Pioneering Application of a Domestically Developed Single-Arm Single-Port Robotic System in Ultra-Remote Telesurgery: A Clinical Report of Two Gynecological Oncology Cases

Objective To evaluate the feasibility and safety of a domestically developed, single-arm single-port robotic system for performing complex gynecological surgeries under extreme conditions, such as ultra-remote locations and high-altitude environments.

Methods In November and December 2024, a surgeon on the campus of West China Second Hospital, Sichuan University in Chengdu remotely manipulated a domestically developed single-arm, single-port robotic surgical system via a high-speed, low-latency communication network to perform two telesurgical procedures. The first procedure was a transumbilical single-port robot-assisted laparoscopic total hysterectomy, bilateral salpingectomy, and left ovarian cystectomy on a patient with multiple uterine fibroids at the Maternity and Child Health Hospital of Xizang Autonomous Region (distance between Chengdu and Lhasa > 2000 km and altitude difference >3000 m). The second procedure was a transumbilical single-port robot-assisted laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy on a patient with FIGO stage IA endometrial cancer at Zhujiang Hospital, Southern Medical University in Guangzhou (the distance between Chengdu and Guangzhou > 1500 km). Perioperative data were collected and analyzed.

Results Both procedures were successfully completed without conversion to laparotomy or the use of additional auxiliary ports. The operative times for the Chengdu-Lhasa and Chengdu-Guangzhou surgeries were 90 minutes and 135 minutes, respectively, with estimated blood loss ≤ 50 mL in both cases. The intraoperative bidirectional network latency remained around 40 ms, and the total end-to-end latency was less than 60 ms. The surgeon reported no perceptible delay in instrumental response. Both patients recovered well postoperatively, and no surgery-related complications or disease recurrence were observed during follow-up until July 2025.

Conclusion This study provides preliminary evidence supporting the feasibility and safety of a domestically developed single-arm, single-port robotic system for performing complex gynecological surgeries in ultra-remote and high-altitude settings. This technical approach offers a promising solution to address geographic disparities in access to high-quality medical resources and demonstrates significant potential for improving the availability of advanced minimally invasive surgery in remote areas and regions of special settings.