Robotic telesurgery: technological fundamentals, clinical applications and perspective

ABSTRACT

Introduction:  Robotic bariatric surgery has established itself as a safe and effective approach for the treatment of severe obesity. At the same time, recent advances in connectivity and digital infrastructure have rekindled interest in telesurgery as a strategy to expand access to specialized surgery, especially in scenarios of inequality in the distribution of centers of excellence.

Objective:  To discuss robotic bariatric surgery as a strategic platform for the development of telesurgery, with emphasis on its implications for care, medical education and academic research. Method: Review of the fundamentals of robotic bariatric surgery, the conceptual evolution of telesurgery and the potential of bariatric surgery as a model applicable to remote interventions, discussing the impacts on the formation and supervision of surgical teams, the main technical challenges in addition to the ethical, legal and regulatory issues involved in the implementation.

Results:  Considering only articles that were more related to the theme, the full texts were read and 21 articles were included.

Conclusion:  Robotic bariatric surgery goes beyond the role of a minimally invasive technique and is a central element in the digital transformation of surgery. Its progressive integration into telesurgery can contribute to the democratization of access, innovation in teaching, and strengthening of surgical research as long as it is implemented gradually and safely.

KEYWORD:
Telesurgery; Robotic surgery; Medical robotics; Innovation in health

VISUAL ABSTRACT

RESUMO

Introdução:  A cirurgia bariátrica robótica consolidou-se como abordagem segura e eficaz para o tratamento da obesidade grave. Em paralelo, avanços recentes em conectividade e em infraestrutura digital têm reacendido o interesse pela telecirurgia como estratégia para ampliar o acesso à cirurgia especializada, especialmente em cenários de desigualdade na distribuição de centros de excelência.

Objetivo:  Discutir a cirurgia bariátrica robótica como plataforma estratégica para o desenvolvimento da telecirurgia, com ênfase em suas implicações para assistência, ensino médico e pesquisa acadêmica.

Método:  Revisão dos fundamentos da cirurgia bariátrica robótica, a evolução conceitual da telecirurgia e o potencial da cirurgia bariátrica como modelo aplicável às intervenções remotas, discutindo os impactos na formação e supervisão de equipes cirúrgicas, os principais desafios técnicos além das questões éticas, legais e regulatórias envolvidas na implementação.

Resultado:  Considerando-se somente artigos que tivessem maior relação ao tema, foi realizada a leitura da íntegra dos textos e incluíram-se 21 artigos.

Conclusão:  A cirurgia bariátrica robótica ultrapassa o papel de técnica minimamente invasiva e se configura como elemento central na transformação digital da cirurgia. Sua integração progressiva à telecirurgia pode contribuir para a democratização do acesso, inovação no ensino e fortalecimento da pesquisa cirúrgica, desde que implementada de forma gradual e segura.

PALAVRAS-CHAVE:
Telecirurgia; Cirurgia robótica; Robótica médica; Inovação em saúde

RESUMO VISUAL

INTRODUCTION

The continued incorporation of advanced technologies into surgical practice has profoundly reshaped contemporary models of patient care, medical education, and translational research. Among these innovations, robotic surgery has emerged, not only as an incremental refinement of laparoscopy, but as a technological platform capable of integrating precision mechanics, digital control systems, real-time data transmission, and advanced imaging.^1-5

In bariatric and metabolic surgery, robot-assisted procedures have progressively demonstrated safety, feasibility, and reproducibility, especially in technically demanding scenarios, such as revisional surgery, superobese patients, and more complex sutures.^2,6-9 However, the relevance of robotic platforms goes beyond operational ergonomics or dexterity.

Although telesurgery was conceptually introduced more than two decades ago, its widespread clinical adoption has historically been limited by constraints related to communication latency, network reliability, cybersecurity, and systems costs.^1,10 Recent advances in high-speed connectivity, low-latency networks, encryption protocols, and reliability of robotic systems have redefined the viability of remote surgical applications.^4,11 These advances position robotic bariatric surgery as a particularly relevant field for telesurgery within a modern and realistic framework.^3,4,9,12

Given the global burden of obesity, the uneven geographic distribution of specialized bariatric surgeons, and the standardized nature of many bariatric procedures, it is reaffirmed that robotic bariatric surgery represents an attractive model to explore the integration of telesurgery into clinical practice, academic training, and research.^3.7-9.12

This article aimed to discuss robotic bariatric surgery as a strategic platform for telesurgery, emphasizing its implications for multidisciplinary medical education and scientific research.

METHOD

Integrative review made by collecting information for reading and analysis from online research on virtual platforms. Initially, a search was carried out for DECs descriptors related to the theme, using the following keywords: “telesurgery, robotic surgery, medical robotics, health innovation” with AND or OR search, considering the title and/or abstract; The chosen ones were read in full. The material for reading and analysis was selected from the SciELO, Google Scholar, Pubmed and Scopus platforms. Afterwards, considering only those that were more related to the theme, the full text was read (Table).

TABLE
Preferred metadata of the review carried out^1-21

Author (year)	Article Title	Objectives	Conclusion
Marescaux et al. (2001)1	Transatlantic robot-assisted telesurgery	To evaluate the technical feasibility and safety of long-range robotic telesurgery, including transoceanic experimental model and clinical application in robot-assisted laparoscopic cholecystectomy.	The study demonstrated that transatlantic robotic telesurgery was technically feasible and safe under controlled conditions, with total latency of about 155 ms, paving the way for expanding remote access to surgical expertise.
Hung et al. (2019)2	Deep learning on automated performance metrics and clinical features to predict urinary continence recovery after robot-assisted radical prostatectomy	To develop a deep learning model capable of predicting urinary continence recovery after robot-assisted radical prostatectomy, using automated metrics of surgical performance and clinicopathological characteristics, in addition to evaluating the relationship between surgeon technical performance and functional outcomes.	The DeepSurv model was able to predict urinary continence recovery after RARP, and surgeons with more efficient automated performance metrics had better urinary continence rates at 3 and 6 months, reinforcing the usefulness of objective metrics and artificial intelligence in assessing surgical quality.
Dimou et al. (2021)3	Understanding the Current Role of Robotic-Assisted Bariatric Surgery	To identify temporal trends in the use of robotic bariatric surgery between 2015 and 2018 and to analyze the patient factors associated with the choice of the robotic approach in sleeve gastrectomy and Roux-en-Y gastric bypass.	Robotic bariatric surgery increased in the period studied, but still represented less than 10% of the procedures. The use of the robotic platform was associated with some specific clinical profiles, but the reasons for this selection are not yet fully understood, requiring further studies to better define its indications.
Mohan et al. (2021)4	Telesurgery and Robotics: An Improved and Efficient Era	Review current advances in telesurgery and robotic surgery, highlighting benefits, limitations, and future perspectives related to connectivity, latency, haptic feedback, and new technologies such as 5G and IoT.	Telesurgery is a promising strategy to expand surgical access with greater precision, especially in remote areas, but its expansion still depends on reducing latency, improving haptic feedback, technological safety, reducing costs, and addressing legal and ethical issues.
Rosa et al. (2024)5	Impact of videosurgery training of general surgery residents in a low-fidelity simulator adapted from the Fundaments of Laparoscopic Surgery (FLS) program	To evaluate the impact of theoretical-practical training in videosurgery, with a low-fidelity simulator adapted from the FLS, on the skill acquisition of first- and second-year general surgery residents, comparing performance before and after training and in relation to a control group of experienced surgeons.	The training promoted a significant improvement in the technical performance of residents in both groups. First-year residents, after training, achieved similar performance to the initial performance of second-year residents, suggesting that sequenced training with a low-fidelity simulator can accelerate the acquisition of skills in videosurgery.
de Barros et al. (2023)6	Robotic versus laparoscopic Roux-en-Y gastric bypass: a retrospective study in a single center	To compare patients undergoing Roux-en-Y gastric bypass by robotic versus laparoscopic approaches, at a single center and by a single surgeon, analyzing surgical time, length of hospital stay, and postoperative complications.	The robotically operated group had a shorter surgical time and a shorter hospital stay, with no differences in stenosis, bleeding or fistula, suggesting that robotic gastric bypass is a safe and potentially advantageous alternative in specialized centers.
Spurzem et al. (2024)7	Robotic bariatric surgery reduces morbidity for revisional gastric bypass when compared to laparoscopic: outcome of 8-year MBSAQIP analysis of over 40,000 cases	To evaluate the use of robotic surgery in revisional bariatric surgery and to compare perioperative outcomes at 30 days between laparoscopic and robotic approaches, especially in revisional sleeve gastrectomy and revisional Roux-en-Y gastric bypass, based on the MBSAQIP database from 2015 to 2022.	The use of the robotic platform has progressively increased in revisional bariatric surgery. In cases of revisional gastric bypass, the robotic approach was associated with lower postoperative morbidity and shorter hospital stay when compared to the laparoscopic approach, although with longer operative time, suggesting a potential benefit of robotics in more complex revisional cases.
Pastrana et al. (2020)8	Outcomes of robotic bariatric surgery in super-obese patients: first report based on MBSAQIP database	To compare the safety and short-term outcomes of robotic versus laparoscopic bariatric surgery in superobese patients, based on the MBSAQIP database from 2015 to 2017.	In superobese patients, the robotic approach had 30-day outcomes similar to those of laparoscopy, with no clear clinical benefit in safety or short-term complications, although both techniques showed worse results in this group when compared to non-superobese obese patients.
Guérios et al. (2021)9	Impact of bariatric surgery on lipid and glycemic profile in obese patients	To evaluate the impacts of bariatric surgery on anthropometric, metabolic and biochemical parameters of obese patients, comparing preoperative data with 3 and 6 months postoperatively.	Bariatric surgery was effective in reducing anthropometric and metabolic parameters, with a significant decrease in total cholesterol, LDL, triglycerides, fasting glucose, glycated hemoglobin and insulin in the postoperative period.
Anvari et al. (2005)10	Establishment of the World’s First Telerobotic Remote Surgical Service: For Provision of Advanced Laparoscopic Surgery in a Rural Community	To describe the implementation of the first regular hospital service of remote telerobotic surgery between a university hospital and a rural hospital, evaluating its feasibility for offering advanced laparoscopic surgery and collaboration between surgeons at a distance.	The study demonstrated that remote telerobotic surgery can be incorporated into clinical practice safely and effectively, with good collaboration among surgeons, absence of major intraoperative complications, and the potential to expand access to advanced laparoscopic procedures for rural communities.
Fan et al. (2023)11	Feasibility and Safety of Dual-console Telesurgery with the KangDuo Surgical Robot-01 System Using Fifth-generation and Wired Networks: An Animal Experiment and Clinical Study	To evaluate the feasibility and safety of telesurgery with double console using the KangDuo Surgical Robot-01 system, through animal experiment and clinical study, using 5G and wired networks.	Dual-console telesurgery proved to be feasible and safe both in the animal model and in the clinical study, with acceptable latency, packet loss of less than 1%, and absence of important intraoperative complications, suggesting potential clinical and educational application of this technology.
Veilleux et al. (2020)12	A Review of the Role of Robotics in Bariatric Surgery: Finding Our Future?	To critically review the available literature on the use of robotic surgery in bariatric procedures, evaluating its impact on operative time, clinical outcomes, cost, and possible applications in specific subgroups, such as superobese and revision surgeries.	Most studies suggest that robotic bariatric surgery increases operative time and cost, with no clear generalizable benefit in outcomes. Still, it may play a promising role in more complex cases, such as super-obese patients, revisional procedures, and future applications associated with technological maturation and artificial intelligence.
Patel et al. (2024)13	Technical and ethical considerations in telesurgery	Analyze the main technical, regulatory and ethical aspects involved in the implementation of telesurgery, focusing on network infrastructure, latency, security, data privacy, professional responsibility and doctor-patient relationship.	Telesurgery has great potential to expand access to surgical expertise, but its secure and large-scale adoption depends on robust, low-latency connectivity, cyber protection, technical standardization, and improved ethical and regulatory frameworks.
Dohler et al. (2025)14	The crucial role of 5G, 6G, and fiber in robotic telesurgery	Analyze the role of 5G networks, future 6G networks, and fiber optic infrastructure in enabling robotic telesurgery, with a focus on latency, reliability, transmission requirements, network architecture, security, and smart hospital applications.	The study concludes that robotic telesurgery depends on very high-performance connectivity, and that the combination of 5G and fiber backbone represents the most appropriate solution to ensure low latency, high reliability, and scalability. In addition, it points out that 6G, artificial intelligence and smart hospitals tend to further expand the feasibility and clinical reach of telesurgery in the future.
Motiwala et al. (2025)15	Telesurgery: current status and strategies for latency reduction	Review the current state of telesurgery, focusing on factors related to latency, its impacts on surgical performance, and proposed technological strategies for its reduction, including 5G/6G, artificial intelligence, edge computing, haptic feedback, and cybersecurity.	Latency remains one of the main barriers to the widespread adoption of telesurgery, and it is ideal to keep it below 200 ms. Advances such as 5G/6G networks, artificial intelligence, edge computing, and improved haptic feedback show potential to reduce this problem, but ethical, legal, regulatory, and safety challenges still need to be overcome to enable its large-scale application.
by Paula Loureiro et al. (2025)16	Implementation of Robotic Telesurgery in Brazil: The First Experimental Remote Surgery Performed Between Two Brazilian Cities	To report the first telesurgery performed between two Brazilian cities, evaluating the technical feasibility and safety of a remote robotic cholecystectomy in a porcine model, with high-performance fiber optic connection and 5G redundancy between Campo Largo and Cascavel.	The study demonstrated that robotic telesurgery between two Brazilian cities was technically feasible and safe, with low latency, connection stability, and absence of technical-surgical complications, reinforcing the potential of this technology to expand access to specialized surgery in distant regions.
Carmo et al. (2023)17	Late post-sleeve gastric fistula	To report a case of late gastric fistula after sleeve gastrectomy and to discuss the diagnosis and therapeutic management of this postoperative complication.	Conservative treatment with an endoscopic approach, including dilation of the narrowing area, proved to be effective in controlling late post-sleeve fistula, suggesting that it is an adequate alternative in selected cases, without the mandatory need for prosthesis or reoperation.
Trute et al. (2022)18	Development of a Robotic Surgery Training System	Develop and describe a low-cost robotic surgery training system, with the possibility of local and remote use via the internet, incorporating teleoperation, haptic feedback and 2D/3D vision, aimed at surgical training and experimental research.	The proposed system proved to be viable as an accessible platform for training in robotic surgery and research, allowing remote teleoperation with acceptable latency in good quality networks, in addition to offering visual and haptic feedback. The authors conclude that the platform has the potential to expand access to robotic training, although it still requires future technical improvements.
Saikali et al. (2025)19	Society of Robotic Surgery (SRS) special meeting in 2024: insights from the telesurgery consensus meeting	Present the key insights, collaborative proposals, and recommendations discussed at the Society of Robotic Surgery’s global meeting on telesurgery, focusing on technical requirements, ethical issues, cybersecurity, regulation, training, and safe implementation of this practice on a global scale.	The meeting highlighted that the safe expansion of telesurgery depends on a multidisciplinary approach, with standardization of training and accreditation, improvement of hospital connectivity, specific regulatory framework and appropriate reimbursement models, reinforcing that the consolidation of telesurgery requires not only technical feasibility, but also ethical, legal and institutional alignment.
Frenkel (2023)20	Telesurgery’s Evolution During the Robotic Surgery Renaissance and a Systematic Review of its Ethical Considerations	To review the recent evolution of telesurgery in the context of the revival of robotic surgery, to discuss its current trends of use, and to systematically analyze the main ethical considerations related to its adoption.	Telesurgery has the potential to expand access to safe, equitable, and high-quality surgical care, but its integration depends on addressing ethical, legal, regulatory, technical, and institutional barriers, with the active participation of surgeons and medical societies in the construction of this process.
Saikali et al. (2024)21	Telesurgery: humanitarian and surgical benefits while navigating technologic and administrative challenges	Discuss the humanitarian and surgical benefits of telesurgery, as well as analyze the key technological, administrative, ethical, regulatory, and safety challenges involved in its implementation.	Telesurgery has the potential to expand equitable access to specialized surgery and favor the dissemination of surgical expertise, especially in remote areas. However, its wide and secure adoption depends on addressing barriers related to latency, connectivity, cybersecurity, regulation, informed consent, and institutional standardization.

RESULTS

The bibliographic search allowed the identification of studies with different approaches, ranging from the historical milestone of telesurgery to contemporary applications of robotics in bariatric surgery, surgical training, advanced connectivity and ethical-regulatory challenges. After reading the titles, abstracts and full texts, 21 articles were selected with greater adherence to the objective proposed in this review (Table).

DISCUSSION

Robotic bariatric surgery: beyond a surgical technique

Robotic bariatric surgery has evolved from an alternative minimally invasive approach to a mature surgical modality with distinct technical and educational attributes. While the core principles of bariatric procedures such as Roux-en-Y gastric bypass and sleeve gastrectomy remain unchanged, robotic systems offer enhanced visualization, articulated instrumentation, tremor filtering, and improved surgeon ergonomics.^2,6,7

From an academic point of view, the importance of robotic bariatric surgery lies in its potential for standardization. Robotic platforms enable the consistent execution of critical operational steps, facilitating reproducibility between institutions and operators. This standardization is particularly valuable for research settings and multicenter studies.^2,7,8

In addition, robotic systems naturally generate digital data related to instrument movement, operating time, force application, and workflow patterns. These data streams offer a unique opportunity for objective evaluation of surgical performance, skill acquisition, and learning curves in an area of increasing relevance in surgical education research.³

Thus, robotic bariatric surgery should be seen not only as a minimally invasive technique, but as an enabling technology for broader transformations in the delivery of surgical care.^3.4

Telesurgery: concept, evolution and current scenario

Telesurgery is defined as the performance of surgical procedures in which surgeon and patient are geographically separated, connected by robotic systems and advanced telecommunications networks.^1,10 The historical milestone of telesurgery is known as “Operation Lindbergh” (2001), with cholecystectomy performed between New York, USA and Strasbourg. France.

For many years, telesurgery has remained largely experimental, limited by high latency, limited bandwidth, and concerns about safety, reliability, and legal liability.^4.10

Contemporary analyses reinforce that these limitations are not only technological, but also ethical and organizational. Recent reviews highlight that overcoming these barriers depends not only on the advancement of communication networks, but also on the adoption of clear regulatory frameworks, cybersecurity protocols, and ethical models adapted to the specificities of telesurgery.¹³

In recent years, however, the rapid expansion of fiber optic infrastructure, fifth-generation (5G) mobile networks, and secure data transmission protocols have substantially altered this scenario.^4.11

Dohler et al. in 2025¹⁴ highlighted that the introduction of 5G and 6G networks in telesurgery not only improves latency and reliability, but also offers a robust platform for the necessary advances in telesurgery. 5G networks in particular offer ultra-low latency and high data throughput, which are essential for critical modalities such as kinesthetic, audio-visual and tactile feedback, which are critical for performing precise remote surgical procedures.¹⁴

According to Motiwala et al. in 2025¹⁵, reducing latency is one of the main challenges that limits the feasibility of large-scale telesurgery. The paper reviews emerging strategies to minimize this delay, such as the use of 5G networks, artificial intelligence (AI)-driven latency compensation, and network infrastructure optimization. Such approaches are seen as fundamental to ensure greater precision, dexterity, and patient safety during teleoperated procedures.

Modern telesurgical paradigms now span the spectrum of remote interactions, including: 1) teleproctoring, in which an expert surgeon provides real-time guidance from a remote location; 2) telementoring, involving structured educational support during in-person procedures; and 3) teleoperation, in which the surgeon directly controls the robotic system from a distant location.^4.12

Among them, telesurveillance and telementoring have already demonstrated practical applicability in bariatric surgery, especially for training, accreditation, and dissemination of expertise. Fully remote teleoperation, while technically feasible, remains limited to highly controlled environments and pilot programs.^1.11

Recent experimental studies show that this scenario is beginning to become feasible in emerging countries as well. In 2025, the first experimental robotic telesurgery was performed in Brazil, connecting two Brazilian cities separated by approximately 600 km, using dedicated fiber optic infrastructure with mobile network redundancy. The procedure was successfully performed, presenting ultra-low latency and communication stability throughout the surgical act, reinforcing the technical feasibility of robotic teleoperation in highly controlled environments and under strict safety protocols.¹⁶

From an academic point of view, telesurgery represents a convergence of surgery, engineering, informatics, and ethics.⁴ Its integration into bariatric surgery offers a unique opportunity to study not only clinical outcomes,17 but also educational efficiency, system resilience, and new models of surgical collaboration.^2,3,12 Thus, robotic bariatric surgery offers an ideal clinical framework to advance telesurgical research and define best practices for future implementation.^2,4,11

Robotic bariatric surgery as a strategic model for telesurgery

Bariatric surgery brings together a set of characteristics that make it particularly suitable to serve as a strategic model in the discussion and development of telesurgery. This is an area with a high prevalence of indication, significant impact on public health, and unequal geographic distribution of highly specialized professionals.^2,7,8 In many countries, centers of excellence are concentrated in large urban areas, while peripheral or remote regions face structural and human limitations in providing adequate surgical treatment for severe obesity.^2.4

Robotic surgery enhances this scenario by offering stability of movements, high-definition three-dimensional vision, and articulated instruments, which allow greater precision in digitally controlled environments.^2,7 These attributes are fundamental for any application of a remote surgical procedure, as they reduce the dependence on fine manual skills directly mediated by physical contact with the patient.^1.4

In this context, robotic bariatric surgery can be understood as a clinical and academic proving ground for telesurgery.^2-4

The recent performance of a teleoperated robotic procedure in an experimental model in Brazil reinforces this concept of clinical and academic proving ground. Although not performed in the bariatric context, the study validated fundamental aspects for telesurgery, such as network stability, secure latency, communication redundancy, and precise remote control of the robotic system, indispensable elements for future more complex clinical applications.¹⁶

Impacts on medical education and academic research

The incorporation of robotic bariatric surgery in the context of telesurgery has direct and profound implications for medical education and scientific research.^3,4,12 From an educational point of view, the possibility of remote supervision and mentoring redefines the traditional models of surgical training, allowing experienced specialists to monitor, guide and evaluate procedures performed in different centers, without the need for physical displacement.^4.12

This approach is especially relevant for medical residency, graduate and advanced training programs, as it expands access to specialized expertise and reduces regional inequalities in surgical training.^2,4,12 In addition, robotic surgery enables the systematic and standardized recording of operative data, creating a favorable environment for objective performance evaluation, skill acquisition, and learning curve.³

The recent development of robotic surgery training systems with a focus on broad accessibility reinforces this educational and scientific potential. In 2025, the creation of a low-cost robotic training platform, designed for local and remote use, incorporating teleoperation, digital twin environment and real-time monitoring, was described. The system demonstrated high accuracy in instrument control, rigorous maintenance of the remote motion center and very low latency, configuring itself as a robust tool for surgical training, experimental research and validation of educational models in academic environments.¹⁸

In the field of research, robotics associated with telesurgery opens up new fronts of translational investigation.^3,4 Data generated by robotic systems, such as execution time, instrument trajectory, and movement patterns, can be used for multicenter studies, validation of educational models, and development of tools based on artificial intelligence applied to surgery.³

Finally, the discussion on robotic bariatric surgery and telesurgery also stimulates ethical, regulatory, and pedagogical reflections, which are fundamental for the training of medical researchers who are aware of the responsibilities associated with the use of advanced technologies in clinical practice.^1,4,10

In this context, recent initiatives by international scientific societies have reinforced the centrality of structured teaching and professional certification in the evolution of telesurgery. The Society of Robotic Surgery consensus highlights the need for multidimensional training programs, clear proficiency criteria, and accreditation processes specific to telesurgical practice, prioritizing clinical outcomes, patient safety, and ethical responsibility.¹⁹

Current limitations and ethical-regulatory challenges

Despite the significant advances in robotic surgery and the renewed interest in telesurgery, several limitations still restrict its widespread clinical adoption, especially in the context of bariatric surgery.^2,7,8 The high cost of robotic systems, combined with the need for referral hospitals with adequate technological infrastructure, remains one of the main barriers, particularly in health systems with limited resources.^2.4

Frenkel et al. in 2023²⁰ discussed the evolution of telesurgery and the ethical and regulatory hurdles that arise as technology advances. They noted that, in addition to technological limitations, the adoption of telesurgery depends on a robust regulatory framework, including clear regulations on informed consent, professional responsibility, and the creation of legal infrastructure that supports safe practice in different global contexts. The lack of clear guidelines can hinder the growth and universal adoption of telesurgery.

In 2024, Saikali et al.²¹ highlighted that, in addition to technological challenges related to latency and connectivity, telesurgery faces significant administrative and regulatory obstacles. Global implementation of it requires collaboration between governments, academic institutions, and medical societies to overcome issues such as training, certification of surgeons, and the creation of clear international regulations. Addressing these challenges is crucial to ensure that the benefits of telesurgery, such as global access to specialist surgery, can be widely accessed without compromising patient safety.

From a technical point of view, telesurgery requires highly stable connectivity, with minimal latency and system redundancy, to ensure operative safety.^1,4,11 Signal interruptions, image transmission failures, or delays in command response pose unacceptable risks in complex surgical procedures.^1,10 Although high-speed networks have reduced these limitations, their availability is still heterogeneous.^4.11

Recent reviews have systematically delved into these technical and ethical challenges associated with telesurgery. Aspects such as acceptable latency, network quality of service, cybersecurity, protection of sensitive data, and reliability of robotic systems are pointed out as critical requirements for safe telesurgical practice. In addition, ethical issues related to extended informed consent, shared professional responsibility, and institutional governance are highlighted as central elements for responsible clinical implementation of telesurgery.¹³

Ethical and regulatory challenges are equally relevant. Issues related to professional responsibility, informed consent, interregional or international medical licensing, and patient data protection remain under debate.^4.10

Recent studies by the Society of Robotic Surgery (SRS) address these critical points and propose a set of guidelines and recommendations to overcome ethical and regulatory challenges in telesurgery. The article by Patel et al. in 2024¹³ highlights in particular, the need for shared governance between surgeons, institutions, and regulatory authorities to ensure the safe implementation of telesurgery in different global contexts. The clear definition of responsibilities, the establishment of training and certification standards, and the protection of patient data are pointed out as pillars for the sustainable evolution of this practice.

In telesurgery scenarios, it becomes essential to clearly define the responsibility between the remote surgeon, the local team, and the healthcare institution involved.^1.12

These concerns were recently systematized in an international consensus promoted by the Society of Robotic Surgery (SRS), which brought together global experts in surgery, engineering, telecommunications, ethics, and public policy. The meeting resulted in a Delphi-like consensus, establishing recommendations on technological requirements, cybersecurity, training, professional accreditation, legal aspects, and ethical frameworks necessary for the safe and scalable implementation of telesurgery. The document emphasizes the need for standardized guidelines and multidisciplinary governance to enable the responsible adoption of telesurgery in different health systems.¹⁹

In the academic sphere, these limitations reinforce the need for gradual approaches, initially prioritizing hybrid models, such as teleproctoring and telementoring that offer educational and care gains without exposing patients to unnecessary risks.^4,12 The consolidation of clear regulatory frameworks will be decisive for the safe evolution of bariatric telesurgery.^4.10

Perspectives

The future for robotic bariatric surgery in the context of telesurgery is promising.^2,4,11 The trend of expansion of the robotic platform market, with greater competition and technological diversification, can contribute to cost reduction and increased access.^2,7,8 At the same time, the continuous advancement of communication networks, with lower latency and greater reliability, brings telesurgery closer to a more feasible clinical scenario.^4,11 In the field of teaching, hybrid training models, combining simulation, robotics, and remote mentoring, are expected to become progressively more integrated into residency and graduate programs.^3,4,12 Telesurgery can play a central role in democratizing access to specialized training, especially in countries with large regional inequalities.^4,12 Recent initiatives point to the practical feasibility of this model. The development of robotic training platforms integrating teleoperation, advanced simulation, and digital twins has allowed expanding access to training in robotic surgery, reducing institutional costs, and creating controlled environments for research and technological validation. These systems represent a concrete step in the consolidation of hybrid educational ecosystems in robotic surgery and telesurgery.¹⁸

From a research perspective, the integration of robotic surgery, data analysis, and artificial intelligence opens up new possibilities for surgical performance studies, technical standardization, and outcome evaluation.^3,4 Bariatric surgery, due to its high prevalence and metabolic impact, tends to occupy a prominent position in this process of translational innovation.^2,7,8

Thus, more than an isolated technological tool, robotic bariatric surgery must be understood as part of an evolving digital ecosystem, capable of transforming the way surgery is practiced, taught, and investigated.^3,4,11

CONCLUSION

Although technical, economic, and regulatory challenges still limit the widespread adoption of telesurgery, the current scenario indicates a progressive transition to more integrated models of care, teaching, and research. In this context, robotic bariatric surgery emerges as a privileged field to test, validate, and consolidate these transformations. It goes beyond the role of a minimally invasive technique and is a central element in the digital transformation of surgery. Its progressive integration into telesurgery can contribute to the democratization of access, innovation in teaching, and strengthening of surgical research as long as it is implemented gradually and safely.

References

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• ⁶ de Barros F, Fonseca ABM, Kiss ASB, Braga CF, da-Silva FR, Regonati YH. Robotic versus laparoscopic Roux-en-Y gastric bypass: a retrospective study in a single center. Arq Bras Cir Dig. 2023;36:e1756. https://doi.org/10.1590/0102-672020230038e1756
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• Central Message
  The progressive introduction of highly complex technologies in surgical practice has promoted significant transformations in the current paradigms of patient care, medical training, and translational research. In this context, robotic surgery stands out not as a simple evolution of conventional laparoscopy, but as an integrated technological architecture, which brings together mechanical precision, advanced digital control, real-time data communication, and high-definition imaging systems.
• Perspective
  More than representing a minimally invasive approach, robot-assisted bariatric surgery is a strategic component of the digitalization of surgical procedures. The future incorporation of these systems into telesurgery platforms has the potential to expand access to specialized care, boost new educational models, and consolidate lines of research in surgery, as long as their adoption occurs in a progressive, judicious, and safety-based manner.
• How to cite this article
  Loureiro MP, Ramalho GL, de Almeida Junior A, Palermo M, Cavazzola LT, Nassif PAN. Telecirurgia robótica: fundamentos tecnológicos, aplicações clínicas e perspectiva. BioSCIENCE. 2026;84:e00010. https://doi.org/10.55684/2026.84.pt.e00010.
• Funding:
  None
• Data availability:
  Data are available from the corresponding author upon reasonable request.

Edited by

• Editor
  Selma Maria Bezerra Jerônimo http://orcid.org/0000-0002-4784-9904

Data availability

Data are available from the corresponding author upon reasonable request.

Publication Dates

• Publication in this collection
  21 Aug 2026
• Date of issue
  2026

History

• Received
  05 Feb 2026
• Accepted
  14 Mar 2026
• Published
  10 Apr 2026