ArticleJournal of robotic surgery2026
Establishing an international clinical framework for telesurgery: the first bidirectional transatlantic procedure across a world-record distance.
Article in Journal of robotic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Telesurgery has progressed from experimental demonstrations to clinical application, but its feasibility across true transcontinental distances has not been established. We report the first bidirectional transatlantic operation, performed across a world-record distance, and propose a clinical framework, intended to provide international guidance across surgical specialties for the safe and reproducible global implementation of telesurgery. Two bidirectional robotic transabdominal preperitoneal patch plasty (RTAPP) hernia repairs were performed between Kuwait and Brazil across 12,035 km using EDGE MP1000 robotic systems equipped with telesurgery modules. Dedicated high-capacity fibre-optic networks with redundant pathways and real-time monitoring ensured stable connectivity. Intraoperative performance metrics and clinical outcomes were prospectively collected and compared against predefined safety thresholds. Both procedures were completed without conversion or complication, establishing a Guinness World Record for the longest distance between surgeon and patient. Mean latency was ~ 196 ms in both directions, with minimal jitter (1 ms), negligible packet loss (0.19%), and 100% connection uptime. Operative times and blood loss were consistent with conventional robotic hernia repair, and both patients recovered uneventfully. This is the first bidirectional transcontinental telesurgery, demonstrating that safe, effective robotic surgery is possible across > 12,000 km. Beyond setting a distance record, it proposes a clinical framework intended to guide the safe international implementation of telesurgery, covering technical requirements, safety protocols, and clinical governance. By linking technical feasibility with structured standards of care, this work the first structured foundation for the safe international adoption of telesurgery across surgical specialties.
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