 4 Complications. Items DV group (N = 141) KD group (N = 60) P value Infection 41 (29.1) 7 (11.7) 0.008 Fever 43 (30.5) 9 (15.0) 0.023 Acute kidney injury 6 (4.3) 4 (6.7) 0.489 Uracratia 5 (3.5) 3 (5.0) 0.698 All characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher’s exact test. DV, Da Vinci; KD, KangDuo. Comparison of postoperative and follow-up information between the KD and DV groups Time of uracratia improvement ( P = 0.786), administration of hemostatic ( P = 0.679), pain NRS score ( P = 0.055), Barthel’s index score ( P = 0.558), or patient satisfaction ( P = 0.628) was not different between the two groups (Table 5 ). Table 5 Postoperative and follow-up information. Items DV group (N = 141) KD group (N = 60) P value Time of uracratia improvement 0.786 0.5 months 1 (0.7) 0 (0.0) 2 months 2 (1.4) 0 (0.0) 3 months 1 (0.7) 2 (3.3) 6 months 1 (0.7) 1 (1.7) Administration of hemostatic 22 (15.6) 8 (13.3) 0.679 Pain NRS score 2.7 ± 0.5 2.5 ± 0.5 0.055 Barthel's index score 68.7 ± 5.1 68.2 ± 6.0 0.558 Patient satisfaction 0.628 Very satisfied 136 (96.5) 57 (95.0) Satisfied 2 (1.4) 1 (1.7) Neutrality 3 (2.1) 2 (3.3) Unsatisfied 0 (0.0) 0 (0.0) Very unsatisfied 0 (0.0) 0 (0.0) Pain NRS score and Barthel's index score were shown using mean ± standard deviation and analyzed using t-test; other characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher’s exact test. Time of uracratia improvement was assessed among patients who had uracratia during follow-up. DV, Da Vinci; KD, KangDuo; NRS, numeric rating scale. Discussion The emergence of robotic surgical platforms brings nonnegligible benefits for patients receiving urologic surgeries [ 25 – 28 ]. KD surgical robot is a newly developed robotic surgical system in China, and several studies have compared the performance of this surgical robot with the DV robotic system in patients who receive gastrointestinal and urologic surgeries [ 19 – 21 , 29 , 30 ]. Regarding urologic surgeries, two studies indicated that the KD surgical robot for prostatectomy and pyeloplasty led to a longer operation time than the DV robotic system [ 19 , 21 ]. In line with previous studies [ 19 , 21 ], we discovered that the operation time was longer in patients who received the KD surgical robot-assisted urologic surgeries than in those who received the DV robotic system-assisted urologic surgeries. A possible reason would be that, by comparison with the DV robotic system, physicians would be unfamiliar with the operation of the KD surgical robot and they would need more time to master this technology, leading to a long operation time [ 20 ]. We also discovered that the KD surgical robot resulted in a prolonged indwelling time of the abdominal drainage tube compared to the DV robotic system in patients who received urologic surgeries. A potential explanation would be that compared with the DV robotic system, the KD surgical robot was a novel technology, and physicians might be cautious about patients’ postoperative conditions [ 11 , 19 , 20 ]. Therefore, the indwelling time of the abdominal drainage tube was prolonged to monitor patients’ recovery and prevent complications in patients receiving the KD surgical robot-assisted urologic surgeries. Another finding was that the KD surgical robot contributed to less intraoperative blood loss compared to the DV robotic system. A possible reason might be that the DV robotic system was a well-established technology compared with the KD surgical robot [ 5 , 11 , 31 ], which was mainly applied in complicated surgeries, such as nephrectomy and prostatectomy, in this study. Therefore, more intraoperative blood loss was found in patients who received the DV robotic system-assisted urologic surgeries than those who received the KD surgical robot-assisted urologic surgeries. Postoperative complications are major concerns when considering applying new technologies, and several previous studies indicated that postoperative complications were not different between patients receiving the KD surgical robot-assisted urologic surgeries and those receiving the DV robotic system-assisted urologic surgeries [ 19 – 21 ]. In the current study, we found that infection and fever were decreased in patients receiving the KD surgical robot-assisted urologic surgeries compared to those receiving the DV robotic system-assisted urologic surgeries. A possible reason would be that the KD surgical robot was a relatively new technology compared with the DV surgical robot, physicians and nurses might pay more attention to patients’ postoperative management, leading to a lower occurrence of infection and fever. It was also found that white blood cells at D1 and D3 were decreased in patients receiving the KD surgical robot-assisted urologic surgeries compared to those receiving the DV robotic system-assisted urologic surgeries, which could be attributed to the lower incidence of infection [ 32 , 33 ]. However, other postoperative complications and biochemical indexes did not differ between patients who received the KD surgical robot-assisted urologic surgeries and those who received the DV robotic system-assisted urologic surgeries, suggesting the comparable safety of the KD surgical robot to the DV surgical robot in patients who received urologic surgeries. Urinary continence recovery is an important issue after urologic surgeries, and one previous study indicated that urinary continence recovery was not affected by the KD surgical robot or the DV robotic system in patients receiving prostatectomy [ 19 ]. Consistent with this previous study [ 19 ], we also discovered that the uracratia improvement was not affected by the KD surgical robot or the DV robotic system in patients receiving urologic surgeries. Apart from that, we found that the impact of the KD surgical robot on postoperative bleeding, pain, self-care ability, and patient satisfaction was comparable to the DV robotic system in patients receiving urologic surgeries. Overall, our findings disclosed that the KD surgical robot possessed comparable performance to the DV robotic system in patients receiving urologic surgeries. Importantly, the estimated cost of the KD surgical robot was about 25–30% of that of the DV robotic system [ 16 , 20 ]. Therefore, the KD surgical robot might be a promising surgical technology for patients who received urologic surgeries. Several limitations should be noted in this study. (1) The number of patients was unmatched in the DV group and the KD group, which might influence the outcomes of this study. (2) Baseline features, such as disease types and surgical types were different between the DV group and the KD group. Further randomized controlled trials were needed to validate the findings of our study. (3) To support the wide application of the KD surgical robot, the cost-effectiveness comparison between the KD surgical robot and the DV robotic system was required, which could be a direction for subsequent studies. In conclusion, the KD surgical robot shows good surgical performance compared to the DV robotic system in patients receiving urologic surgeries. Considering the high cost of the DV robotic system and the demand for the evolution of surgical robot systems, the KD surgical robot may possess the potential to serve as an optional choice for patients who receive urologic surgeries. Declarations Author Contribution xuexin li collected clinical data and generated the idea. fengjiao wang analyzed, prepared figures and tables, wrote the paper. we all reviewed the manuscript. 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Int J Surg 110 (3):1511-1518 Sun Z, Ma T, Huang Z et al (2024) Robot-assisted radical resection of colorectal cancer using the KangDuo surgical robot versus the da Vinci Xi robotic system: short-term outcomes of a multicentre randomised controlled noninferiority trial. Surg Endosc 38 (4):1867-1876 Koukourikis P, Rha KH (2021) Robotic surgical systems in urology: What is currently available? Investig Clin Urol 62 (1):14-22 Luo J, Chen C, Li Q (2020) White blood cell counting at point-of-care testing: A review. Electrophoresis 41 (16-17):1450-1468 Chmielewski PP, Strzelec B (2018) Elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis: a review. Folia Morphol (Warsz) 77 (2):171-178 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4587270","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":329514154,"identity":"6c2001ca-126b-4d0d-bffc-1c2845970030","order_by":0,"name":"XUEXIN LI","email":"","orcid":"","institution":"Third Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"XUEXIN","middleName":"","lastName":"LI","suffix":""},{"id":329514156,"identity":"d60714b9-b0c3-47ac-a501-2d438a2edeeb","order_by":1,"name":"fengjiao wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYLCCCiBmbAYSHyps5PiZmQ8/IKjlDFQL44wzacaS7WxpBkRpAQFm3pbDiQbneRQk8Kk2OH728IsDFXfsmtuZHz6c2ZCWYHyYh8GAocYmGqeWM3lpFgfOPEtubGYzNvi4wybP7DDvgQcMx9JyG3BoMTuQY2b8se1wMtAvZpIzz6QVmx3mSzBgbDiMW8v5N2YGB/+BtLB/k+ZtO5y4uZnHQAKvlhs5xg8ONhy2Y2zmMQNr2cBMQIv9jTdmDAeOHU4Aaik2BAWyxGFgICfg8Ytkf47xhwM1h+0N+49vfACOyv7Dhx98qLHBqQUI2ECxkLgRRUUCbuUgwPwB5EB5/IpGwSgYBaNgJAMAaWFnTi0n/aEAAAAASUVORK5CYII=","orcid":"","institution":"Third Affiliated Hospital of Harbin Medical University","correspondingAuthor":true,"prefix":"","firstName":"fengjiao","middleName":"","lastName":"wang","suffix":""}],"badges":[],"createdAt":"2024-06-15 16:15:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4587270/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4587270/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61002701,"identity":"269e78bf-678c-4cf3-af0c-5ccdc680f8d6","added_by":"auto","created_at":"2024-07-24 13:19:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3924047,"visible":true,"origin":"","legend":"\u003cp\u003eThe KD surgical robot. The surgeon control console (\u003cstrong\u003eA\u003c/strong\u003e). The patient cart (\u003cstrong\u003eB\u003c/strong\u003e). The vision cart (\u003cstrong\u003eC\u003c/strong\u003e). The surgeon sitting in front of the open console of the KD (\u003cstrong\u003eD\u003c/strong\u003e).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4587270/v1/b6458cf225898b415fb50fdb.png"},{"id":61002702,"identity":"13c6a581-a486-466a-a384-acae34f3b5ca","added_by":"auto","created_at":"2024-07-24 13:19:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7392484,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical technique of prostatectomy with the KD surgical robot. Suturing-ligation of the dorsal venous plexus (\u003cstrong\u003eA\u003c/strong\u003e). Bladder neck dissection (\u003cstrong\u003eB\u003c/strong\u003e). Preparation of the seminal vesicles (\u003cstrong\u003eC\u003c/strong\u003e). Dissection of the rectoprostatic fascia (\u003cstrong\u003eD\u003c/strong\u003e). Disconnection of the urethra (\u003cstrong\u003eE\u003c/strong\u003e). Vesicourethral anastomosis (\u003cstrong\u003eF\u003c/strong\u003e).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4587270/v1/2b1c126a5be8c868ca2aad20.png"},{"id":64621132,"identity":"9cf464cf-1498-4016-acb2-2d84c16ef718","added_by":"auto","created_at":"2024-09-16 16:26:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":21942297,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4587270/v1/6aff073e-22bf-4c3e-9569-8725f13fc45e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Performance and safety of Kangduo surgical robot versus da Vinci robotic system for urologic surgeries","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRobotic systems for urologic surgeries, such as nephrectomy, prostatectomy, and pyeloplasty, have improved surgical outcomes in patients with urologic diseases [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The da Vinci (DV) robotic system is the most widely used surgical robot worldwide, dominating the market for nearly two decades, with the advantages of magnified stereoscopic vision, minimal invasion, and good accuracy and dexterity [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite its various benefits, there are still some concerns regarding the DV robotic system, such as high costs, which hinder its application [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, the occurrence of surgical complications is also a concern of the DV robotic system, which prolongs hospitalization and reduces the quality of life in patients with urologic diseases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, exploring potential robotic surgical systems for urologic surgeries is meaningful to improve the management of patients with urologic diseases.\u003c/p\u003e \u003cp\u003eThe Kangduo (KD) surgical robot is a recently developed robotic system in China, which is a master-slave system and consists of a surgeon console, patient cart, and vision cart [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Currently, some animal experiments [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and single-arm clinical trials [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] have suggested that the KD surgical robot is effective, feasible, and safe for urologic surgeries. Moreover, a few studies have compared the performance and safety of the KD surgical robot and the DV robotic system in patients who receive urologic surgeries [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For instance, one study discovered that operation time was longer in patients who received the KD surgical robot-assisted radical prostatectomy than those who received the DV robotic system-assisted radical prostatectomy; however, other factors, such as neurovascular bundle sparing, blood loss, and complications were not affected [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Another study reported that operation time and time per stitch were longer in patients receiving the KD surgical robot-assisted pyeloplasty compared with those receiving the DV robotic system-assisted pyeloplasty, but the blood loss, the postoperative length of hospitalization, and complications were not different [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Nevertheless, the sample size was small in the previous studies (N\u0026thinsp;=\u0026thinsp;16 in both arms in two previous studies; N\u0026thinsp;=\u0026thinsp;49 in the KD surgical robot arm and N\u0026thinsp;=\u0026thinsp;50 in the DV robotic system arm in one previous study) [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, a large-scale study is required to further assess the performance of the KD surgical robot in patients who receive urologic surgeries.\u003c/p\u003e \u003cp\u003eAccordingly, the current study enrolled 201 patients and aimed to compare the performance and safety of the KD surgical robot and the DV robotic system in these patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBetween 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.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTreatment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePatients received urologic surgeries with a KD surgical robot or DV robotic system according to the actual disease condition, patient willingness, and the surgeon\u0026apos;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 \u003cstrong\u003eFigure 1A-D.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData collection and assessment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe 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 \u0026gt;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 1\u003csup\u003est\u003c/sup\u003e day after surgery (D1), Barthel\u0026apos;s index score at 3\u003csup\u003erd\u003c/sup\u003e day after surgery (D3), and patient satisfaction. Pain NRS score ranged from 0-10, with a higher score indicating a higher pain level. Barthel\u0026rsquo;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].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSPSS v.26.0 (IBM, USA) was used for analyses. The clinical data were shown using mean\u0026plusmn;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\u0026rsquo;s exact test. \u003cem\u003eP\u003c/em\u003e \u0026lt;0.05 indicated statistical significance.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical features in the KD and DV groups\u003c/h2\u003e \u003cp\u003eThe mean age was 63.0 (32.0\u0026ndash;82.0) years in the KD group and 61.0 (21.0\u0026ndash;92.0) years in the DV group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.494). There were 19 (31.7%) females and 41 (68.3%) males in the KD group as well as 45 (31.9%) females and 96 (68.1%) males in the DV group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.972). The disease types and surgical types were different between the two groups (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The detailed clinical information of the two groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDV group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKD group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61.0 (21.0\u0026ndash;92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.0 (32.0\u0026ndash;82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45 (31.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (31.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (68.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41 (68.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKidney cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97 (68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (58.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatic cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdrenal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e100 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (56.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCystectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstatectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdrenalectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAge was shown using median (range) and analyzed using Wilcoxon rank sum test; other characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher\u0026rsquo;s exact test. DV, Da Vinci; KD, KangDuo.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e\u003cem\u003eComparison of intraoperative and perioperative parameters between the KD and DV groups\u003c/em\u003e\u003c/h2\u003e \u003cp\u003eOperation time [median (range): 180.0 (30.0-540.0) minutes vs. 130.0 (70.0-360.0) minutes] (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and indwelling time of abdominal drainage tube [median (range): 5.0 (2.0\u0026ndash;14.0) days vs. 3.0 (2.0\u0026ndash;18.0) days] (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were longer in the KD group than in the DV group. Intraoperative blood loss was decreased in the KD group compared to the DV group [median (range): 50.0 (10.0-200.0) mL vs. 50.0 (10.0-400.0) mL] (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Other intraoperative and perioperative parameters were not different between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative and perioperative parameters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDV group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKD group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142.0\u0026thinsp;\u0026plusmn;\u0026thinsp;50.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197.1\u0026thinsp;\u0026plusmn;\u0026thinsp;103.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130.0 (70.0-360.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180.0 (30.0-540.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.2\u0026thinsp;\u0026plusmn;\u0026thinsp;60.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.7\u0026thinsp;\u0026plusmn;\u0026thinsp;38.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.0 (10.0-400.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.0 (10.0-200.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative blood transfusion (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0 (0.0-400.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0 (0.0-200.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrainage volume within 24h after surgery (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.2\u0026thinsp;\u0026plusmn;\u0026thinsp;58.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.9\u0026thinsp;\u0026plusmn;\u0026thinsp;50.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.0 (21.0-455.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.0 (9.0-400.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrine output within 24h after surgery (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1916.4\u0026thinsp;\u0026plusmn;\u0026thinsp;511.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1940.6\u0026thinsp;\u0026plusmn;\u0026thinsp;541.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2000.0 (150.0-3000.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1900.0 (200.0-3100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndwelling time of abdominal drainage tube (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (2.0\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0 (2.0\u0026ndash;14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to first flatus (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.0 (2.0\u0026ndash;5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0 (1.0\u0026ndash;5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.0 (5.0\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0 (5.0\u0026ndash;20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll characteristics were shown using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (range), and analyzed using Wilcoxon rank sum test.\u003c/p\u003e \u003cp\u003eDV, Da Vinci; KD, KangDuo.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eComparison of postoperative biochemical indexes and complications between the KD and DV groups\u003c/h2\u003e \u003cp\u003eWhite blood cells at D1 [median (range): 7.4 (4.5\u0026ndash;14.5)\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L vs. 8.1 (4.5\u0026ndash;17.8)\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L] (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032) and D3 [median (range): 6.5 (3.6\u0026ndash;11.3)\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L vs. 7.5 (4.4\u0026ndash;15.7)\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L] (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.022) were lower in the KD group than in the DV group. Other postoperative biochemical indexes were not different between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative biochemical indexes.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDV group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKD group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea nitrogen at D1 (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.3 (2.7\u0026ndash;8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.9 (2.8\u0026ndash;8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine at D1 (\u0026micro;moI/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.7\u0026thinsp;\u0026plusmn;\u0026thinsp;16.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.8 (46.0-101.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.7 (56.3-134.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell at D1 (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.1 (4.5\u0026ndash;17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.4 (4.5\u0026ndash;14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil percentage at D1 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.2\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.9 (45.7-134.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.6 (34.2\u0026ndash;99.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell at D3 (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.5 (4.4\u0026ndash;15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.5 (3.6\u0026ndash;11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil percentage at D3 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.3 (34.2-113.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.2 (34.8\u0026ndash;86.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll characteristics were shown using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (range), and analyzed using Wilcoxon rank sum test\u003c/p\u003e \u003cp\u003eDV, Da Vinci; KD, KangDuo; D1, 1st day after surgery; D3, 3rd day after surgery.\u003c/p\u003e \u003cp\u003eRegarding complications, the rates of infection (11.7% vs. 29.1%) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) and fever (15.0% vs. 30.5%) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023) were decreased in the KD group compared to the DV group. However, the rates of acute kidney injury and uracratia were not different between the two groups (both \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDV group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKD group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (29.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUracratia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.698\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003eDV, Da Vinci; KD, KangDuo.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eComparison of postoperative and follow-up information between the KD and DV groups\u003c/h2\u003e \u003cp\u003eTime of uracratia improvement (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.786), administration of hemostatic (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.679), pain NRS score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.055), Barthel\u0026rsquo;s index score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.558), or patient satisfaction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.628) was not different between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative and follow-up information.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDV group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;141)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKD group\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of uracratia improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.786\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.5 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdministration of hemostatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePain NRS score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel's index score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136 (96.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery unsatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePain NRS score and Barthel's index score were shown using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and analyzed using t-test; other characteristics were shown using No. (percentage) and analyzed using Chi-square test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003cp\u003eTime of uracratia improvement was assessed among patients who had uracratia during follow-up.\u003c/p\u003e \u003cp\u003eDV, Da Vinci; KD, KangDuo; NRS, numeric rating scale.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe emergence of robotic surgical platforms brings nonnegligible benefits for patients receiving urologic surgeries [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. KD surgical robot is a newly developed robotic surgical system in China, and several studies have compared the performance of this surgical robot with the DV robotic system in patients who receive gastrointestinal and urologic surgeries [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Regarding urologic surgeries, two studies indicated that the KD surgical robot for prostatectomy and pyeloplasty led to a longer operation time than the DV robotic system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In line with previous studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], we discovered that the operation time was longer in patients who received the KD surgical robot-assisted urologic surgeries than in those who received the DV robotic system-assisted urologic surgeries. A possible reason would be that, by comparison with the DV robotic system, physicians would be unfamiliar with the operation of the KD surgical robot and they would need more time to master this technology, leading to a long operation time [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. We also discovered that the KD surgical robot resulted in a prolonged indwelling time of the abdominal drainage tube compared to the DV robotic system in patients who received urologic surgeries. A potential explanation would be that compared with the DV robotic system, the KD surgical robot was a novel technology, and physicians might be cautious about patients\u0026rsquo; postoperative conditions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, the indwelling time of the abdominal drainage tube was prolonged to monitor patients\u0026rsquo; recovery and prevent complications in patients receiving the KD surgical robot-assisted urologic surgeries. Another finding was that the KD surgical robot contributed to less intraoperative blood loss compared to the DV robotic system. A possible reason might be that the DV robotic system was a well-established technology compared with the KD surgical robot [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which was mainly applied in complicated surgeries, such as nephrectomy and prostatectomy, in this study. Therefore, more intraoperative blood loss was found in patients who received the DV robotic system-assisted urologic surgeries than those who received the KD surgical robot-assisted urologic surgeries.\u003c/p\u003e \u003cp\u003ePostoperative complications are major concerns when considering applying new technologies, and several previous studies indicated that postoperative complications were not different between patients receiving the KD surgical robot-assisted urologic surgeries and those receiving the DV robotic system-assisted urologic surgeries [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In the current study, we found that infection and fever were decreased in patients receiving the KD surgical robot-assisted urologic surgeries compared to those receiving the DV robotic system-assisted urologic surgeries. A possible reason would be that the KD surgical robot was a relatively new technology compared with the DV surgical robot, physicians and nurses might pay more attention to patients\u0026rsquo; postoperative management, leading to a lower occurrence of infection and fever. It was also found that white blood cells at D1 and D3 were decreased in patients receiving the KD surgical robot-assisted urologic surgeries compared to those receiving the DV robotic system-assisted urologic surgeries, which could be attributed to the lower incidence of infection [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, other postoperative complications and biochemical indexes did not differ between patients who received the KD surgical robot-assisted urologic surgeries and those who received the DV robotic system-assisted urologic surgeries, suggesting the comparable safety of the KD surgical robot to the DV surgical robot in patients who received urologic surgeries.\u003c/p\u003e \u003cp\u003eUrinary continence recovery is an important issue after urologic surgeries, and one previous study indicated that urinary continence recovery was not affected by the KD surgical robot or the DV robotic system in patients receiving prostatectomy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Consistent with this previous study [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], we also discovered that the uracratia improvement was not affected by the KD surgical robot or the DV robotic system in patients receiving urologic surgeries. Apart from that, we found that the impact of the KD surgical robot on postoperative bleeding, pain, self-care ability, and patient satisfaction was comparable to the DV robotic system in patients receiving urologic surgeries. Overall, our findings disclosed that the KD surgical robot possessed comparable performance to the DV robotic system in patients receiving urologic surgeries. Importantly, the estimated cost of the KD surgical robot was about 25\u0026ndash;30% of that of the DV robotic system [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Therefore, the KD surgical robot might be a promising surgical technology for patients who received urologic surgeries.\u003c/p\u003e \u003cp\u003eSeveral limitations should be noted in this study. (1) The number of patients was unmatched in the DV group and the KD group, which might influence the outcomes of this study. (2) Baseline features, such as disease types and surgical types were different between the DV group and the KD group. Further randomized controlled trials were needed to validate the findings of our study. (3) To support the wide application of the KD surgical robot, the cost-effectiveness comparison between the KD surgical robot and the DV robotic system was required, which could be a direction for subsequent studies.\u003c/p\u003e \u003cp\u003eIn conclusion, the KD surgical robot shows good surgical performance compared to the DV robotic system in patients receiving urologic surgeries. Considering the high cost of the DV robotic system and the demand for the evolution of surgical robot systems, the KD surgical robot may possess the potential to serve as an optional choice for patients who receive urologic surgeries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003exuexin li collected clinical data and generated the idea. fengjiao wang analyzed, prepared figures and tables, wrote the paper. we all reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting this study has been prepared and can be obtained for valid reasons by contacting the corresponding author via email.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests regarding the publication of this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEzer M, Aydogan TB, Huri E (2021) Urologic Surgery in Digital Era: Foresights and Futuristic Approach. Balkan Med J 38 (6):324-330\u003c/li\u003e\n\u003cli\u003eFalagario U, Veccia A, Weprin S et al (2020) Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 17 (6):579-590\u003c/li\u003e\n\u003cli\u003eMikhail D, Sarcona J, Mekhail M et al (2020) Urologic Robotic Surgery. Surg Clin North Am 100 (2):361-378\u003c/li\u003e\n\u003cli\u003eRao PP (2018) Robotic surgery: new robots and finally some real competition! World J Urol 36 (4):537-541\u003c/li\u003e\n\u003cli\u003eMorrell ALG, Morrell-Junior AC, Morrell AG et al (2021) The history of robotic surgery and its evolution: when illusion becomes reality. Rev Col Bras Cir 48 e20202798\u003c/li\u003e\n\u003cli\u003eBrassetti A, Ragusa A, Tedesco F et al (2023) Robotic Surgery in Urology: History from PROBOT((R)) to HUGO(TM). 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J Robot Surg 18 (1):145\u003c/li\u003e\n\u003cli\u003eFan S, Xu W, Diao Y et al (2023) Feasibility and Safety of Dual-console Telesurgery with the KangDuo Surgical Robot-01 System Using Fifth-generation and Wired Networks: An Animal Experiment and Clinical Study. Eur Urol Open Sci 49 6-9\u003c/li\u003e\n\u003cli\u003eXu L, Shen C, Li X et al (2024) Feasibility and safety of dual-console telesurgery with the KangDuo Surgical Robot-1500 System using fifth-generation and wired networks: an animal experiment and sea-spanning clinical study. Minerva Urol Nephrol 76 (2):241-246\u003c/li\u003e\n\u003cli\u003eXu L, Li X, Fan S et al (2024) Analysis of KangDuo-SR-1500 and KangDuo-SR-2000 robotic partial nephrectomy from an operative and ergonomic perspective: a prospective controlled study in porcine models. 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Investig Clin Urol 62 (1):14-22\u003c/li\u003e\n\u003cli\u003eLuo J, Chen C, Li Q (2020) White blood cell counting at point-of-care testing: A review. Electrophoresis 41 (16-17):1450-1468\u003c/li\u003e\n\u003cli\u003eChmielewski PP, Strzelec B (2018) Elevated leukocyte count as a harbinger of systemic inflammation, disease progression, and poor prognosis: a review. Folia Morphol (Warsz) 77 (2):171-178\u003cbr\u003e \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Urologic surgeries, Kangduo surgical robot, da Vinci robotic system, performance, complications","lastPublishedDoi":"10.21203/rs.3.rs-4587270/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4587270/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eKangduo (KD) surgical robot is a novel robotic system in China, and some animal experiments and single-arm clinical trials have indicated its effectiveness, feasibility, and safety for urologic surgeries. This study intended to compare the performance and safety of the KD surgical robot with the da Vinci (DV) robotic system in patients who received urologic surgeries.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 201 patients who received urologic surgeries were divided into the KD group (N=60) and the DV group (N=141) according to the actual surgical methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe median (range) operation time [180.0 (30.0-540.0) minutes vs. 130.0 (70.0-360.0) minutes] (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) and indwelling time of abdominal drainage tube [5.0 (2.0-14.0) days vs. 3.0 (2.0-18.0) days] (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) were longer, but the intraoperative blood loss [50.0 (10.0-200.0) mL vs. 50.0 (10.0-400.0) mL] (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001) was less in the KD group than the DV group. The median values of white blood cells at the 1\u003csup\u003est\u003c/sup\u003e (\u003cem\u003eP\u003c/em\u003e=0.032) and 3\u003csup\u003erd\u003c/sup\u003e (\u003cem\u003eP\u003c/em\u003e=0.022) day after surgery were decreased in the KD group compared to the DV group. The incidence of infection (11.7% vs. 29.1%) (\u003cem\u003eP\u003c/em\u003e=0.008) and fever (15.0% vs. 30.5%) (\u003cem\u003eP\u003c/em\u003e=0.023) was lower in the KD group compared to the DV group. Postoperative and follow-up parameters, including time of uracratia improvement, administration of hemostatic, pain numeric rating scale score, Barthel’s index score, and patient satisfaction, were not different between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe KD surgical robot unveils satisfactory surgical performance compared to the DV robotic system in patients receiving urologic surgeries.\u003c/p\u003e","manuscriptTitle":"Performance and safety of Kangduo surgical robot versus da Vinci robotic system for urologic surgeries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 13:19:40","doi":"10.21203/rs.3.rs-4587270/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12b00f94-8382-4e9e-9f1f-79795db093e1","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-16T16:18:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-24 13:19:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4587270","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4587270","identity":"rs-4587270","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}