Could a Surgeon Operate from Thousands of Miles Away? The Rise of Remote Robotic Surgery

By Mr Neil Haldar, Consultant Urological Surgeon

In June 2025, a surgeon in Florida performed a robotic prostatectomy on a patient more than 6,000 miles away in Angola.

The operation sounded like science fiction. Yet it represented the latest chapter in a story that began four decades earlier, when engineers adapted an industrial robot to help guide a needle during brain surgery.

Remote surgery, also known as telesurgery, aims to separate the surgeon’s location from the patient’s. The surgeon’s movements are transmitted through a communications network to robotic instruments beside the patient.

In theory, this could allow highly specialised surgical expertise to reach patients living in remote regions, smaller hospitals or countries where particular procedures are not routinely available.

In practice, the challenge is much greater than simply connecting a surgical robot to the internet.

Remote surgery requires:

• a sophisticated robotic system;
• a reliable, extremely low-delay communications network;
• a trained team beside the patient;
• protection against technical failure and cyberattack;
• clear legal responsibility;
• appropriate medical licensing;
• and a safe plan if the remote connection is lost.

The story of telesurgery is therefore not only a story about robots. It is also about telecommunications, regulation, professional responsibility and the uneven distribution of surgical expertise around the world.

In brief

Remote robotic surgery has progressed through several distinct stages:

• early industrial robots were adapted for tightly controlled surgical tasks;
• surgeon-controlled robotic systems emerged during the 1990s;
• the first transatlantic operation was performed in 2001;
• a Canadian team subsequently established a sustained remote surgical service;
• commercial 5G and fibre networks have revived interest in telesurgery;
• recent programmes have demonstrated transcontinental human operations;
• artificial intelligence may eventually assist with selected surgical tasks.

The technology can now support remote surgery in carefully controlled circumstances.

The harder question is whether it can be made sufficiently safe, reliable, affordable, and equitable for routine clinical use.

What is remote robotic surgery?

Remote robotic surgery is a form of surgery in which the operating surgeon is physically separated from the patient.

The patient-side robotic system remains in the operating theatre. The surgeon uses a console elsewhere, and their hand movements are transmitted to the robot through a telecommunications connection.

The robot then translates those movements into movements of surgical instruments inside the patient.

The robot does not independently decide what operation to perform. The surgeon remains responsible for:

• planning the procedure;
• identifying anatomy;
• deciding where to cut;
• responding to bleeding or unexpected findings;
• adapting the operation;
• and deciding when the procedure should stop or change.

Remote surgery is therefore more accurately understood as remote control of advanced surgical instruments, rather than an autonomous robot performing an operation.

Telesurgery, telementoring and teleproctoring

Several related terms are frequently confused.

Telesurgery means that a remote surgeon directly controls surgical instruments beside the patient.

Telementoring means that an experienced surgeon provides remote advice or educational guidance while another surgeon performs the operation locally.

Teleproctoring means a qualified expert remotely observes, supervises, or assesses a surgeon introducing a new procedure or technology.

Some newer robotic systems may also allow control to be transferred between local and remote surgeons. This creates a hybrid model in which remote supervision can, in carefully controlled circumstances, progress to temporary remote intervention.

These arrangements all use telepresence technology, but their risks and regulatory implications differ greatly.

Remote mentoring is already much easier to deploy than full telesurgery because the local surgeon retains direct control throughout.

The earliest surgical robots

The history of surgical robotics did not begin with a purpose-built operating robot.

In the 1980s, engineers and surgeons began adapting industrial robotic arms for medical tasks that required highly accurate positioning.

One of the earliest examples involved the PUMA 560, an industrial robot originally designed for manufacturing. In 1985, it helped orient a biopsy needle during a stereotactic brain procedure.

The robot was not performing a complete operation. Its value was much narrower: it could guide an instrument along a carefully planned geometric path with great precision.

That experiment demonstrated an idea that remains central to modern surgical robotics:

A robot may be particularly valuable when a complex human decision can be translated into a clearly defined and measurable physical task.

Early urological researchers later explored whether a robot could assist with removing prostate tissue. This work led to the development of the Probot, a purpose-built experimental system designed to perform defined parts of transurethral prostate surgery under human supervision.

At around the same time, orthopaedic systems such as ROBODOC were being developed to prepare bone according to a preoperative plan.

These differed greatly from modern robotic systems. They were generally designed to carry out a specific planned task rather than continuously reproduce the surgeon’s hand movements.

From robotic tools to surgeon-controlled systems

The major change came during the 1990s.

Instead of programming a robot to carry out a predetermined movement, engineers developed systems that could reproduce the surgeon’s movements in real time.

The surgeon sat at a console and moved hand controls. The system scaled and filtered those movements before transmitting them to instruments beside the patient.

This created the basic architecture used in modern robotic surgery.

Two American companies became particularly important:

• Computer Motion, which developed AESOP and later ZEUS;
• Intuitive Surgical, which developed the da Vinci system.

AESOP was a robotic camera holder controlled initially by foot pedal and later by voice. It allowed the surgeon to reposition the laparoscopic camera without relying entirely on a human assistant.

ZEUS expanded this concept into a full surgeon-controlled system using several robotic arms.

Da Vinci used a different design, with a highly immersive surgeon console, three-dimensional vision and articulated instruments capable of reproducing many of the movements of the human wrist.

Early clinical operations using these systems included heart surgery, gallbladder surgery and radical prostatectomy.

The systems were still generally used with the surgeon close to the patient. However, the physical separation between the surgeon’s console and the patient-side robot meant that long-distance operation was theoretically possible.

Operation Lindbergh: surgery across the Atlantic

On 7 September 2001, surgeons in New York removed the gallbladder of a patient in Strasbourg, France.

The operation became known as Operation Lindbergh, after the aviator Charles Lindbergh’s historic transatlantic flight.

The surgeons used a modified ZEUS robotic system. They transmitted their movements through a dedicated fibre-optic connection to the robot in France.

The procedure was completed successfully, and the patient left the hospital two days later.

Its importance did not lie in the operation itself. Laparoscopic gallbladder removal was already routine.

The achievement was showing that a surgeon could safely control instruments on another continent with a sufficiently small communications delay.

Years of preparation were required. The team had studied the effect of network delay, refined video transmission and rehearsed the procedure in animal models. The communications link was specially configured rather than being an ordinary public internet connection.

Operation Lindbergh proved that transoceanic surgery was technically possible.

It did not prove that it was affordable, scalable or ready for routine clinical practice.

Why remote surgery did not immediately become widespread

After Operation Lindbergh, some observers predicted that remote surgery would develop rapidly.

That did not happen.

The next 15 years saw major growth in conventional robotic surgery but relatively little progress in routine long-distance operating.

Several factors contributed.

The most suitable commercial platform disappeared

Computer Motion and Intuitive Surgical merged in 2003 after patent disputes.

The ZEUS system, used for Operation Lindbergh and designed for remote operation, was discontinued.

The da Vinci system became the dominant robotic platform, but its commercial development concentrated on surgeons operating in the same hospital as their patients.

Telecommunications remained expensive

Operation Lindbergh depended on a specially engineered communications link.

Hospitals could not simply rely on ordinary broadband connections. Small variations in network performance could delay instrument movement, interrupt the video feed, or disrupt communication between teams.

Regulation was unclear

Remote surgery raised difficult questions:

• Where is the operation legally taking place?
• In which country must the surgeon be licensed?
• Which country’s law applies if something goes wrong?
• Who is responsible for network failure?
• Does the remote surgeon require professional indemnity in both locations?

These questions remain incompletely resolved.

There was no obvious financial model

A remote operation might require:

• a specialist surgeon at the remote console;
• a second experienced surgeon beside the patient;
• two clinical teams;
• two institutions;
• expensive robotic technology;
• and a high-reliability communications network.

That can make remote surgery more expensive rather than less expensive, particularly if hospitals are reimbursed only for the procedure rather than for sharing specialist expertise.

Canada’s pioneering remote surgical service

One important programme showed that clinical telesurgery could be sustained beyond a single demonstration.

In 2003, Professor Mehran Anvari and colleagues established a remote surgical service linking Hamilton, Ontario, with a community hospital in North Bay, approximately 250 miles away.

The team performed procedures including:

• anti-reflux surgery;
• bowel surgery;
• and inguinal hernia repair.

The programme used a commercial telecommunications network rather than a bespoke transatlantic connection.

Its first published series reported 22 operations without serious intraoperative complications or conversion to open surgery.

This was an important demonstration of clinical feasibility.

However, it did not lead to an immediate international expansion of remote surgical services. The technology had proved that distance could be overcome, but the economic, regulatory and organisational barriers remained.

Why network delay matters

When a surgeon moves a hand controller, the movement must be:

1. detected by the console;
2. converted into digital data;
3. transmitted through the network;
4. interpreted by the patient-side robot;
5. performed by the instrument;
6. captured by the camera;
7. and transmitted back to the surgeon.

This round trip takes time.

The delay is known as latency.

A small delay may be almost imperceptible. As latency increases, the surgeon may begin to overshoot movements or make repeated corrections.

This is similar to trying to steer a vehicle when the windscreen image appears slightly after the steering wheel moves.

Latency is not the only issue. A safe connection must also control:

• variations in delay, known as jitter;
• loss of data packets;
• video quality;
• interruptions in the connection;
• and the synchronisation of visual and instrument information.

Operation Lindbergh maintained a delay of well under 200 milliseconds. That figure has often been used as a practical benchmark, although acceptable latency depends on the task’s complexity and speed.

Simple, slow movements may tolerate more delay than controlling bleeding or dissecting close to a major blood vessel.

The rise of 5G telesurgery

Interest in remote surgery increased again with the deployment of fifth-generation mobile networks.

5G offered:

• lower latency;
• greater bandwidth;
• improved reliability;
• network prioritisation;
• and the ability to connect hospitals that lacked dedicated communications infrastructure.

China became a major centre for 5G-enabled telesurgery.

Clinical and experimental programmes included remote spinal surgery, microsurgery and several urological procedures.

One Chinese programme used the Toumai robotic system to perform remote spermatic-vein operations over approximately 3,800 kilometres.

Japan also developed structured telesurgery research, using commercial communications networks and domestically produced robotic systems.

However, the phrase “5G surgery” can be misleading.

The local connection may use 5G, but the information usually travels over fibre networks for much of the distance. The system’s safety therefore depends on the complete route between surgeon and patient—not only the mobile signal within each hospital.

Modern communications infrastructure has reduced the need for completely bespoke networks, but remote surgery still requires prioritisation, monitoring, backup systems and carefully planned failure protocols.

Transcontinental prostate surgery

The most widely publicised recent milestone occurred on 14 June 2025.

A team led by robotic prostate surgeon Professor Vipul Patel performed a radical prostatectomy with the operating surgeon in Florida and the patient in Luanda, Angola.

The procedure formed part of a United States Food and Drug Administration-authorised clinical trial.

The case was not an improvised long-distance operation. It followed extensive testing of the robotic platform, communications network and clinical arrangements.

A surgical team was physically present with the patient in Angola.

The case demonstrated that modern robotic and telecommunications systems could support an intercontinental human operation over a distance considerably greater than Operation Lindbergh.

It remains important to interpret the event carefully.

A successfully reported operation shows feasibility. It does not by itself prove:

• that remote surgery is as safe as local surgery;
• that it should be used routinely;
• that it is cost-effective;
• or that the same result can be reproduced across different hospitals and healthcare systems.

The human evidence base remains relatively small, although several recent international programmes have now reported short series of remote urological operations.

What happens if the connection fails?

Every remote surgical programme requires a clear answer to this question.

A safe system should include:

• more than one communications route;
• continuous monitoring of latency and packet loss;
• automatic safe stopping if the signal deteriorates;
• a method of transferring control locally;
• trained staff beside the patient;
• and the ability to convert to conventional laparoscopic or open surgery.

Network reliability alone cannot protect the patient.

A local surgical team remains essential because certain emergencies cannot wait for a remote connection to be restored.

This creates a paradox.

Telesurgery is often proposed as a solution for hospitals without specialist surgeons. Yet safe remote surgery may still require an experienced surgeon at the patient’s side.

The greatest early value may therefore be in hospitals that already have competent surgical teams but lack expertise in a particular complex operation.

The importance of touch

Current robotic surgeons rely heavily on visual information.

The conventional da Vinci system does not provide true tactile feedback through the hand controls. Surgeons learn to interpret tissue tension by observing:

• movement;
• deformation;
• colour;
• stretching;
• and how tissues respond to the instruments.

This works well when the surgeon operates locally and receives an immediate, high-quality video image.

At a distance, video compression and small delays may make the absence of touch more significant.

Some newer robotic systems provide forms of force or haptic feedback. Future platforms may also use wearable devices or improved sensor technology to recreate some of the forces instruments experience inside the patient.

Haptic feedback could be particularly valuable when dissecting fragile tissues or applying tension to a suture.

Cybersecurity and the networked operating theatre

A remote surgical system creates risks that do not exist in conventional surgery.

The operating theatre becomes part of a computer network.

Potential threats include:

• interruption of the video feed;
• denial-of-service attacks;
• unauthorised access;
• manipulation of data;
• malware;
• loss of communication between the sites;
• and attacks on connected hospital systems.

The possibility of someone maliciously taking control of a surgical robot is alarming, although modern systems are designed with multiple safeguards.

More realistic risks may involve service disruption, loss of network availability or compromised patient data.

Cybersecurity therefore cannot be added after a remote surgical service has been designed. It must be part of the architecture from the beginning.

This requires:

• authenticated control channels;
• strong encryption;
• restricted system access;
• continuous monitoring;
• software-update governance;
• redundant communications;
• and clear incident-response plans.

Who is responsible for a remote operation?

In conventional surgery, the responsible surgeon and hospital are usually in the same jurisdiction as the patient.

Remote surgery may involve:

• a surgeon in one country;
• a patient in another;
• a robotic manufacturer in a third;
• telecommunications providers operating internationally;
• and clinical staff employed by several organisations.

If a complication occurs, responsibility could potentially involve:

• the remote surgeon;
• the bedside surgeon;
• the hospital;
• the robotic manufacturer;
• the network provider;
• or several parties simultaneously.

Medical regulators will need to determine where a remote surgeon must be licensed.

Insurers will need to define whether professional indemnity covers a surgeon operating across a national border.

Patients will need to understand who is in control, what the local team can do and what happens if the connection is lost.

Engineers alone cannot answer these questions.

Could remote surgery improve global access?

The most compelling argument for telesurgery is that it could bring specialist expertise to patients who would otherwise have to travel long distances or go without advanced treatment.

Potential beneficiaries include:

• patients in rural areas;
• island communities;
• military personnel;
• people working in remote industrial settings;
• patients in countries with shortages of specialist surgeons;
• and hospitals introducing a complex procedure.

Remote surgery could also support regional networks in which specialists based at a major centre help teams in smaller hospitals.

However, telesurgery could have unintended consequences.

A health system might rely on remote experts instead of investing in local surgeons, training programmes and infrastructure.

This could create a permanent dependency on wealthier institutions or foreign specialists.

Remote surgery should therefore strengthen local capacity rather than replace it.

A sustainable programme would ideally combine:

• local training;
• in-person operating experience;
• remote mentoring;
• staged supervision;
• and progressively greater independence for the local team.

The goal should not simply be to complete an operation from another country. It should improve the local service’s long-term ability to care for its own patients.

Will artificial intelligence make remote surgery safer?

Artificial intelligence may assist remote surgery in several ways.

Monitoring the network

AI could detect patterns suggesting:

• rising latency;
• unstable bandwidth;
• packet loss;
• or an increased risk of connection failure.

The system might then warn the surgeon, reduce the transmission load or automatically transfer the robot into a safe state.

Recognising anatomy

Computer-vision systems may help identify:

• blood vessels;
• nerves;
• ureters;
• tissue planes;
• surgical instruments;
• and different stages of the operation.

This information could be displayed to both the remote surgeon and the local team.

Stabilising movements

Software may compensate for:

• minor delay;
• tremor;
• sudden movements;
• or changes in the position of tissues.

Assisting with defined tasks

A future system might help with repetitive steps such as:

• spacing sutures;
• controlling a camera;
• maintaining tension;
• measuring tissue;
• or aligning a three-dimensional scan with the live operative image.

This could reduce the cognitive burden on a surgeon operating remotely.

Could the robot operate autonomously?

Researchers have developed experimental robots that can perform defined surgical tasks under supervision.

The Smart Tissue Autonomous Robot programme has demonstrated automated intestinal suturing and anastomosis in animal models.

The system used imaging to plan where to place sutures and then carried out parts of the task while a human team monitored it.

This is a remarkable technical achievement, but it should not be confused with an autonomous robot performing a complete operation on a patient.

Real operations involve constant uncertainty.

The surgeon may encounter:

• unexpected anatomy;
• scar tissue;
• abnormal blood vessels;
• fragile tissues;
• bleeding;
• findings not visible on preoperative scans;
• or evidence that the planned operation is no longer appropriate.

The near-term future is therefore more likely to involve supervised automation of selected tasks.

The surgeon will continue to make the important decisions while the system assists with highly defined technical steps.

Will 6G solve the telecommunications problem?

Sixth-generation communications networks are expected to emerge during the next decade.

Proposed benefits include:

• lower local network latency;
• greater bandwidth;
• improved reliability;
• better integration of terrestrial and satellite networks;
• and more sophisticated prioritisation of critical data.

These advances could make regional remote surgery easier and more dependable.

However, no network can overcome the laws of physics.

A signal travelling from one continent to another still requires time to pass through thousands of miles of fibre and network equipment.

6G may reduce processing delays and improve reliability, but it cannot make intercontinental communication instantaneous.

For remote surgery, the most valuable advances may therefore be:

• better redundancy;
• predictable rather than merely low latency;
• guaranteed network quality;
• improved cybersecurity;
• and rapid transfer of control to the bedside team.

Is telesurgery ready for routine clinical use?

Not yet.

Remote surgery has demonstrated that it can work in selected human cases and carefully organised programmes.

But the available evidence remains too limited to conclude that routine long-distance telesurgery is as safe or effective as surgery performed by a specialist physically present with the patient.

Further research needs to examine:

• complication rates;
• conversion to local or open surgery;
• network failures;
• patient-reported outcomes;
• cancer outcomes;
• costs;
• environmental effects;
• surgeon workload;
• and the performance of local teams.

Studies should also report unsuccessful attempts and technical interruptions, not only successful headline cases.

Telesurgery should progress through carefully designed clinical trials and regulated programmes, not commercial enthusiasm alone.

What does remote surgery mean for patients?

A patient considering a remote operation should understand:

• where the main surgeon will be located;
• who will be physically present in the operating theatre;
• who can take control if the connection fails;
• how the communications network is protected;
• whether the remote surgeon is licensed and insured appropriately;
• whether remote surgery offers a genuine benefit over travelling to a specialist centre;
• and what evidence supports the proposed approach.

Patients should not assume that remote surgery is automatically more advanced or safer than conventional treatment.

In many cases, travelling to a specialist centre may remain the safer and more practical option.

The strongest justification for remote surgery will probably arise when delay or distance would otherwise prevent the patient from receiving appropriate treatment.

The real challenge is no longer simply technical

The history of remote surgery is often presented as a story of ever-improving robots and faster networks.

That is only part of the story.

The technical capability to operate over great distances has existed in some form since Operation Lindbergh in 2001.

What has limited adoption is the absence of a complete clinical system around the technology.

Remote surgery requires:

• regulation;
• professional standards;
• reimbursement;
• training;
• cybersecurity;
• network governance;
• local clinical capacity;
• and public trust.

The key question is therefore no longer:

Can a surgeon operate on a patient thousands of miles away?

In carefully controlled circumstances, the answer is yes.

The more important questions are:

When should remote surgery be used?
Who should be responsible?
How should patients be protected?
And will it reduce inequality—or create new forms of dependence?

The answers will determine whether telesurgery becomes a meaningful part of future healthcare or remains a series of impressive technical demonstrations.

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Looking for Expert Advice About Robotic Urological Surgery?

Remote surgery and new robotic technologies are developing rapidly, but for patients the most important question remains much simpler: what is the safest and most appropriate treatment for my condition?

If you have been diagnosed with prostate cancer or another urological condition and are considering robotic surgery, I can provide an individual specialist opinion based on your diagnosis, scans, pathology, general health and treatment priorities.

I am a Consultant Urological Surgeon specialising in prostate cancer, uro-oncology, and robotic surgery. I see private patients in various locations in Buckinghamshire, Berkshire and London.

Whether you have been advised to undergo robotic surgery, are considering different surgical approaches, or would simply like a second opinion, an individual consultation can help clarify your options.

Arrange a consultation with Mr Neil Haldar to discuss whether robotic surgery is appropriate for you.

Frequently asked questions

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Mr Neil Haldar is a Consultant Urological Surgeon specialising in prostate cancer, robotic and open prostate surgery, uro-oncology and general urology. He sees private patients in Buckinghamshire, London and the Thames Valley.

This article provides general information about emerging surgical technology. It does not imply that telesurgery is currently suitable or available for an individual patient. Treatment decisions should be made with an appropriately qualified surgical team.