Clinical and Technical Outcomes of Transcontinental Urological Telesurgery: A Series of 11 Cases

To report the clinical and technical outcomes of ultra-long-distance, transcontinental human telesurgeries across multiple countries and continents using a variety of major urological procedures.

A total of 14 patients underwent telesurgery from December 2024 to November 2025. Three were done locally in Kuwait and so were excluded. A dedicated fiber-optic broadband network was primarily used for connection, with 5G network as a backup.

Eleven (male, n = 10; female, n = 1) robotic telesurgeries were included in the study. The follow-up ranged from 3 to 14 months from the first to the last case. While the patients were in Kuwait, the remote surgeon (SA) conducted 8 procedures from Shanghai (China), 2 from Strasbourg (France), and 1 from Muscat (Oman), 7000, 5000, and 1590 km away, respectively. Procedures included radical prostatectomies, partial and radical nephrectomies, radical nephroureterectomy, and simple prostatectomy. No clinical or technical adverse events were encountered. The average round-trip latencies for Shanghai-Kuwait, Strasbourg-Kuwait, and Muscat-Kuwait were 166.6, 103, and 46 ms, respectively. At last follow-up, no major or minor complications were recorded, and all patients had no evidence of disease recurrence. An experienced robotic surgeon (ANA) was present in the operating room in Kuwait with a clear take-over plan in case of emergencies.

This study demonstrated promising short-term clinical and technical outcomes of 11 cross-border human telesurgeries, involving 4 different countries and continents. Studies with a larger number of patients and longer follow-up are warranted to allow safe implementation of human telesurgery.