Triple-console robotic telesurgery: first impressions and future impact

Telesurgery has been recently gaining momentum as a natural evolution of robotic surgery. Besides providing expert surgical care to patients who cannot geographically access it, telesurgery can also facilitate surgical collaboration between surgeons who might need urgent assistance or coaching experts. The idea of having two consoles, with one remote and one local, has been the ideal setup for such ecosystems. However collaborations can take on many forms and might require more than one remote surgeon, depending on procedure complexity and surgeon availability. The objective of the study was to describe our perspectives and experience performing telesurgery on one patient, using three surgeon consoles for three surgeons, operating from three separate cities. In November 2023, a triple-console, robot-assisted radical prostatectomy (RARP) was performed in a collaborative effort among three surgeons in three separate locations employing telesurgery using the Kangduo Endosopic Surgical Robot (KD-SR-01, Sagebot Medical). The furthest distance between participants was approximately 2600 km between Beijing and Hainan. We described and illustrated the applications and outcomes of this procedure to treat a single patient with prostate cancer. The local surgeon, along with the operating room team, and the patient were in Hainan, while the other two surgeons were in Beijing and Hunan Telesurgery command centers. The procedure lasted approximately 120 min and there were no intra- or postoperative complications. Estimated blood loss was 100 ml. The patient was ambulating 4 h after surgery and remained in the hospital for 2 days secondary to the postoperative care protocol followed by the local team taking care of the patient. The Foley catheter was removed on postoperative day 7 without complication. The final pathology was ISUP Grade Group 4 (Gleason score 4 + 4 = 8) T2cN0 with negative surgical margins. Our experience shows that telesurgery involving multiple surgeons at multiple remote locations is possible and can be completed safely with low-latency connections via available telecommunication networks.