Safety, efficacy and scope of telerobotic surgery with the SS Innovations MantraSync: A case report with workflow and outcomes

Abstract Background: Telerobotic surgery allows expert surgical care delivery across large distances using robotic systems and high-speed, low-latency networks. However, concerns regarding technical safety, clinical workflow and outcomes – particularly in settings without on-site surgical expertise – limit its global adoption. Objective: To evaluate the feasibility, safety, efficacy, workflow and technical requirements of long-distance telerobotic cholecystectomy in India using the indigenous SS Innovations (SSI) MantraSync robotic system and Multiprotocol Label Switching (MPLS)-based dedicated connectivity. Patients and Methods: Two female patients underwent an elective telerobotic cholecystectomy with the surgeon located at Gurugram and the patient at Guwahati, separated by ~ 1950 km. A pre-established surgical workflow with a modified surgical safety checklist was followed. A strict contingency protocol, multilayered network security and backup conversion plans were implemented. Technical requirements included a dedicated 40 Mbps MPLS line, ultra-low latency video and control data paths and the RASCOW2 protocol for stable streaming. Perioperative and network parameters were prospectively recorded. Results: Both surgeries were completed successfully without intraoperative complications, conversions or technical failures. Console times were 51 and 30 mins, blood loss was minimal (10–15 mL), Visual Analogue Scale pain score at 24 h was 1–2 and uneventful discharge occurred on day 2. Network transmission latency was 35–40 ms, round-trip latency 250–260 ms, with jitter <10 ms and packet loss <0.1%. All values were within recommended global benchmarks for telerobotic safety (<320 ms round-trip). Functional handover to local control was verified and could be achieved in 2–3 min if needed. Conclusion: Telerobotic cholecystectomy using the SSI MantraSync platform and a robust network infrastructure is safe, feasible and effective, with technical and clinical outcomes comparable to in-person robotic surgery. Adherence to multidisciplinary workflow, safety checklists and redundancy protocols is critical. These results support expanded adoption of telerobotic surgery in resource-limited and remote environments, enabling broader access to advanced surgical care.