Feasibility of telesurgery using fifth-generation wireless cellular technology and dedicated internet lines for cross-continental procedures: A pilot study

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 al[1] 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 al[2] 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