Integration of aquablation through telemetry: an alternative to onsite proctoring?

PURPOSE: To evaluate the feasibility of telementoring for aquablation by comparing the outcomes of onsite versus telemetry proctoring. METHODS: The telemetry device of choice was Proximie, an innovative digital platform that uses live video stream with an augmented reality technology. Our study retrospectively reviewed outcomes from our IRB approved prospective Aquablation database from March 2018 till October 2019. Procedures were guided by a proctor either onsite or remotely through telemetry. One-way ANOVA or Chi-square was used to compare perioperative parameters and mixed model ANOVA was used to compare functional outcomes. RESULTS: Our data included 59 patients who underwent a proctored-based Aquablation of which 21 were telementor guided and 38 were onsite guided. The initial ten procedures were done with the latter approach. There was no statistical difference in age, comorbidities, prostate size, and baseline serum markers amongst the two groups. In contrast, telementor guidance was associated with increased general anaesthesia use (76.2% vs. 21.1%) and haemostatic cauterization (81.0% versus 47.4%) with a p value < 0.00001 and 0.004 respectively. However, the main procedure outcomes: operative time, time to Foley catheter removal, haemoglobin drop, urinary retention, and adverse events were statistically insignificant (p value > 0.05). CONCLUSION: Following an initial phase of onsite proctoring, telementoring can be safely used in the adoption phase of a new robotic technology. This approach allowed more flexibility in patient scheduling and reduced travel costs with similar surgical outcomes.