## 6 Telesurgery and the Future of Remote Robotic Urology  
Telesurgery--the remote execution or guidance of surgical procedures via robotic systems--has become an increasingly viable model thanks to advances in robotic precision, low-latency networking, and global digital infrastructure. While early demonstrations, such as the Lindbergh transatlantic procedure in 2001, were hampered by high costs and transmission delays, recent breakthroughs using 5G technology have renewed interest in the field [55]. The ultra-low latency and high bandwidth of 5G networks, with transmission delays consistently below 200 milliseconds, now enable real-time control of surgical robots across vast distances.  
Clinical studies in China have successfully demonstrated 5G-assisted telesurgeries involving radical cystectomy, radical nephrectomy, adrenalectomy, and varicoelectomy, all performed without intraoperative complications and with acceptable operative metrics [56; 57; 58; 59; 60]. These real-world applications suggest that latency under 300 milliseconds is generally safe for technically demanding tasks such as laparoscopic suturing. In these settings, novel robotic platforms have played a pivotal role. The MicroHand Edge MP1000 and KD-SR-01 (KangDuo) systems have demonstrated stable telesurgical performance, each offering dual-console capabilities to ensure safe handover in case of network interruptions [56; 61]. The Edge MP1000, for example, has completed over 30 human telesurgeries across distances exceeding 6000 km, maintaining round-trip latencies under 200 ms and achieving full procedural success without perceptible delay. The KangDuo system has advanced the concept further by enabling triple-console telesurgery, which supports real-time collaboration and teaching. Its open-console design provides multi-angle visualization of the operating room, enhancing situational awareness. Similarly, the Toumai(r) system developed by MicroPort has been used in over 100 telesurgeries, including complex urologic procedures, such as radical prostatectomy, with latency values ranging from 24 to 159 ms depending on network distance. Notably, this platform has achieved safe operation over distances up to 5000 km using both 5G and dedicated fiber optic networks. In Japan, the Hinotori(tm) system has undergone successful preclinical telesurgery testing across distances up to 2000 km, with latency as low as 40 ms in cadaveric models [62]. While not yet used for human telesurgery, Hinotori's compact design, haptic feedback, and intuitive interface have positioned it as a strong candidate for future deployment in clinical remote surgery. These developments illustrate the growing maturity of telesurgical platforms, underscoring the importance of robust network reliability, modular hardware design, and integrated safeguards as key enablers for global telesurgery adoption.  
Beyond these technical advancements, telesurgery holds the potential to significantly expand access to specialized surgical care. By enabling expert surgeons to operate remotely, this model can help bridge the gap between high-volume centers and geographically isolated or underserved regions. Patients may benefit from reduced travel burdens, while healthcare systems can make more efficient use of specialized expertise. However, several challenges must be addressed before widespread adoption becomes feasible. Ensuring secure, encrypted data transmission is critical to maintaining patient safety and privacy. The initial costs associated with telesurgical infrastructure remain substantial, raising concerns about cost-effectiveness in the early stages of implementation. Furthermore, the shift to remote surgery demands a rethinking of training and credentialing processes. Surgeons must adapt to working without tactile feedback and develop proficiency through structured simulation and virtual environments to ensure safety and competence in remote settings.