The Path to Global Equity in Surgical Care: Clinical and Technical Results of Cross-Border, Ultra-Long-Distance, Asia to Middle East Human Telesurgery

Abstract

PURPOSE: To demonstrate the feasibility and reproducibility of Ultra-long-distance, Asia to Middle East human telesurgery using low latency connectivity on multiple patients and different procedures. METHODS: Five human telesurgeries were performed over six months using a multiport robotic platform with fiber-optic and 5G connection. Remote surgeon (SA) was in Shanghai, China, and patients were in Kuwait City, Kuwait 7,000 kilometers (Km) apart. RESULTS: Case 1 was performed in December 2024. Cases 2 - 5 were performed consecutively over four days in April 2025. Three robotic assisted radical prostatectomies and two robotic assisted partial nephrectomies were performed. There were no clinical or technical issues encountered during any of the procedures. The average round-trip latency for all procedures was 166.6 milliseconds (ms) using fiber-optic broadband network with 5G network as back-up. Enhanced cybersecurity was employed with no recorded threats. There was an experienced robotic surgeon (AA) present in the operating room in Kuwait with a clear criteria for console take-over in case of emergencies. There were no reported complications. Patients were discharged on post-operative day two and three. Final pathology showed low grade, low stage disease in all patients and no evidence of disease at eight weeks follow-up. CONCLUSION: This study demonstrated the feasibility and reproducibility of multiple human telesurgical procedures through successful collaboration between two countries using a robotic system with telecommunication capabilities, with good outcomes and without complications. However, there is a need to establish robust international guidelines to allow globalization of telesurgery.