Real-world evaluation of low-earth-orbit satellite communication for surgical telementoring: implications for future robotic surgery.

Reliable communication is a prerequisite for future robotic surgery and surgical telementoring, particularly in geographically remote and disaster-affected regions. As a preparatory step toward these applications, we evaluated the real-world performance of low-Earth-orbit (LEO) satellite communication using laparoscopic surgical telementoring as an experimental model. Starlink-based communication was evaluated in three stepwise telementoring experiments: an intra-urban test in Tokyo (~ 15 km), an interhospital test between Fukuoka and Beppu (~ 100 km), and a long-distance test between Yamagata and Fukuoka (~ 1,000 km). Multiple Starlink terminals with bonding router configurations were used to assess communication redundancy. Real-time surgical video transmission with remote annotation was performed throughout the experiments. In the Tokyo experiment, communication was established but was affected by frequent bitrate fluctuations and intermittent image freezing. In the Fukuoka-Beppu experiment, stable bidirectional communication could not be maintained because of a combination of local-network connectivity limitations, Starlink WAN connectivity losses, and insufficient cellular fallback bandwidth. In the Yamagata-Fukuoka experiment, communication was stable on Day 1 (mean latency, 34.4 ms; mean bitrate, 2.51 Mbps), enabling smooth telementoring. However, using the same equipment and network configuration on the following day, latency increased to a maximum of 765 ms and 16.7% of bitrate measurements fell below 2 Mbps, resulting in marked deterioration of communication quality. These findings indicate temporal variability in communication performance across the two sessions. The LEO-satellite based end-to-end communication configurations tested in this study did not consistently demonstrate the reliability required for clinical surgical telementoring. Although laparoscopic telementoring was used as the experimental model, these findings provide practical information for the design and evaluation of communication infrastructure for future robotic telesurgical applications.