Remote robotic surgery: a systematic review

To assess the clinical effectiveness, safety, technical feasibility, and challenges of remote robotic surgery in general surgery, gynecology, orthopedics, and urology, focusing on issues like communication technology, ethics, and cost.

Relevant reports on remote robotic surgery were retrieved from databases such as PubMed, EMbase, Web of Science, Cochrane Library, VIP, CNKI, and Wanfang (2001-2025). Literature quality was evaluated using tools from the Joanna Briggs Institute (JBI).

A total of 26 articles were included (13 in Chinese, 13 in English) covering general surgery, gynecology, orthopedics, urology, and thyroid surgery. The results showed that the average operation time was slightly longer than that of traditional methods (about 10-30 min), but the safety was good. Most studies had communications backup plans, such as backup networks or local physician take-overs, to deal with the risk of disruption. Tele-robotic surgery has a high success rate and accuracy with controllable network latency, showing the potential to expand access to medical resources, especially in remote areas. However, it still faces challenges such as network stability, equipment cost, operation accuracy, data privacy, and ethical issues. Most of the included studies reported successful cases, and there was a lack of in-depth analysis of failure cases or adverse outcomes of patients, which may have publication bias.

Despite challenges, remote robotic surgery shows promise in overcoming geographical and resource limitations. The quality of current evidence is low, with serious methodological limitations and reporting bias. The establishment of international mandatory registration systems, standardized safety protocols, and transnational collaboration networks are urgent to promote this field from "proof of concept" to "clinical practice". But, with continuous technological advancements, it is expected to play an increasingly significant role in global healthcare.