To the Editor: Telesurgery represents a promising advancement in medical technology, allowing skilled surgeons to perform complex procedures remotely. By leveraging high-speed internet infrastructure such as 5th generation mobile communication technology (5G), telesurgery has the potential to overcome geographical constraints and expand access to expert surgical care. However, its successful implementation depends on several critical factors, including stable, low-latency data transmission, reliable network performance, and the ability to maintain surgical precision over long distances. Patel et al1 established a remote surgical connection between Orlando and Shanghai using 5G, Wi-Fi, and fiber-optic technologies, and performed 10 robot-assisted nephrectomies on pig models. Rogers et al2 reported on a short-distance study in which three surgeons completed remote robot-assisted prostatectomies, demonstrating that telesurgery can be safely performed using low-latency telecommunications. Additionally, our team has previously conducted a series of remote animal model procedures and short-distance clinical trials.3,4 In this study, we evaluated the feasibility of cross-continental telesurgery, specifically examining the use of 5G networks and dedicated internet lines to ensure high-speed, uninterrupted communication between the surgical console and operative site Figure 1A.Figure 1: Network connection of remote renal partial and prostate radical resection. (A) Telesurgery system architecture and network configuration for cross-continental surgical procedures. (B) Real-time round-trip network latency during the procedure. (C) Video encoding and decoding latency during the procedure. (D) Real-time frame loss monitoring during the procedure.The study involved two procedures: One for prostate cancer and one for a lower pole renal mass. Both surgeries were conducted using robotic-assisted systems, with data transmission via 5G networks and dedicated internet lines. The primary objective was to assess the viability of such systems for remote operations conducted over distances exceeding 20,000 km. The study protocol has been prospectively registered on ChiCTR.org (ChiCTR2300074761) and received approval from the Ethics Committee of the Hospital of the People’s Liberation Army (Approval No. KY2024-21). All participants signed the informed consent forms. Two patients diagnosed with prostate cancer and two with renal masses were enrolled. The prostate cancer patients were 65 and 63 years old, with prostate specific antigen levels of 8.3 and 8.6 ng/mL, and Gleason scores of 3 + 3 and 3 + 4, respectively. Radical prostatectomy was performed using an anterior pelvic approach via telesurgery between Rome and Beijing, and between Bordeaux and Beijing, respectively. The two patients with renal masses were 37 and 60 years old, with lesions measuring 2.6 × 2.3 cm and 2.5 × 2.2 cm, respectively. Both underwent partial nephrectomy via a laparoscopic approach, with telesurgery conducted between Bordeaux and Beijing. All procedures were completed using robotic-assisted laparoscopic systems, with real-time video and instrument control transmitted over the 5G network. Data transmission was facilitated through a dedicated internet line employing a 1 + n redundant network strategy to minimize latency and mitigate the risk of data loss. Statistical analyses were performed using SPSS 25.0 (IBM Corp., Armonk, NY, USA), with P values <0.05 considered statistically significant. Network latency was continuously monitored, as maintaining low-latency communication is critical for successful telesurgical performance. In the prostate cancer group, both procedures were completed without intraoperative complications. The first patient underwent surgery between Rome and Beijing (bi-directional network communication distance: 22,320 km), with an operative time of 65 minutes and estimated blood loss of 300 mL. The second procedure, conducted between Bordeaux and Beijing (bi-directional distance: 23,000 km), had an operative time of 116 minutes and blood loss of 350 mL. Preoperative hemoglobin levels were 153 and 138 g/L, decreasing postoperatively to 132 and 113 g/L, respectively. Recovery in both cases was uneventful, with no postoperative complications such as fever or rectal or vascular injury. Drainage volumes during the first three postoperative days were 70, 95, and 50 mL for the first patient, and 70, 30, 100, 40, and 20 mL across five days for the second patient. Both patients were discharged on postoperative day five. Final pathological examination confirmed prostate adenocarcinoma with negative surgical margins. The renal mass group also demonstrated favorable outcomes. The first patient, a 37-year-old male patient, underwent partial nephrectomy with an operative time of 70 minutes and blood loss of 100 mL. The second patient, a 60-year-old female patient, had an operative time of 126 minutes and blood loss of 50 mL. Warm ischemia times were 15 and 14 minutes, respectively. One case involved an intraoperative bowel injury that was promptly repaired, with no further complications during recovery. Preoperative hemoglobin levels were 149 and 142 g/L, rising postoperatively to 156 and 124 g/L, respectively. The first patient had no measurable postoperative drainage and was discharged on postoperative day three. The second patient had drainage volumes of 95 and 65 mL on the first two days and was discharged on day four. Final pathology confirmed clear cell renal carcinoma with negative margins. Network performance was continuously monitored throughout all telesurgical procedures to ensure the integrity of data transmission. In the prostate cancer group, the median round-trip network latency was 135.2 ms (interquartile range IQR: 135.2–135.3 ms) for the Rome–Beijing surgery and 132.1 ms (IQR: 132.0–132.1 ms) for the Bordeaux–Beijing surgery. Median display latency was 20.02 ms (IQR: 19.95–20.08 ms) and 20.00 ms (IQR: 19.96–20.04 ms), respectively. The full range of round-trip latencies was 135.1–140.4 ms and 131.9–135.4 ms, while display latency ranged from 19.7–20.4 ms and 19.8–20.1 ms, respectively. Similarly, in the renal mass group, the median round-trip latency was 132.1 ms (IQR: 132.0–132.1 ms) for both procedures, with display latencies of 20.00 ms (IQR: 19.98–20.03 ms) and 20.00 ms (IQR: 19.97–20.04 ms), respectively. Round-trip latency ranged from 131.9 to 135.7 ms and from 131.9 to 135.0 ms, and display latency from 19.9 to 20.3 ms and from 19.9 to 20.4 ms Figure 1B, C, respectively. Notably, no frame loss was observed during any procedure, confirming the stability of data transmission throughout the telesurgeries Figure 1D. One complication occurred in the nephrectomy group, as a bowel injury sustained intraoperatively, which was promptly repaired. This event was not attributable to network latency or transmission instability. All patients were followed up at two weeks postoperatively, with no complications exceeding Clavien–Dindo grade II. This study demonstrates that telesurgery can be effectively performed over long distances using 5G networks and dedicated internet lines, ensuring high-quality, stable communication between the surgeon and the operating site. The median round-trip latency recorded in this study (132–135 ms) remained well within acceptable thresholds for telesurgery, as robotic control requires low-latency transmission to prevent interruptions during the procedure. These findings are consistent with previous reports indicating that latency below 150 ms supports precise robotic performance in telesurgical environments. Notably, no frame loss was detected, a critical factor in maintaining the visual clarity essential for surgical accuracy. Continuous visual feedback enables the surgeon to guide robotic movements with precision, thereby safeguarding patient outcomes. Despite the significant geographic separation between operating locations (exceeding 20,000 km), the network exhibited robust performance, providing a reliable communication link between the surgeon and the robotic platform. Although most procedures in this study were completed without incident, one complication—a bowel injury during nephrectomy—occurred. The event was promptly managed and determined to be unrelated to network performance, underscoring that intraoperative complications were not attributable to connectivity issues. This emphasizes the importance of a seamlessly functioning telesurgical system in preventing technical factors from affecting procedural safety. In terms of future applications, the successful implementation of 5G networks in telesurgery has the potential to transform surgical practice, particularly in remote and underserved regions. As 5G technology continues to advance, further reductions in latency and improvements in the stability of remote surgical systems are expected. In addition, the integration of artificial intelligence (AI) and machine learning (ML) into telesurgical platforms will enable real-time adaptation to network conditions, thereby enhancing the safety and precision of remote procedures. Finally, to facilitate seamless cross-border surgeries and safeguard patient rights, international collaboration, expert consensus, and harmonized legal frameworks and technical standards are urgently required.5 Although the research findings on remote medicine and robotic surgery systems are promising, several limitations still exist. First, system latency and unstable network issues remain key challenges for telesurgery systems. As the communication distance increases, the real-time performance and precision of telesurgery face fundamental limitations. While the use of 5G wireless networks and dedicated lines has shown improvements, in remote or underdeveloped areas, insufficient network coverage or unstable network connections may still lead to increased latency. Second, the hardware and software development of remote healthcare and robotic-assisted systems still require further advancement. To prevent severe surgical outcomes caused by unexpected system failures, telesurgery systems must incorporate multiple backup mechanisms to ensure that surgeons can perform remote surgeries efficiently and precisely. Third, our study sample may not fully represent patients with different types of conditions or surgical situations, it provides preliminary support for the potential of remote surgery. This pilot study confirms the viability of performing cross-continental telesurgery using 5G networks and dedicated internet connections. The results support the use of such systems to provide reliable, low-latency control and high-fidelity video transmission, enabling remote surgeons to conduct complex procedures with precision. As technology evolves, telesurgery is likely to become a standard component of surgical practice, increasing access to specialized care and addressing disparities in global health infrastructure. Funding This work is supported in part by the National Key Research and Development Program of China (No. 2023YFB4706000). Conflicts of Interest None.
Huang et al. (Wed,) studied this question.