Reframing Anesthetic Principles: Telesurgery as the Natural Evolution of Robotic Surgery

Abstract

We read with great interest the article by Wang and colleagues describing the anesthesia perspective in telesurgery procedures (1).The expansion of telesurgery through the integration of high-speed 5G networks has enabled the remote delivery of surgical care using robotic systems (2, 3).This development has been highlighted for its potential to democratize access to high-quality surgical expertise, particularly in regions with limited local resources (4, 5).However, the anesthetic management of these procedures is often portrayed as novel or fundamentally different.We argue that telesurgery is an extension of robotic surgery; thus, the anesthetic principles applied to robotic procedures should also govern telesurgical practice (6)(7)(8).In this context, considering that telesurgery is a form of robotic surgery, the foundational anesthetic principles-general anesthesia with deep muscle relaxation, appropriate monitoring, and multimodal analgesia-apply equally to telesurgery (6).The patient's physiology and the type of procedure are not affected by the geographic location of the surgeon.Consequently, from the anesthesiologist's perspective, anesthetic goals remain unchanged: to ensure immobility, hemodynamic stability, adequate ventilation, and rapid recovery.Specific considerations such as patient positioning, pneumoperitoneum effects, neuromuscular blockade, and temperature regulation are identical to traditional robotic cases and should be managed accordingly.Furthermore, robotic surgery technology has been established for several years, and even the most recent platforms have demonstrated safety in clinical settings before market release (9, 10).Therefore, the robotic platform-whether operated locally or remotely-offers the same performance and safety for patients, and communication between anesthesia providers and local surgeons remains unchanged.On-site surgical expertise is imperative to ensure patient safety and optimal outcomes (11, 12).Despite the advanced capabilities of remote control in telesurgical procedures, the physical presence of an experienced surgeon in the operating room is non-negotiable (8).This individual plays a critical role in managing potential intraoperative complications, such as unexpected bleeding, conversion to open surgery, or system failure due to signal loss.Their immediate availability ensures procedural continuity and safeguards patient safety during high-stakes or time-sensitive events.From the anesthetic standpoint, coordination with the local surgeon is equally essential, especially when sudden changes in the surgical plan require prompt anesthetic adjustments.However, it is important to empha-