Telesurgery, the remote execution of surgical procedures through telecommunication and robotic systems, has witnessed substantial growth in recent years, promising to address global healthcare disparities and enhance surgical expertise. This paper explores the humanitarian and surgical benefits of telesurgery, emphasizing its potential to provide expert surgical care to underserved regions. Despite its transformative potential, telesurgery faces significant technologic challenges, including issues of data transmission, latency, and the need for advanced robotic platforms. The advent of 5G networks and innovative robotic systems provides a promising technological landscape, yet global disparities in 5G coverage remain a concern. Ethical considerations, ranging from preserving the surgeon-patient relationship to addressing patient vulnerability and conflicts of interest, are pivotal aspects that demand attention. The paper underscores the importance of clear regulatory frameworks and international collaboration to navigate legal complexities and ensure ethical standards. As telesurgery progresses, integrating artificial intelligence, augmented reality, and haptic feedback technologies holds promise for further advancements. Despite these challenges, telesurgery has the potential to achieve equitable access to expert surgical care; however, it requires a collective effort to overcome its intricate technologic and administrative hurdles.© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

Telesurgery, a cutting-edge field at the intersection of medicine and technology, holds immense promise for enhancing surgical capabilities, extending medical care, and improving patient outcomes. In this scenario, this article explores the landscape of technical and ethical considerations that highlight the advancement and adoption of telesurgery. Network considerations are crucial for ensuring seamless and low-latency communication between remote surgeons and robotic systems, while technical challenges encompass system reliability, latency reduction, and the integration of emerging technologies like artificial intelligence and 5G networks. Therefore, this article also explores the critical role of network infrastructure, highlighting the necessity for low-latency, high-bandwidth, secure and private connections to ensure patient safety and surgical precision. Moreover, ethical considerations in telesurgery include patient consent, data security, and the potential for remote surgical interventions to distance surgeons from their patients. Legal and regulatory frameworks require refinement to accommodate the unique aspects of telesurgery, including liability, licensure, and reimbursement. Our article presents a comprehensive analysis of the current state of telesurgery technology and its potential while critically examining the challenges that must be navigated for its widespread adoption.© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

To explore the views of experts about the development and validation of a robotic surgery training curriculum, and how this should be implemented.An international expert panel was invited to a structured session for discussion. The study was of a mixed design, including qualitative and quantitative components based on focus group interviews during the European Association of Urology (EAU) Robotic Urology Section (ERUS) (2012), EAU (2013) and ERUS (2013) meetings. After introduction to the aims, principles and current status of the curriculum development, group responses were elicited. After content analysis of recorded interviews generated themes were discussed at the second meeting, where consensus was achieved on each theme. This discussion also underwent content analysis, and was used to draft a curriculum proposal. At the third meeting, a quantitative questionnaire about this curriculum was disseminated to attendees to assess the level of agreement with the key points.In all, 150 min (19 pages) of the focus group discussion was transcribed (21 316 words). Themes were agreed by two raters (median agreement κ 0.89) and they included: need for a training curriculum (inter-rater agreement κ 0.85); identification of learning needs (κ 0.83); development of the curriculum contents (κ 0.81); an overview of available curricula (κ 0.79); settings for robotic surgery training ((κ 0.89); assessment and training of trainers (κ 0.92); requirements for certification and patient safety (κ 0.83); and need for a universally standardised curriculum (κ 0.78). A training curriculum was proposed based on the above discussions.This group proposes a multi-step curriculum for robotic training. Studies are in process to validate the effectiveness of the curriculum and to assess transfer of skills to the operating room.© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Artificial intelligence (AI) has emerged as a transformative tool in surgery, particularly in telesurgery and telementoring. However, its potential to enhance data transmission efficiency and reliability in these fields remains unclear. While previous reviews have explored the general applications of telesurgery and telementoring in specific surgical contexts, this review uniquely focuses on AI models designed to optimise data transmission and mitigate delays. We conducted a comprehensive literature search on PubMed and IEEE Xplore for studies published in English between 2010 and 2023, focusing on AI-driven, surgery-related, telemedicine, and delay-related research. This review includes methodologies from journals, conferences, and symposiums. Our analysis identified a total of twelve AI studies that focus on optimising network resources, enhancing edge computing, and developing delay-robust predictive applications. Specifically, three studies addressed wireless network resource optimisation, two proposed low-latency control and transfer learning algorithms for edge computing, and seven developed delay-robust applications, five of which focused on motion data, with the remaining two addressing visual and haptic data. These advancements lay the foundation for a truly holistic and context-aware telesurgical experience, significantly transforming remote surgical practice and education. By mapping the current role of AI in addressing delay-related challenges, this review highlights the pressing need for collaborative research to drive the evolution of telesurgery and telementoring in modern robotic surgery.© 2024. The Author(s).

Remote surgery provides opportunity for enhanced surgical capabilities, wider healthcare reach, and potentially improved patient outcomes. The network reliability is the foundation of successful implementation of telesurgery. It relies on a robust, high-speed communication network, with ultra-low latency. Significant lag has been shown to endanger precision and safety. Furthermore, the full-fledged adoption of telerobotics demands careful consideration of ethical challenges too. A deep insight into these issues has been investigated during the first Telesurgery Consensus Conference that took place in Orlando, Florida, USA, on the 3rd and 4th of February, 2024. During the Conference, the state of the art of remote surgery has been reported from robotic systems displaying telesurgery potential. The Hinotori, a robotic-assisted surgery platform developed by Medicaroid, experienced remote surgery as pre-clinical testing only; the Edge Medical Company, Shenzen, China, reported more than one hundred animal and 30 live human surgeries; the KanGuo reported human telesurgical cases performed with distances more than 3000 km; the Microport, China, collected more than 100 human operations at a distance up to 5000 km. Though, several issues-cybersecurity, data privacy, technical malfunctions - are yet to be addressed before a successful telesurgery implementation. Expanding the discussion to encompass ethical, financial, regulatory, and legal considerations is essential too. The Telesurgery collaborative community is working together to address and establish the best practices in the field.© 2024. The Author(s).

Assuring communication redundancy during the interruption and establishing appropriate teaching environments for local surgeons are essential to making robotic telesurgery mainstream. This study analyzes robotic telesurgery with telementoring using standard domestic telecommunication carriers. Can multiple carriers guarantee redundancy with interruptions? Three commercial optical fiber lines connected Hirosaki University and Mutsu General Hospitals, 150 km apart. Using Riverfield, Inc. equipment, Hirosaki had a cockpit, while both Mutsu used both a cockpit and a surgeon's console. Experts provided telementoring evaluating 14 trainees, using objective indices for operation time and errors. Subjective questionnaires addressed image quality and surgical operability. Eighteen participants performed telesurgery using combined lines from two/three telecommunication carriers. Manipulation: over 30 min, lines were cut and restored every three minutes per task. Subjects were to press a switch when noticing image quality or operability changes. Mean time to task completion was 1510 (1186-1960) seconds: local surgeons alone and 1600 (1152-2296) seconds for those under remote instructor supervision, including expert intervention time. There was no significant difference (p = 0.86). The mean error count was 0.92 (0-3) for local surgeons and 0.42 (0-2) with remote instructors. Image quality and operability questionnaires found no significant differences. Results communication companies A, B, and C: the A/B combination incurred 0.17 (0-1) presses of the environment change switch, B/C had 0, and C/A received 0.67 (0-3), showing no significant difference among provider combinations. Combining multiple communication lines guarantees communication redundancy and enables robotic telementoring with enhanced communication security.© 2024. The Author(s).

The emergence of telesurgery has received global interest, with secure network transmission identified as a crucial determinant of its success. This study aimed to evaluate the safety and viability of employing quantum cryptography communication in remote partial nephrectomy.

Network latency is the most important factor affecting the performance of telemedicine. The aim of the study is to assess the feasibility and efficacy of a novel network latency management system in 5G telesurgery.We conducted 20 telesurgery simulation trials (hitching rings to columns) and 15 remote adrenalectomy procedures in the 5G network environment. Telemedicine Network Latency Management System and the traditional "Ping command" method (gold standard) were used to monitor network latency during preoperative simulated telesurgery and formal telesurgery. We observed the working status of the Telemedicine Network Latency Management System and calculated the difference between the network latency data and packet loss rate detected by the two methods. In addition, due to the lower latency of the 5G network, we tested the alert function of the system using the 4G network with relatively high network latency.The Telemedicine Network Latency Management System showed no instability during telesurgery simulation trials and formal telesurgery. After 20 telesurgery simulation trials and 15 remote adrenalectomy procedures, the p-value for the difference between the network latency data monitored by the Telemedicine Network Latency Management System and the "Ping command" method was greater than 0.05 in each case. Meanwhile, the surgeons reported that the Telemedicine Network Latency Management System had a friendly interface and was easy to operate. Besides, when the network latency exceeded a set threshold, a rapid alarm sounded in the system.The Telemedicine Network Latency Management System was simple and easy to operate, and it was feasible and effective to use it to monitor network latency in telesurgery. The system had an intuitive and concise interface, and its alarm function increased the safety of telesurgery. The system's own multidimensional working ability and information storage capacity will be more suitable for telemedicine work.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

To show the feasibility of performing human telesurgery robotic-assisted radical prostatectomy (RARP) between two countries using low-latency ultra-long-distance connectivity. This study described the outcomes of performing RARP on a man in his 60's with localized intermediate-risk prostatic adenocarcinoma located in Kuwait City while the surgeon (SA) was approximately 7000 kilometers (Km) away at Toumai robotic surgical system (TRSS) headquarters in Shanghai. Operative and connectivity details were reported. RARP was performed in December 2024. There were no major clinical or technical problems encountered during the procedure. The average round-trip latency (RTL) was 181.4 milliseconds (ms) using fiber optic broadband network with 5G network as back-up. On the Shanghai end two wired broadband networks were employed as back-up to ensure patient safety. There was an experienced fellowship-trained robotic surgeon (AA) in the operating room in Kuwait capable of taking over in case of clinical or connectivity issues. There were no reported complications. The patient was discharged on postoperative day (POD) 2. Final pathology described Gleason score 7(3 + 4), ISUP 2, and negative surgical margins (pT2Nx). The catheter was removed on POD 9, and the patient was continent a week later. His serum prostate specific antigen (PSA) was undetectable seven weeks post-operatively. This study described the feasibility of human RARP telesurgery between two countries using low-latency, long-distance fiber optic broadband network with 5G network as back-up with successful clinical outcomes. There is a need to establish robust legal and regulatory framework to allow wider international expansion of telesurgery.© 2025. The Author(s).

To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and nontechnical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery.

The incidence of thyroid malignancies is increasing due to the development of detection techniques. The demand for aesthetics and precision has led surgeons to innovate in surgery, and with the development of 5G technology, telesurgery has become a reality.We present the case of a 37-year-old woman with a physical examination that revealed a nodule of about 0.5*0.5 cm in size in the left lobe of the thyroid gland, with preoperative puncture pathology suggestive of papillary carcinoma. A 5G remote robotic thyroidectomy was performed from Shanghai to Shenzhen.We believe this paper reports the world's first 5G tele-robotic-assisted transthoracic breast approach thyroidectomy.© 2025. The Author(s).

Telesurgery can revolutionize health care by facilitating remote surgical interventions and expanding access to underserved regions. Its success depends on robust communication networks, latency management, and ethical oversight, which require collaboration between surgeons, engineers, and stakeholders to ensure safe, efficient, and equitable implementation.Copyright © 2025 European Association of Urology. Published by Elsevier B.V. All rights reserved.

For patients with recurrent thyroid cancer, traditional open re-operative surgeries often leave conspicuous cervical scars, significantly impacting patients' long-term quality of life. The potential for robotic surgery to enhance the aesthetic outcomes of re-operative surgery and improve the quality of life for these patients has rarely been studied. This study aimed to assess the feasibility and effectiveness of robotic reoperation for recurrent thyroid cancer following initial surgery, offering a viable surgical alternative tailored to patients with heightened aesthetic concerns.We conducted a retrospective analysis of patients with recurrent thyroid cancer who underwent robotic reoperation via the bilateral axillo-breast approach (BABA) at the 960th Hospital of People's Liberation Army between September 2018 and March 2024. The study design involved a comprehensive review of clinical data, including patient demographics, surgical outcomes, and postoperative complications.A cohort of 24 patients (18 females, 6 males) with a mean age of 34.13±10.06 years successfully underwent robotic BABA reoperation without conversion to open surgery. Two patients underwent completion total thyroidectomy (CTT) with central neck node dissection (CND), four underwent CTT with lateral neck dissection (LND), and the remaining 18 patients received LND alone. Histopathological examination revealed papillary thyroid carcinoma (PTC) in 23 patients and medullary thyroid carcinoma (MTC) in one patient. The mean number of lymph nodes retrieved from LND was 14.21±12.30, with 2.74±2.64 nodes harboring metastases. Postoperative complications were transient, including hypoparathyroidism in four patients and temporary vocal cord palsy in one patient, with no permanent complications reported. During an average follow-up period of 29.71±19.29 months, no recurrences were detected. Cosmetic satisfaction was assessed and yielded a median satisfaction score of 9.2.Robotic BABA reoperation emerges as a feasible and safe surgical modality for managing recurrent thyroid cancer, offering effective treatment while catering to patients' high aesthetic demands.Copyright © 2025 AME Publishing Company. All rights reserved.

To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART).A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were recorded and analyzed.There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups (P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) (P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups (P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case).Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.© 2022. The Author(s).

The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach in pediatric patients has been clinically proven, and its cosmetic results have been recognized by children and their families. However, there are no reports on using transoral robotic in pediatric thyroid surgery. In this study, we report the experience of 5 cases of transoral vestibular robotic thyroidectomy in treating of thyroid disease in children.Retrospective analysis of clinical data of five children who underwent robotic thyroid surgery via the TOVRT in our hospital from February 2021 to April 2023, including operation time, tumor diameter, postoperative hospitalization time, and surgical complications. All five patients were operated on by the same team, and the postoperative pathological results were all follicular adenoma of thyroid. The children had a strong desire for cosmetic surgery, and their families voluntarily chose the robotic surgical system for their surgery.All five patients underwent unilateral thyroid lobectomy without conversion to open surgery. All patients were female, with a mean BMI of (19.63 ± 1.79) kg/m and the mean age was (14.40 ± 2.33) years. The average operation time was (52.00 ± 5.10) mins, the average tumor diameter was (41.60 ± 8.41) mm, and the average postoperative hospital stay was (3.60 ± 0.49) days. There were no complications such as hypoparathyroidism, recurrent laryngeal nerve injury, genioglossal nerve injury, or skin necrosis.The transoral vestibular robotic thyroidectomy is safe and feasible, providing a new treatment option for pediatric thyroid diseases that require surgical treatment.© 2025. The Author(s).

Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications.Two paired investigators screened PubMed, Scopus and Web of Science databases for all full text English language articles published between 1995 and 2016 using the key words "telemedicine," "minimally invasive surgical procedure," "robotic surgical procedure," "education" and "distance." We categorized and included studies of level of interaction between proctors and trainees. Research design, special equipment, telecommunication network bandwidth and research outcomes of each study were ascertained and analyzed.Of 65 identified reports 38 peer-reviewed studies qualified for inclusion. Series were categorized into 4 advancing levels, ie verbal guidance, guidance with telestration, guidance with tele-assist and telesurgery. More advanced levels of surgical telementoring provide more effective and experiential teaching but are associated with increased telecommunication network bandwidth requirements and expenses. Concerns regarding patient safety and legal, financial, economic and ethical issues remain to be reconciled.Telementoring and telesurgery in minimally invasive surgery are becoming more practical and cost effective in facilitating teaching of advanced surgical skills worldwide and delivery of surgical care to underserved areas, yet many challenges remain. Maturity of these modalities depends on financial incentives, favorable legislation and collaboration with cybersecurity experts to ensure safety and cost-effectiveness.Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

It was a systematic review and meta-analysis that aimed to compare the efficiency and safety of robot-assisted urological surgery using both the KangDuo and da Vinci robotic systems. The PubMed, Embase, and Cochrane Library databases were searched for all papers published through September 1, 2024. The focus was on English-language papers comparing the KangDuo surgical robot and the da Vinci system in urological procedures. The screening method focused on RCTs and cohort studies and followed strict criteria. Three cohort studies and two randomised controlled trials with 300 adult urological surgery patients met the inclusion criteria. These 150 patients were operated on with the KangDuo robotic system and 150 with the da Vinci system. The investigation showed that whereas KangDuo operations were slightly longer, intraoperative blood loss, hospital stay, and postoperative complication rates were similar. The KangDuo robotic system performs urological surgery as well as the da Vinci system, although it takes longer. Future large-scale multicenter randomized trials are recommended to gather further evidence and enhance clinical understanding.© 2024. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

The development and implementation of telesurgery are of significant strategic importance for the future expansion and evolution of the surgical robotics industry. Telesurgery has been demonstrated to improve access to advanced medical care but also enhances the overall healthcare delivery in these underserved regions. Here, we presented a telesurgery system that optimized surgical signals via a telesurgery host using real-time signal processing and multi-source signal interaction systems. Additionally, a telesurgery network solution was developed to ensure seamless network switching.

Background: The incidence of thyroid cancer has increased globally. In recent years, robotic surgical systems have been applied in thyroid surgery, and the rapid development of fifth-generation (5G) communication technology has laid a solid foundation for the smooth implementation of remote surgery. Objective: The aim was to explore the feasibility and safety of telerobotic radical thyroidectomy using 5G communication technology to treat thyroid cancer. Methods: From August 2024 to October 2024, telerobotic radical thyroidectomy was performed on seven female patients using a 5G wireless network and a dedicated line network (or ordinary wired broadband) spanning 22–2200 km. The patients’ clinical and information transmission data were analyzed. Results: All patients (papillary thyroid carcinoma, female, with an average age of 44.0 ± 4.6 years) underwent uneventful surgical procedures without any transfer to open surgery or complications. The average surgical duration was 91.3 ± 11.8 min, the average blood loss was 11.4 ± 4.8 mL, and the average postoperative hospital stay was 3.6 ± 0.8 days. All subjects were successfully discharged within 5 days after surgery. The average total latency time of the intraoperative network was 137.5 (range, 121–159) ms, and there were no adverse events, such as network disconnection, frame loss, or network attacks. The operator worked smoothly without any obvious delay or lag, and the recorded audio and video are clear. Conclusions: Telerobotic radical thyroidectomy for thyroid cancer over a 5G network demonstrates promising feasibility and safety. With stable network transmission and a clear surgical field, the precise operations required in thyroid surgery can be performed reliably. These findings suggest that this technology can facilitate high-quality surgical care in remote areas, contributing to a more balanced distribution of medical resources.