In August of 1969, a music festival was organized on a rural property in the Hudson Valley of New York State. This gathering, called Woodstock, brought together individuals with a unified ideal and goal to make the world a better place through the arts. Despite logistical, financial, and social challenges, this jamboree had significant global impact on our cultural evolution. Today the word Woodstock conjures up images of hope and is proof that unified collaboration can improve the human condition.

On February 3 and 4, 2024, the Society of Robotic Surgeons held a Telesurgery Consensus Conference in Orlando, Florida (Figure). The purpose of this gathering was to bring together individuals with the singular idea that telesurgery could improve medical care. This meeting included thought leaders from medicine/surgery, the Food and Drug Administration (FDA), industry, telecommunications, public policy, banking, the government, medical insurers, and hospital administration to discuss the potential of telesurgery.

Figure. Participants from surgical sciences, government, hospital administration, industry, science, and telecommunications at the first consensus meeting on telesurgery.

Telemedical technology has been available for decades. Integration into routine practice was slow due to a multitude of factors including cultural, societal, economic, and technological barriers. The necessity of providing medical care during the COVID-19 pandemic propelled the acceptance of telemedicine. The efficiency advantages, as well as positive reception by patients, have transformed telecognitive interactions into an integral part of medical practice.

Teleinterventions using surgical robots have also been reported since the early 1990s.^1-3 The first complete case was a cholecystectomy performed by Jacques Marescaux from New York to Strasbourg, France, in 2001.⁴ This case was remarkable, though it required expensive dedicated telecommunication channels that did not offer general reproducibility. Over the ensuing decades, there have been remarkable technological developments in robotics and telecommunication that have poised telesurgery as the next tectonic shift in medical practice. The advancement of telecom to 5G and beyond, along with the introduction of diverse surgical robotic systems that have the potential to increase access and reduce cost, have made telesurgery more viable. These advances promulgated a desire to reassess telesurgery in the form of an exploratory conference.

The humanitarian implications globally and the potential ability to deliver health care equity to underserved areas of the world are what led to the Society of Robotic Surgery developing the concept of the Telesurgery Consensus Conference.⁵ From a practical standpoint, the program was broken into 13 sessions discussing various aspects of this technology, each putting patient care front and center. All the key stakeholders were present and participated in the meeting as the concept was analyzed from an array of perspectives. The current global experience of clinical telesurgery was presented, showing viability of telesurgery in real patients at up to 2700 km. Dr Patel’s team was able to collaborate with a variety of robotic companies in China, Japan, and India to demonstrate clinical viability. The technology is now available, but the process has yet to be verified and replicated. The evolution of telesurgery was discussed and culminated with live nonhuman demonstrations of robotic equipment connectivity being controlled from Orlando to Dubai and Shanghai, a round trip distance of 26,000 km. The teleconnectivity of the robots was demonstrated; also demonstrated were the significant challenges with distance and latency over 400 ms. There was time set aside to address various aspects, and workgroups formed to give structure to discussions.

Several important points became apparent. The reproducible and practical application of telesurgery currently exists. Recent clinical experiences in China, India, and Japan were presented where this technology was used to bring advanced surgical care to underserved areas using the existing telecommunication infrastructures. This demonstrated that experience at expert centers can be distributed to provide equity independent of geography. This technology solves issues related to limited surgical expertise in remote areas, as well as needs in the military and space exploration. Decreased requirement for patient travel, coupled with equitable distribution of expert surgical care and efficient use of surgeon time, offer social and economic benefits to a regional or national health care system. Both domestic and international applications can speed up adoption of new techniques via telementoring, and the potential exists to bring surgical cure to underserved nations.

The bulk of the conference was dedicated to defining current challenges to widespread adoption. Nomenclature needs to be standardized to define locations, participants, and equipment. Telecommunication infrastructure for each application will require redundant channels that include strong cybersecurity. Robot companies should provide and activate remote capabilities. This would include providing open source to their code to allow third parties the ability to develop remote control systems or universal controllers. Protocols for a multistep educational program for surgeons and operating room teams on both ends need to be created. Incorporated into the process, fail safe mechanisms are required in the event of a malfunction or complication. Fiscally sound reimbursement by payers needs to be defined to be sure that surgeons and facilities at both sites are compensated.

This consensus meeting illustrated that development of telesurgery is possible, needed, and in its infancy. Expertise of stakeholders including legislatures, patients, health care systems, specialty boards, industry, telecommunications companies, surgical specialties, and nursing organizations need to be leveraged to forge a safe reality. In addition to continued dialogue, the conference has initiated what the FDA terms a “collaborative community.” This is an ongoing cooperative comprised of private- as well as public-sector members, including the FDA, who work on medical device challenges to achieve objectives and outcomes for the good of public health. This group must build public trust, provide deliverables, and tackle challenges as they arise.

Telesurgery is a burgeoning tool that has the potential to address health care access disparities, improve global procedural outcomes, and decrease medical cost. It is a necessary tool for space exploration and can decrease military morbidity. It is feasible today with current technology. The promise of a transformative technology that will improve medicine produced group excitement, and all felt this meeting had the energy of Woodstock. There is no doubt that this will become a reality and an integral part of practice. The second round of the consensus conference will convene this June at the Society of Robotic Surgery annual meeting, where the next step will be taken. All are welcome to participate.