Tele-robot-assisted prostatectomy: the first systematic review and single-arm meta-analysis

Telesurgery has emerged as an important frontier technology for overcoming geographical barriers and enabling the decentralization of high-quality medical resources. However, the evidence for tele-robot-assisted prostatectomy remains limited to small-sample case series, lacking systematic quantitative synthesis of perioperative outcomes. PubMed, Embase, Cochrane Library, and Web of Science were systematically searched from inception to July 2026. Studies reporting perioperative outcomes of tele-robot-assisted prostatectomy were included; non-remote surgeries, animal experiments, and studies from which data could not be extracted were excluded. A single-arm meta-analysis was performed using a random-effects model. Primary outcomes included technical success rate, complications, operative time, estimated blood loss, and postoperative hospital stay. Subgroup analyses were stratified by robotic system type, network type, and sample size. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Case Series. Seven studies comprising 80 patients (77 radical prostatectomies, 3 simple prostatectomies) were included. The pooled technical success rate was 100% (80/80). No Clavien-Dindo ≥ Grade III complications were observed, with a pooled severe complication rate of 0.0% (95% CI: 0.0%-4.3%). Among five studies reporting prostate-specific overall complication data, the pooled overall complication rate (any grade) was 19.4% (95% CI: 7.1%-36.8%, I² = 71.2%), all Clavien-Dindo Grade I events. Pooled operative time was 190.41 min (95% CI: 167.19-213.62), estimated blood loss was 72.25 mL (95% CI: 50.76-93.73), and postoperative hospital stay was 5.16 days (95% CI: 4.25-6.08). Network latency parameters-mean latency (160.58 ms), maximum latency (208.58 ms), minimum latency (160.73 ms), and round-trip time (97.39 ms)-all remained within the established safety threshold of < 300 ms. Subgroup analysis revealed a statistically significant difference in operative time when stratified by patient volume (> 10 vs. ≤10 cases, P = 0.04), suggesting a learning curve effect as an important source of operative time heterogeneity. After stratification by network type, heterogeneity was markedly reduced in the 5G group (I² = 29.6%) while remaining very high in the fiber-optic group (I² = 93.0%), further confirming transmission distance rather than network medium as the core driver of operative time heterogeneity. All seven studies demonstrated low risk of bias (JBI score ≥ 9/10). In this first systematic review and meta-analysis of tele-robot-assisted prostatectomy-based on limited evidence from seven small case series comprising 80 patients-the procedure was associated with 100% technical success and zero high-grade complications, with operative time and blood loss comparable to published benchmarks for conventional robot-assisted prostatectomy, and network parameters consistently within established safety thresholds. Subgroup analyses suggested that the learning curve effect is an important source of operative time heterogeneity, while transmission distance may contribute to heterogeneity in operative time and network latency. However, the evidence base remains limited to small case series with short-term follow-up, and these findings should be interpreted as preliminary evidence of feasibility rather than definitive evidence of established safety. Large-scale prospective comparative studies are urgently needed to validate these findings. Remote prostatectomy should be restricted to high-volume centers with established robotic surgery programs, robust network infrastructure, and well-defined emergency protocols.