Hubbry Logo
Remote surgeryRemote surgeryMain
Open search
Remote surgery
Community hub
Remote surgery
logo
7 pages, 0 posts
0 subscribers
Be the first to start a discussion here.
Be the first to start a discussion here.
Remote surgery
Remote surgery
Remote surgery
View on Wikipedia
from Wikipedia

Remote surgery (also known as cybersurgery or telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. A robot surgical system generally consists of one or more arms (controlled by the surgeon), a master controller (console), and a sensory system giving feedback to the user.[1][2] Remote surgery combines elements of robotics, telecommunications such as high-speed data connections and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery. Remote surgery is remote work for surgeons, where the physical distance between the surgeon and the patient is less relevant. It promises to allow the expertise of specialized surgeons to be available to patients worldwide, without the need for patients to travel beyond their local hospital.

Surgical systems

[edit]

Surgical robot systems have been developed from the first functional telesurgery system-ZEUS-to the da Vinci Surgical System, which is currently the only commercially available surgical robotic system. In Israel a company was established by Professor Moshe Schoham, from the faculty of Mechanical Engineering at the Technion. Used mainly for "on-site" surgery, these robots assist the surgeon visually, with better precision and less invasiveness to patients.[1][2] The Da Vinci Surgical System has also been combined to form a Dual Da Vinci system which allows two surgeons to work together on a patient at the same time. The system gives the surgeons the ability to control different arms, switch command of arms at any point, and communicate through headsets during the operation.[3]

Costs

[edit]

Marketed for $975,000, the ZEUS Robot Surgical System was less expensive than the da Vinci Surgical System, which cost $1 million. The cost of an operation through telesurgery is not precise but must pay for the surgical system, the surgeon, and contribute to paying for a year's worth of ATM technology which runs between $100,000-$200,000.[citation needed][4]

2025 France–India transcontinental bariatric telesurgery

[edit]

In July 2025, the first transcontinental bariatric surgery was successfully performed between Strasbourg, France, and Indore, India—a distance of over 8,500 kilometres—without any perceptible lag. The live robotic procedure was conducted during the Society of Robotic Surgery (SRS) Annual Meeting, with Dr. Mohit Bhandari operating the indigenously developed SSI Mantra 3 robotic system from IRCAD, Strasbourg. The surgery involved a gastric bypass on a morbidly obese, insulin-dependent diabetic patient at Mohak Bariatric and Robotic Surgery Centre in Indore.

The operation was completed in 48 minutes on a patient with a body mass index (BMI) of 50, who also suffered from sleep apnea and coronary artery disease. The patient was reported to have stood and walked within hours of the procedure.[5]

The Lindbergh Operation

[edit]
Main article: Lindbergh Operation

The first true and complete remote surgery was conducted on 7 September 2001 across the Atlantic Ocean, with a French surgeon (Dr. Jacques Marescaux) in New York City performing a cholecystectomy on a 68-year-old female patient 6,230 km away in Strasbourg, France. It was named Operation Lindbergh,[6] after Charles Lindbergh's pioneering transatlantic flight from New York to Paris. France Telecom provided the redundant fiber optic ATM lines to minimize latency and optimize connectivity, and Computer Motion provided a modified Zeus robotic system. After clinical evaluation of the complete solution in July 2001, the human operation was successfully completed on 9/7/2001.[7]

The success and exposure of the procedure led the robotic team to use the same technology within Canada, this time using Bell Canada's public internet between Hamilton, Ontario and North Bay, Ontario (a distance of about 400 kilometers). While operation Lindbergh used the most expensive ATM fiber optics communication to ensure reliability and success of the first telesurgery, the follow on procedures in Canada used standard public internet which was provisioned with QOS using MPLS QOS-MPLS. A series of complex laparoscopic procedures were performed where in this case, the expert clinician would support the surgeon who was less experienced, operating on his patient. This resulted in patient receiving the best care possible while remaining in their hometown, the less experienced surgeon gaining valuable experience, and the expert surgeon providing their expertise without travel. The robotic team's goal was to go from Lindbergh's proof of concept to a real-life solution. This was achieved with over 20 complex laparoscopic operations between Hamilton and North Bay.

Applications

[edit]

Since Operation Lindbergh, remote surgery has been conducted many times in numerous locations. To date Dr. Anvari, a laparoscopic surgeon in Hamilton, Canada, has conducted numerous remote surgeries on patients in North Bay, a city 400 kilometres from Hamilton.[8] Even though he uses a VPN over a non-dedicated fiberoptic connection that shares bandwidth with regular telecommunications data, Dr. Anvari has not had any connection problems during his procedures.[citation needed]

Rapid development of technology has allowed remote surgery rooms to become highly specialized. At the Advanced Surgical Technology Center at Mt. Sinai Hospital in Toronto, Canada, the surgical room responds to the surgeon's voice commands in order to control a variety of equipment at the surgical site, including the lighting in the operating room, the position of the operating table and the surgical tools themselves. With continuing advances in communication technologies, the availability of greater bandwidth and more powerful computers, the ease and cost-effectiveness of deploying remote surgery units is likely to increase rapidly.

The possibility of being able to project the knowledge and the physical skill of a surgeon over long distances has many attractions. There is considerable research underway in the subject. The armed forces have an obvious interest since the combination of telepresence, teleoperation, and telerobotics can potentially save the lives of battle casualties by providing them with prompt attention in mobile operating theatres.

Another potential advantage of having robots perform surgeries is accuracy. A study conducted at Guy's Hospital in London, England compared the success of kidney surgeries in 304 dummy patients conducted traditionally as well as remotely and found that those conducted using robots were more successful in accurately targeting kidney stones.[9]

In 2015, another test was conducted on the lag time involved in the robotic surgery. A Florida hospital successfully tested lag time created by the Internet for a simulated robotic surgery in Ft. Worth, Texas, more than 1,200 miles away from the surgeon who was at the virtual controls. The team found out that the lag time in robotic surgeries was insignificant. Roger Smith, CTO at the Florida Hospital Nicholson Center said that the team had concluded that telesurgery is something that is possible and generally safe for large areas within the United States.[10][11]

In 2024, lung tumour surgery conducted over a 5G wireless connection from 5000km away.[12][13]

Unassisted robotic surgery

[edit]

As the techniques of expert surgeons are studied and stored in special computer systems, robots might one day be able to perform surgeries with little or no human input. Carlo Pappone, an Italian surgeon, has developed a software program that uses data collected from several surgeons and thousands of operations to perform the surgery without human intervention.[14][unreliable source?] This could one day make expensive, complicated surgeries much more widely available, even to patients in regions which have traditionally lacked proper medical facilities.

Force-feedback and time delay

[edit]

The ability to carry out delicate manipulations relies greatly upon feedback. For example, it is easy to learn how much pressure is required to handle an egg. In robotic surgery, surgeons need to be able to perceive the amount of force being applied without directly touching the surgical tools. Systems known as force-feedback, or haptic technology, have been developed to simulate this. Haptics is the science of touch. Any type of Haptic feedback provides a responsive force in opposition to the touch of the hand. Haptic technology in telesurgery, making a virtual image of a patient or incision, would allow a surgeon to see what they are working on as well as feel it. This technology is designed to give a surgeon the ability to feel tendons and muscles as if it were actually the patient's body.[15][16] However these systems are very sensitive to time-delays such as those present in the networks used in remote surgery.

Depth perception

[edit]

Being able to gauge the depth of an incision is crucial. Humans' binocular vision makes this easy in a three-dimensional environment. However, this can be much more difficult when the view is presented on a flat computer screen.

Possible uses

[edit]

One possible use of remote surgery is the Trauma-Pod project conceived by the US military under the Defense Advanced Research Agency. This system is intended to aid wounded soldiers in the battlefield by making use of the skills of remotely located medical personnel.

Another future possibility could be the use of remote surgery during long space exploration missions.

Limitations

[edit]

For now, remote surgery is not a widespread technology in part because it does not have sponsorship by the governments.[17] Before its acceptance on a broader scale, many issues will need to be resolved. For example, establishing secure very fast connections between the two sites, establishing clinical protocols, training, and global compatibility of equipment. Another technological limitation is the risk of interference with the communications (hacking).[18] Also, there is still the need for an anesthesiologist and a backup surgeon to be present in case there is a disruption of communications or a malfunction in the robot. Nevertheless, Operation Lindbergh proved that the technology exists today to enable delivery of expert care to remote areas of the globe.

See also

[edit]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Remote surgery

View on Grokipedia
from Grokipedia
Remote surgery, also known as telesurgery, is a branch of robotic-assisted in which a performs operative procedures on a located at a remote site, typically using telemanipulator robotic systems controlled via high-speed or dedicated networks to enable real-time visualization and instrument manipulation, and in some systems, haptic feedback. This approach extends surgical expertise to geographically isolated or underserved areas, facilitates collaborative procedures involving multiple specialists, and supports training through virtual mentoring, while relying on technologies such as fiber-optic cables, connectivity, and advanced imaging for minimal latency and precision, with recent integrations of for . The concept of remote surgery emerged from early military and space exploration efforts in the mid-20th century, where robotic systems were developed to perform operations in hazardous or inaccessible environments, such as NASA's proposals in the for telesurgery on astronauts. A pivotal milestone occurred in 2001 with Operation Lindbergh, the first transatlantic telesurgery, in which French surgeon Jacques Marescaux successfully performed a laparoscopic on a in , , from a console in using the robotic system over a high-speed fiber-optic link with an average latency of 155 milliseconds. Subsequent advancements included the 2019 demonstration of 5G-enabled remote surgeries in , such as a surgery and a spinal procedure, which highlighted the potential for ultra-low latency (under 100 milliseconds) in real-world clinical settings. More recently, in July 2025, surgeons in performed the world's first transcontinental robotic telesurgeries on patients in , including a gastric bypass and cardiac repair, using the SSI system over a secure network. Key technologies underpinning remote surgery include master-slave robotic platforms like the , which provides three-dimensional high-definition visualization, tremor filtration, and scaled motion control, allowing surgeons to operate through small incisions for minimally invasive procedures. These systems integrate preoperative planning tools, intraoperative navigation, and postoperative monitoring, often enhanced by for and overlays to improve accuracy in complex anatomies, with networks enabling latencies below human detection in 2025 trials. Applications span , gynecology, orthopedics, and , with notable uses in disaster zones, rural clinics, and military operations to deliver specialized care without on-site experts. Despite its promise, remote surgery faces significant challenges, including network latency exceeding 200 milliseconds that can compromise precision, high initial costs (often $1.5-2.5 million per robotic unit plus $3,000-5,000 per procedure as of 2025), cybersecurity risks for data transmission, and regulatory hurdles related to liability, , and ethical in cross-border scenarios. Ongoing research emphasizes robust , fail-safe mechanisms, and to mitigate technical failures and ensure equitable access, positioning telesurgery as a transformative tool for global healthcare disparities.

Overview

Definition and principles

Remote surgery, also known as telesurgery, is a in which a operates on a located at a distant site by controlling robotic instruments through real-time communication networks. This approach enables surgical intervention without the physical presence of the at the 's bedside, leveraging advanced and to bridge geographical distances. At its core, remote surgery operates on the master-slave principle, where the manipulates controls at a master console that translates inputs into precise movements of slave robotic arms positioned at the patient's location. These systems rely on high-speed data transmission to deliver real-time video feeds, audio communication, and haptic feedback—sensory signals that allow the to perceive tissue resistance and instrument interactions remotely. The integration of these elements ensures that the remote maintains and dexterity comparable to in-person procedures, with a local support team available for immediate intervention if connectivity issues arise. The basic workflow of remote surgery encompasses three primary phases. In the preoperative stage, detailed planning occurs, including patient assessment, robotic system setup, and coordination between remote and local teams to obtain and establish links. During the intraoperative phase, the directs the procedure via the master console, with continuous exchange facilitating real-time adjustments and monitoring of . Postoperative monitoring follows, often through platforms that enable remote evaluation of recovery progress, wound healing, and complication detection to support timely follow-up care. Unlike traditional robotic , where the operates the master console in the same room as the patient to enhance precision and minimize invasiveness, remote surgery emphasizes significant geographical separation, often across continents, to extend expertise to underserved areas. This distinction shifts the focus from local augmentation of surgical skills to global accessibility, requiring robust network infrastructure to overcome distance-related challenges.

Historical development

The concept of remote surgery emerged from mid-20th-century advancements in , which explored human-machine interfaces for controlling distant mechanisms, laying foundational ideas for in medical contexts. By the , early prototypes incorporated head-mounted displays and data gloves to enable surgeons to manipulate remote instruments with stereoscopic vision, marking initial steps toward telesurgery. In the , experiments shifted to basic systems using master-slave architectures, where surgeons controlled robotic arms via wired connections, demonstrating feasibility in simulated laparoscopic tasks despite latency challenges. A pivotal milestone occurred in the late 1990s with the development of the , initiated as a U.S. Department of Defense project in collaboration with to enable precise, tremor-free telesurgery for battlefield applications. The system's first three-arm prototype became commercially available in in 1999, followed by U.S. FDA approval in 2000 for general laparoscopic procedures, integrating high-definition 3D visualization and intuitive controls. Concurrently, the first transatlantic telesurgery simulations in 2000 tested the ZEUS robotic system across continents with a 200-millisecond delay, validating long-distance control for basic incisions on inanimate models. The transition to real procedures began in 2001 with Operation Lindbergh, the first transatlantic human telesurgery—a laparoscopic using the system—followed by animal trials in the early 2000s, where transcontinental telesurgery was performed on porcine models using the da Vinci system to conduct nephrectomies, confirming the technology's safety and precision over fiber-optic networks with latencies under 150 milliseconds. These experiments, building on prior laparoscopic studies in animals, addressed haptic feedback and sterilization issues, advancing toward broader clinical use. By mid-decade, such trials expanded to include removals and vessel anastomoses in live subjects, establishing remote surgery's viability beyond simulations. Recent progress from 2020 to 2025 has integrated 5G networks into remote surgery platforms, reducing latency to under 100 milliseconds in regional setups and enabling high-bandwidth transmission of 4K video and haptic data for transcontinental operations with latencies around 100-200 milliseconds. Notable 2025 advancements include transcontinental telesurgeries from France to India using the SSI Mantra robot for gastric bypass and cardiac repair over 10,000 km. Pilot studies during this period, including robot-assisted cholecystectomies in rural settings, demonstrated 5G's role in minimizing delays and enhancing surgeon immersion, with success rates exceeding 95% in controlled trials. This advancement has supported deployments in regions with limited specialist access, such as Asia-Pacific validations of systems like the hinotori Surgical Robot, fostering broader clinical adoption by 2025.

Technology

Robotic surgical systems

Robotic surgical systems for remote surgery typically consist of a master console, where the surgeon operates controls resembling traditional surgical tools, and a slave unit positioned at the patient's site, comprising multiple articulated robotic arms equipped with interchangeable end-effectors such as grippers, scalpels, or cautery devices for precise tissue manipulation. These arms provide enhanced dexterity with up to seven degrees of freedom, surpassing human wrist limitations, and are controlled in real-time to execute scaled and filtered movements. High-definition stereoscopic cameras, often mounted on a dedicated arm, deliver 3D visualization of the surgical field, enabling depth perception and magnified views up to 10x for intricate procedures. Prominent systems adapted for telesurgery include the by , which features a dual-console setup allowing remote operation over secure networks, as demonstrated in a 2025 procedure on an advanced tissue model using the da Vinci 5 platform. This system integrates three or four multi-jointed arms for instruments and an , supporting minimally invasive telesurgery with force-feedback mechanisms to simulate tactile sensations. Newer platforms like the Versius Surgical System by incorporate modular, portable arms, as explored in pediatric trials. Software integration plays a crucial role, with image processing algorithms enabling real-time 3D visualization by stitching stereoscopic feeds and applying noise reduction for clarity during transmission. AI-assisted features include motion scaling, which adjusts surgeon inputs for finer control (e.g., 3:1 or 5:1 ratios), and tremor filtration, which eliminates hand tremors above 6 Hz to ensure steady movements, improving accuracy in delicate tasks. These elements are embedded in systems like da Vinci and Versius to optimize teleoperation performance. By 2025, robotic surgical systems have evolved toward modular designs, with detachable arms and compact carts that allow rapid setup and transport to remote or underserved locations, as seen in platforms like Versius and emerging systems. This modularity supports easier integration into varied clinical environments, reducing deployment time from hours to minutes and broadening access to telesurgery.

Communication and control mechanisms

Remote surgery relies on robust network infrastructures to ensure reliable, transmission between the surgeon's console and the operating room. Essential requirements include high-bandwidth connections capable of supporting data rates exceeding 10 Mbps for video and control signals, alongside ultra-low latency, typically under 100 milliseconds round-trip time, to maintain surgical precision and safety. Technologies such as optic cables provide , high-speed terrestrial links, while networks offer mobile flexibility with latencies as low as 48 ms in clinical trials, and satellite systems enable global reach in remote areas despite higher inherent delays. These standards, including minimal and rates below 0.1%, are critical to prevent disruptions during procedures. Control in remote operates through two primary paradigms: direct , where the issues continuous real-time commands to the robotic , and supervisory control, in which the sets high-level parameters and the autonomously executes subtasks under oversight. Direct demands instantaneous feedback to mimic in-person but is vulnerable to network , whereas supervisory control enhances in unstable connections by reducing the frequency of command transmissions. To mitigate latency effects, predictive algorithms forecast robot movements based on inputs and historical patterns, compensating for by preemptively adjusting actions and stabilizing haptic feedback. These methods, often integrated with , allow operations to proceed safely even with round-trip times up to 320 ms in controlled settings. The transmitted in remote surgery encompasses multiple streams to provide comprehensive . feeds, including up to endoscopic images at 8 Mbps, deliver visual clarity of the surgical field. Haptic packets convey tactile sensations, such as tissue resistance, through force feedback signals sampled at high rates to simulate instrument interactions. monitoring, including and , is streamed in real-time alongside control commands at 2 Mbps to enable immediate physiological assessments. These heterogeneous types are prioritized and compressed to fit bandwidth constraints without compromising . In 2025, advancements in hybrid 5G-satellite systems have expanded remote surgery's feasibility for global applications, combining 's low-latency terrestrial coverage with low-Earth orbit satellites for uninterrupted connectivity over vast distances. Notable trials, such as those conducted by Chinese teams using geostationary satellites linked to 5G networks, achieved successful surgeries with latencies under 200 ms across thousands of kilometers, demonstrating enhanced reliability in underserved regions. These integrations, as seen in low-Earth orbit-based procedures on mobile platforms, support seamless data flow and pave the way for broader clinical adoption.

Notable procedures

The Lindbergh Operation

The Lindbergh Operation, conducted on September 7, 2001, marked the first transoceanic telesurgery procedure on a human patient. Performed by French surgeon Jacques Marescaux and his team from the European Institute of Telesurgery (IRCAD) in New York, it involved the laparoscopic —removal of the gallbladder—from a 68-year-old woman located in , , approximately 6,000 kilometers (3,700 miles) away across the Atlantic Ocean. The procedure utilized the developed by Computer Motion, consisting of three robotic arms: two for manipulating surgical instruments and one for controlling an via voice commands. The technical setup relied on a dedicated transatlantic fiber-optic network provided by France Telecom, operating at a bandwidth of 10 Mbps to transmit and control signals. This connection achieved an average round-trip latency of 155 milliseconds, which was deemed acceptable for visual-based control despite the absence of haptic feedback in the ZEUS system, requiring surgeons to depend entirely on visual cues from the endoscopic feed. Safety features included redundant signal verification, with controls checked over 1,000 times per second to prevent unintended movements. The 45-minute operation proceeded without complications, successfully completing the removal through four small incisions, after which the patient experienced a rapid recovery and was discharged from the hospital after two days. This demonstrated the feasibility of remote surgery over vast distances using then-available technology, though the latency highlighted potential challenges for more complex procedures requiring precise, real-time tactile input. Named in honor of Charles Lindbergh's pioneering 1927 solo from New York to , the operation symbolized a similar breakthrough in overcoming geographical barriers in , paving the way for global collaboration in surgical expertise. It underscored the potential of telesurgery to extend specialized care to remote areas while emphasizing the need for reliable, low-latency communication .

2025 France–India transcontinental telesurgery

In July 2025, during the Society of Robotic Surgery (SRS) Annual Meeting in Strasbourg, France, surgeons performed the world's first transcontinental bariatric telesurgery, connecting a control station in France to a patient in Indore, India, over approximately 8,500 kilometers. Dr. Mohit Bhandari, President of IRCAD India and a leading bariatric surgeon, operated remotely using the Indian-developed SSi Mantra 3 robotic system to conduct a gastric bypass on an obese patient with comorbidities including diabetes and sleep apnea. The procedure lasted 44 minutes and concluded without complications, with the patient showing uneventful recovery and discharge within days. The technical setup relied on a high-speed 5G-enabled network combined with dedicated fiber optic connections to ensure real-time data transmission, achieving imperceptible latency, which is critical for precise surgical control. The SSi Mantra system incorporated advanced features such as multi-arm robotic manipulation and haptic feedback, allowing the surgeon to sense tissue resistance remotely and maintain dexterity comparable to in-person operations. Local teams in Indore provided on-site support, including anesthesia and monitoring, highlighting the hybrid human-robotic approach. This breakthrough demonstrated the viability of robotic telesurgery for complex procedures across continents, fostering international collaboration between IRCAD France, IRCAD India, and SS Innovations. By enabling expert surgeons to treat patients in resource-limited regions without travel, it advanced the concept of equitable global surgical access, potentially reducing disparities in specialized care for conditions like .

Applications

Current clinical uses

Remote surgery, also known as telesurgery, has transitioned from experimental demonstrations to established clinical applications, particularly in minimally invasive procedures across several surgical specialties. As of , it enables surgeons to operate on patients located at significant distances using robotic systems, with low-latency networks ensuring precise control. In , remote surgery has seen substantial adoption for procedures such as robotic-assisted radical and complex reconstructions. For instance, in 2025, surgeons performed cross-continental prostatectomies, including one connecting the to over 7,000 miles, demonstrating feasibility for treatment. Additional urological telesurgeries include retrocaval ureteral reconstruction and adrenal tumor resection, contributing to over 1,000 documented cases in alone using 5G-enabled systems. Gynecology has emerged as another key field, with the first European telesurgery case conducted in May 2025 at AZORG Hospital in , focusing on minimally invasive gynecological interventions. This procedure highlighted the potential for remote expert guidance in hysterectomies and other pelvic surgeries, leveraging systems like the Toumai® for enhanced precision in underserved settings. applications include cholecystectomies and other abdominal procedures, where telesurgery facilitates minimally invasive techniques in resource-limited environments. By 2025, these have been demonstrated in clinical settings, particularly for removals, using robotic platforms to minimize incisions and recovery time. Current clinical uses are prominent in rural hospitals, military field operations, and disaster zones, where access to on-site specialists is limited. In military contexts, telesurgery serves as multiplier, allowing skilled surgeons to perform operations in austere environments via secure networks. For rural and disaster-affected areas, it bridges gaps in expertise, as seen in European and Asian initiatives providing remote support to isolated facilities. These applications offer key benefits, including to specialist expertise in underserved regions and reduced need for travel, thereby lowering logistical burdens and improving equity in surgical care. By 2025, over 50 fully remote telesurgeries have been documented worldwide, with the majority occurring in and through congresses and clinical programs like the SRS and ERUS meetings.

Potential future implementations

Remote surgery holds significant promise for extreme environments, such as space missions to Mars, where communication delays of up to 24 minutes preclude real-time , necessitating autonomous or semi-autonomous robotic systems for emergency procedures like trauma care and . NASA's testing of miniaturized robots like spaceMIRA on the demonstrates feasibility for such applications, with prototypes weighing as little as 0.9 kg enabling precise interventions in microgravity. Similarly, undersea habitats have been used to simulate telesurgery in confined, high-pressure settings analogous to expeditions, where teleoperated robots successfully performed basic tasks, highlighting potential for remote medical support in polar or submarine operations. Integration of (AR) and (VR) with remote surgery platforms is advancing training paradigms, allowing experts to provide real-time annotations and holographic guidance to trainees via mixed-reality overlays on robotic systems like da Vinci. Pilot studies show AR reduces cognitive workload and accelerates skill acquisition in telesurgery simulations, with dynamic cues improving procedural efficiency compared to traditional methods. Scalability in low-resource countries is bolstered by networks, which offer ultra-low latency under 20 ms and bandwidth exceeding 1 Gbps, enabling streaming and haptic feedback for telementoring in rural areas. Affordable deployment, combined with integration, could extend telesurgery to underserved regions, as demonstrated in various trials in remote areas. Unassisted AI-robot hybrids further enhance this by automating routine tasks like tissue retraction and vessel clipping, with zero-shot adaptation from simulations in and trials. To promote global equity, remote surgery could mitigate projected shortages of over 1 million surgical specialists in low- and middle-income countries by 2030, where 5 billion people currently lack access to basic procedures. The telesurgery market is expected to grow from USD 2.41 billion in to USD 5.91 billion by 2030 at a 15.9% CAGR, driven by expanded applications in workforce-constrained settings. While ethical concerns around access disparities persist, these advancements offer a pathway to redistribute expertise without requiring on-site surgeons.02357-1/fulltext) Ongoing research directions include trials in and orthopedics, such as 5G-enabled remote robot-assisted spine surgeries, which have completed phases showing safe vertebroplasty with latency under 100 ms. These efforts build toward broader adoption in complex procedures, integrating AI for precision in dynamic environments.

Challenges

Technical limitations

One of the primary technical limitations in remote surgery is time delay and latency in between the surgeon's console and the ic system at the operative site. Latencies exceeding 200 ms significantly impair surgical precision, as they introduce noticeable disruptions in instrument manipulation, with effects escalating from mild interference below 200 ms to substantial degradation in task performance between 300 and 700 ms. To mitigate these delays, motion prediction algorithms are employed, such as autoregressive models, recurrent neural networks, and networks, which forecast trajectories and intents to preemptively adjust movements and maintain operational stability. Force feedback and haptics present another critical challenge, as current systems struggle to deliver realistic simulations of tissue interactions, often lacking the fidelity needed for precise control during delicate procedures. Commercial robotic platforms, such as the da Vinci system, typically omit integrated force sensors, relying instead on indirect estimation methods that are confounded by dynamic factors like robot and , resulting in incomplete or inaccurate tactile cues. Achieving high-resolution force feedback—ideally below 1 N, with some applications requiring resolutions as fine as 0.2 N within a 10 N range—remains essential for simulating tissue resistance but is limited by stability-transparency trade-offs and underdeveloped tactile sensing for spatially distributed pressures and textures. Depth perception is further compromised in remote surgery due to the reliance on endoscopic imaging, where traditional two-dimensional (2D) views fail to convey spatial relationships, leading to misjudgments in instrument positioning and increased error rates compared to three-dimensional (3D) visualization. This challenge arises particularly in converting 2D monocular feeds to 3D perceptions, as monocular endoscopes cannot directly capture depth, exacerbating issues in minimally invasive contexts. Solutions include binocular endoscopy systems, which provide stereoscopic imaging to enhance depth cues and improve surgical accuracy by reconstructing 3D environments from dual-camera inputs. Additional constraints involve bandwidth limitations, especially in remote or underserved areas lacking robust , where insufficient data rates degrade video quality and introduce , potentially compromising real-time control. For instance, remote robotic systems require at least 150 Mbps to avoid image degradation and ensure safe operation over long distances, though technologies like offer potential mitigation by enabling high-speed connectivity in isolated regions. Cybersecurity risks also threaten control signals, as networked exposes systems to or hijacking, allowing unauthorized manipulation of robotic movements that could cause immediate harm during procedures.

Ethical and regulatory issues

Remote surgery, also known as telesurgery, presents several ethical challenges, particularly around and equitable access. Obtaining valid for remote procedures is complicated by factors such as language barriers, cultural differences, and the physical distance between surgeon and patient, which may hinder patients' full understanding of risks like network failures or delays. To address this, the use of AI-powered translation tools has been proposed to ensure comprehension, though cultural nuances remain a persistent issue. Equity in access is another concern, as the high costs of telesurgery could widen healthcare disparities between urban and rural areas or between high-income and low-resource regions, potentially leading to exploitation where developing countries serve as testing grounds for procedures without adequate local benefits or oversight. Liability and regulatory frameworks for remote surgery remain underdeveloped, creating uncertainty about responsibility in cases of errors. Accountability may fall on the remote , the operating , on-site personnel, or even network providers, depending on jurisdictional interpretations, with some cases holding the liable and others implicating institutional protocols. As of November 2025, the U.S. (FDA) has granted Investigational Device Exemption (IDE) approvals for specific telesurgery trials, such as the first transcontinental robotic procedure between the and using the Toumai® system in June 2025, which successfully demonstrated low-latency prostatectomy over 17,000 km but highlighted needs for further cybersecurity safeguards. However, full commercial approvals for remote capabilities in systems like the MIRA Surgical System are still pending clinical validation in human subjects. In , the (EMA) oversees robotic systems through under the Medical Device Regulation (MDR), but telesurgery-specific approvals emphasize rigorous certification for safety and efficacy without a unified framework for cross-border operations; policies from bodies like the stress the need for international standards to mitigate risks. Privacy and data security are critical in remote surgery due to the transmission of sensitive patient information over international networks, raising compliance issues with regulations like the General Data Protection Regulation (GDPR) in and the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. These laws mandate , secure data handling, and breach notification, yet cross-border transfers increase vulnerability to cyberattacks, necessitating advanced protocols such as for immutable records. Non-compliance could result in severe penalties, underscoring the need for standardized international agreements to protect patient data during telesurgical procedures. The adoption of remote surgery also impacts the surgical workforce, requiring specialized training for on-site assistants who manage local aspects of the procedure while relying on remote guidance. Programs like telementoring have demonstrated success in enhancing skills for assistants in low-resource settings through real-time expert input, potentially democratizing expertise. However, overreliance on robotic telesurgery raises concerns about local surgeons, as reduced hands-on experience with traditional techniques could erode manual proficiency and professional judgment over time.

References

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10569862/
  2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10784205/
  3. https://www.sermo.com/resources/robotics-in-surgery/
  4. https://spectrum.ieee.org/doc-at-a-distance
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10683436/
  6. https://pmc.ncbi.nlm.nih.gov/articles/PMC8075759/
  7. https://www.surgicalroboticstechnology.com/news/ss-innovations-completes-worlds-first-intercontinental-robotic-cardiac-telesurgery/
  8. https://www.fda.gov/medical-devices/surgery-devices/computer-assisted-surgical-systems
  9. https://journals.lww.com/juop/fulltext/2025/08000/juop_july_2025__telesurgery_in_2025_will_technical.15.aspx
  10. https://www.medtechdive.com/news/intuitive-da-vinci-5-robot-sages-conference/713937/
  11. https://www.intechopen.com/chapters/83749
  12. https://pmc.ncbi.nlm.nih.gov/articles/PMC11266380/
  13. https://link.springer.com/article/10.1007/s40012-023-00373-2
  14. https://www.mdpi.com/2079-9292/13/1/124
  15. https://www.sociostudies.org/almanac/articles/cybernetic_revolution_and_forthcoming_technological_transformations_-the_development_of_the_leading_/
  16. https://pmc.ncbi.nlm.nih.gov/articles/PMC6261744/
  17. https://www.sciencedirect.com/science/article/pii/S2666676625000262
  18. https://www.sciencedirect.com/science/article/pii/S1878788611000324
  19. https://www.wjols.com/doi/WJOLS/pdf/10.5005/jp-journals-10033-1304
  20. https://www.researchgate.net/publication/5556075_Transcontinental_Telesurgical_Nephrectomy_Using_the_da_Vinci_Robot_in_a_Porcine_Model
  21. https://jamanetwork.com/journals/jamasurgery/fullarticle/392176
  22. https://pmc.ncbi.nlm.nih.gov/articles/PMC1422462/
  23. https://pmc.ncbi.nlm.nih.gov/articles/PMC12170204/
  24. https://wjso.biomedcentral.com/articles/10.1186/s12957-025-03780-8
  25. https://www.springermedicine.com/toward-safe-clinical-deployment-of-remote-robotic-surgery-in-jap/51634924
  26. https://r2surgical.com/blogs/news/what-is-robotic-assisted-telesurgery
  27. https://www.cureus.com/articles/191019-advancements-in-robotic-surgery-a-comprehensive-overview-of-current-utilizations-and-upcoming-frontiers
  28. https://www.news-medical.net/health/What-is-Remote-SurgeryTelesurgery.aspx
  29. https://www.massdevice.com/intuitive-demonstrates-remote-telesurgery-capabilities-with-da-vinci-5/
  30. https://isrg.intuitive.com/news-releases/news-release-details/intuitive-demonstrates-telesurgery-capabilities
  31. https://www.clinicaltrialsarena.com/news/cmr-surgical-to-trial-surgical-robot-versius-in-paediatrics/
  32. https://www.cureus.com/articles/217847-robotic-revolution-in-surgery-diverse-applications-across-specialties-and-future-prospects-review-article
  33. https://www.medtronic.com/covidien/en-gb/robotic-assisted-surgery/hugo-ras-system/blog/modular-design-in-surgical-robotic-systems.html
  34. https://publishing.rcseng.ac.uk/doi/10.1308/rcsbull.2020.114
  35. https://academic.oup.com/milmed/article/190/Supplement_2/419/8256289
  36. https://www.medicaldesignandoutsourcing.com/new-technical-guidelines-set-to-advance-remote-robotic-surgery/
  37. https://pmc.ncbi.nlm.nih.gov/articles/PMC8173578/
  38. https://citris-uc.org/research/project/raven-surgical-robotic-system/
  39. https://pmc.ncbi.nlm.nih.gov/articles/PMC11554828/
  40. https://www.frontiersin.org/journals/robotics-and-ai/articles/10.3389/frobt.2020.578805/full
  41. https://www.sciencedirect.com/science/article/pii/S2666676625000171
  42. https://arxiv.org/pdf/1803.03586
  43. https://www.nature.com/articles/s41598-025-12027-1
  44. https://www.healthcareitnews.com/news/asia/chinese-surgeons-perform-satellite-connected-robotic-telesurgery
  45. https://microport.com/news/microport-medbot-s-toumai-performs-worlds-first-leo-satellite-based-remote-robotic-surgery-using-mobile-platform
  46. https://www.nature.com/articles/35096636
  47. https://pmc.ncbi.nlm.nih.gov/articles/PMC1084071/
  48. https://www.ircad.fr/le-geste-chirurgical-a-traverse-latlantique/
  49. https://www.tandfonline.com/doi/full/10.3109/10929080500228654
  50. https://www.bariatricnews.net/post/from-france-to-india-world-s-first-transcontinental-bariatric-robotic-procedure
  51. https://www.ircad.fr/telesurgery-a-lever-for-equity-in-access-to-healthcare-worldwide/
  52. https://www.indiatoday.in/health/story/indian-ssi-mantra-robotic-system-enables-remote-surgeries-france-indore-2760729-2025-07-24
  53. https://www.researchgate.net/publication/392214296_Surgery_without_distance_will_5G-based_robot-assisted_telesurgery_redefine_modern_surgery
  54. https://www.urotoday.com/conference-highlights/wcet-2025/163044-wcet-2025-state-of-the-art-lecture-remote-robotic-surgery-current-state-of-telesurgery.html
  55. https://pmc.ncbi.nlm.nih.gov/articles/PMC11893634/
  56. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/june-24-2025-issue/fellow-leads-groundbreaking-prostatectomy-on-patient-7-000-miles-away/
  57. https://www.urotoday.com/video-lectures/prostate-cancer/video/mediaitem/5014-first-cross-continent-robotic-prostatectomy-performed-using-tele-surgery-vipul-patel.html
  58. https://auanews.net/issues/articles/2025/april-2025/aua2025-plenary-preview-telesurgery-the-next-frontier-in-surgery
  59. https://pmc.ncbi.nlm.nih.gov/articles/PMC12334479/
  60. https://standardbots.com/blog/robotic-surgery-procedures-and-benefits-explained
  61. https://pubmed.ncbi.nlm.nih.gov/40434479/
  62. https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2025/06000/the_legal_and_ethical_considerations_in.68.aspx
  63. https://uroweb.org/news/erus25-telesurgery-is-the-present-no-longer-the-future
  64. https://www.nature.com/articles/s41526-021-00183-3
  65. https://www.nasa.gov/podcasts/houston-we-have-a-podcast/robotic-surgery-in-space/
  66. https://pubmed.ncbi.nlm.nih.gov/19441950/
  67. https://www.cureus.com/articles/419642-the-role-of-augmented-reality-in-surgical-training-a-narrative-review
  68. https://pmc.ncbi.nlm.nih.gov/articles/PMC12394307/
  69. https://www.science.org/doi/10.1126/scirobotics.adt3093
  70. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/fulltext
  71. https://www.grandviewresearch.com/industry-analysis/telesurgery-market-report
  72. https://clinicaltrials.gov/study/NCT05545709
  73. https://pmc.ncbi.nlm.nih.gov/articles/PMC12431945/
  74. https://pubmed.ncbi.nlm.nih.gov/40220039/
  75. https://pmc.ncbi.nlm.nih.gov/articles/PMC2701448/
  76. https://par.nsf.gov/servlets/purl/10359277
  77. https://academic.oup.com/bjs/article/104/8/1097/6122970
  78. https://www.mdpi.com/2313-433X/10/5/120
  79. https://pmc.ncbi.nlm.nih.gov/articles/PMC9095415/
  80. https://pmc.ncbi.nlm.nih.gov/articles/PMC9489690/
  81. https://link.springer.com/article/10.1007/s00595-025-03142-7
  82. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573433/
  83. https://microport.com/news/microport-medbot-s-toumai-completes-worlds-first-fda-ide-approved-usa-africa-robotic-telesurgery
  84. https://healthcare-in-europe.com/en/news/robot-assisted-surgery-europe-legislation.html
  85. https://pmc.ncbi.nlm.nih.gov/articles/PMC9660630/
Add your contribution
Related Hubs
User Avatar
No comments yet.