Telesurgery, in which a surgeon operates on a patient remotely via a robot and a secure telecommunications connection, is just as reliable as conventional robotic surgery in which the doctor and patient are in the same operating room. This is according to a randomised controlled study from China.
Although telesurgery has been in development for more than thirty years and has been researched in fields such as urology, orthopaedics and military medicine, robust clinical evidence of its reliability has been lacking until now. The Chinese study, which was recently published in BMJ, is the first randomised trial to directly compare telesurgery with local robotic surgery.
Study design
The researchers included 72 patients with kidney tumours or prostate cancer who were treated in five Chinese hospitals between December 2023 and June 2024. All participants were eligible for minimally invasive robotic surgery: a radical prostatectomy or a partial nephrectomy. Patients were randomly assigned to telesurgery or local robotic surgery.
The median age was 61 years in the telesurgery group and 65 years in the local surgery group. Both groups were comparable in terms of demographic and disease characteristics. Patients were monitored four and six weeks after surgery. All surgeons involved had extensive experience and had each performed more than 500 robot-assisted procedures.
Technical malfunctions were recorded during and prior to the operations. In addition, outcomes such as operation duration, blood loss, complications, ICU admission, reoperations, readmissions and mortality were measured.
No relevant difference
Nine patients dropped out prematurely, resulting in 32 patients undergoing telesurgical procedures and 31 patients undergoing local surgery. The results show that telesurgery was not inferior to local surgery, with a difference in success rate of 0.02. The telesurgery system functioned stably over distances between 1,000 and 2,800 kilometres. No significant differences were found between the two groups on other outcome measures, including complications, early recovery, oncological results and workload of the surgical team.
The researchers emphasise that the study focused primarily on technical and clinical feasibility. Aspects such as long-term outcomes, cost-effectiveness, impact on medical training and patient-centred factors could not be investigated within this trial. However, the results remained consistent in additional sensitivity analyses.
Basis for further research
According to the authors, this study is an important first step. ‘As the first randomised controlled trial in the field of telesurgery, this study shows that its reliability is comparable to that of conventional local surgery,’ they conclude. In their view, this provides a solid basis for larger-scale clinical follow-up research.
In an accompanying editorial commentary, British researchers point to the importance of patient involvement and standardisation of evaluations now that telesurgery is back in the spotlight. Policy frameworks covering informed consent, system safety and emergency procedures, among other things, already exist, but public acceptance remains an issue. Recent research shows that people are willing to participate in clinical studies, but are still reluctant to undergo fully autonomous surgery.
According to the authors, initiatives such as the Responsible AI UK ecosystem should help to ensure that trust remains central as surgery becomes more digitised and telesurgery gains a more permanent place within healthcare systems worldwide.
Remote surgery
In May last year, two operations were performed via telesurgery at the AZORG hospital in Belgium. The first operation was performed by Dr Geert De Naeyer from the Orsi Academy in Merelbeke, while the patient was at the AZORG hospital in Aalst. The second procedure was led by Dr. Emily Jamaer, a gynaecologist at AZORG, who was the first female surgeon in Europe to perform a hysterectomy via telesurgery. Both operations were performed using the Toumai Tele-Robotic Surgical System, an innovative Chinese system that has been CE certified in Europe since 2024.
And in 2024, Dr. Alberto Breda from Bordeaux performed a successful kidney operation on a patient in Beijing, more than 8,000 km away. The procedure was guided by the Edge Robotics System with a latency of only 132 milliseconds, imperceptible to the human eye. In the same year, experiments were also conducted with performing an operation from Earth in the ISS space station. Incidentally, this was still a simulation.
