“5G wireless + wired network”-based multi-console robotic telesurgery: adaptability to complex surgical procedures and diverse network infrastructures—a case report
Case Report

“5G wireless + wired network”-based multi-console robotic telesurgery: adaptability to complex surgical procedures and diverse network infrastructures—a case report

Zixing Ye1, Yongxue Ding2, Weifeng Xu1, Yi Xie1, Mingwei Qin3, Jing Fan3, Liang Cui4, Na Li5, Xin Qiao2, Yu Fang2, Zhigang Ji1, Yan Yang6, Jie Dong1

1Department of Urology, Peking Union Medical College Hospital, Beijing, China; 2Department of Urology, Liaoyang City Central Hospital, Liaoyang, China; 3Teleconsultation Center, Peking Union Medical College Hospital, Beijing, China; 4Department of Urology, Civil Aviation General Hospital, Beijing, China; 5China Mobile Communications Group Co., Ltd., Beijing, China; 6Liaoyang City Central Hospital, Liaoyang, China

Contributions: (I) Conception and design: Z Ji, Y Yang, Y Ding; (II) Administrative support: Z Ji, Y Yang, M Qin, Y Ding, Y Fang; (III) Provision of study materials or patients: Y Ding; (IV) Collection and assembly of data: Z Ye, Y Xie, W Xu, X Qiao, L Cui, N Li; (V) Data analysis and interpretation: Z Ye; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Jie Dong, MD. Department of Urology, Peking Union Medical College Hospital, No.1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. Email: pumchdongjie@163.com; Yan Yang, BS. Liaoyang City Central Hospital, Zhonghua Street, Baita District, Liaoyang 111000, China. Email: 514461936@qq.com.

Background: Robotic telesurgery enables patients at local hospitals to receive treatment from specialists at distant medical centers, while also facilitating intraoperative multidisciplinary collaboration. Stable and reliable network access is a critical prerequisite for telesurgery. Both traditional wired networks and 5G wireless networks have inherent limitations. This study reports a multi-console robotic telesurgery integrating existing wired networks with 5G technology, aiming to fully exploit the clinical potential of robotic systems in telesurgical settings.

Case Description: A 62-year-old female was admitted to Liaoyang City Central Hospital following the detection of a left renal tumor 8 days prior. Abdominopelvic contrast-enhanced computed tomography (CT) revealed a 5.4 cm × 4.6 cm mass in the middle-lower segment of the left kidney, consistent with renal cell carcinoma. Physical examination findings were unremarkable. Robot-assisted remote radical nephrectomy was performed using the domestic Kangduo KD-SR-01 system: the patient cart and one console were positioned in Liaoyang, while two consoles and imaging platforms were located in Peking Union Medical College Hospital in Beijing, approximately 700 km away. The surgery utilized a public 5G wireless network (China Mobile) and 5G customer premise equipment (CPE), which transmitted signals from the consoles and patient cart to the base station, with subsequent relaying to the target destination via the 5G core network. Distributed base stations were deployed to optimize signal quality, reduce latency, and enhance signal stability. The User Datagram Protocol (UDP) was employed for real-time monitoring of latency and packet loss rate. In the event of significant latency or other network abnormalities, the telesurgery was designed to switch to bedside surgery immediately. Three surgeons (two in Beijing, one in Liaoyang) transferred the robotic control authority intraoperatively as clinically required. Stable transmission of 3D surgical video and console control signals was achieved. The surgery was performed successfully without complications. The patient was discharged on postoperative day 4.

Conclusions: The “5G wireless + wired network” model applied in this case effectively integrates the advantages of both network types and offers a feasible solution for complex telesurgeries, especially in settings with variable network infrastructure. The multi-console robotic system based on this integrated network model enhances surgical safety and provides technical support for the performance of complex telesurgeries.

Keywords: Robotic; telesurgery; 5G wireless network; wired network; case report

Submitted Jan 18, 2026. Accepted for publication Mar 06, 2026. Published online Mar 23, 2026.

doi: 10.21037/tau-2026-1-0058

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Key findings

• This study successfully implemented a multi-console robotic remote radical nephrectomy using an integrated “5G wireless + wired network” model, achieving stable intraoperative signal transmission (average latency: 220 ms; no packet loss) over a 700-km intercity distance. The model overcomes the limitations of single-network-dependent telesurgery and supports multidisciplinary collaboration, providing a feasible technical solution for complex telesurgeries in diverse network environments.

What is known and what is new?

• Robotic telesurgery is constrained by network stability, with single-console configurations and single-network reliance limiting its application in complex procedures.

• This study reports the initial application of a multi-console robotic system combined with an integrated 5G-wired network model for complex urological telesurgery, providing clinical evidence of its safety and efficacy in a multi-console, hybrid-network setting.

What is the implication, and what should change now?

• The integrated network model can provide reliable telesurgical connectivity in regions with suboptimal 5G coverage. To perform a successful telesurgery, we should take full advantage of the strengths of different network modalities and consider the network accessibility. Future prospective studies with larger patient cohorts are needed to validate these findings and establish the generalizability of this approach.

Introduction

Robotic laparoscopic systems (e.g., the da Vinci Surgical System) have been widely adopted in clinical practice. The precise, dexterous robotic arms and magnified visual field contribute to reduced surgical complications and accelerated patient recovery. The development of domestic surgical robots has facilitated the deployment of surgical robots in more medical institutions. However, surgeon expertise remains the decisive factor influencing patient outcomes. In China, highly skilled surgeons are concentrated in large hospitals in major cities, which hinders the full utilization of surgical robots in primary-level hospitals.

Currently, efforts have been made to apply robotic systems in telesurgery to mitigate the uneven distribution of highly skilled surgeons, yet limitations persist. Wired network-based telesurgery has been performed since 2001 (1,2). Although it enables stable and secure signal transmission, its reliance on existing or newly laid network cables restricts its widespread adoption. Animal or cadaver-based telesurgeries can partially simulate clinical surgical procedures but have lower requirements for network latency (3-6). Previous remote robotic surgeries have primarily utilized single- or dual-console configurations, which are not conducive to cooperation among experts from different hospitals (7-11). Currently, multi-console remote robotic surgery remains in the development stage, constrained by the limited penetration of surgical robots and the demand for robust network support. Our team successfully performed a multi-console remote robotic surgery based on the “5G + wired network” model—a procedure rarely reported previously, and provided valuable experience for the promotion and advancement of this surgical approach. We present this article in accordance with the CARE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0058/rc).

Case presentation

A 62-year-old female patient was admitted to Liaoyang City Central Hospital due to the detection of a left renal tumor 8 days prior. Ultrasonography revealed a hypoechoic mass measuring 5.1 cm × 4.4 cm at the lower pole of the left kidney. Abdominopelvic contrast-enhanced computed tomography (CT) showed a lesion in the middle-lower segment of the left kidney (size: approximately 5.4 cm × 4.6 cm) with significant enhancement in the arterial phase and reduced enhancement in the parenchymal phase—consistent with the “quick in and quick out” enhancement pattern typical of renal cell carcinoma, and no enlarged lymph node was observed. The chest CT was performed to rule out the lung metastasis. The past medical history, personal history and family history were normal. Physical examination showed stable vital signs, with no percussion pain or tenderness in the bilateral renal regions. The diagnosis of renal carcinoma (cT1bN0M0) was made and robot-assisted laparoscopic radical nephrectomy was determined to be the indicated surgical intervention.

Network preparation

The surgery utilized a public 5G wireless network (China Mobile) and 5G customer premise equipment (CPE) to establish connectivity between the consoles and the patient cart. The CPE, a network access device enabling connection to the 5G base station, transmitted signals from the consoles and patient cart to the base station, which then relayed the signals to the target destination via the 5G core network (Figure 1). Beijing Mobile and Liaoyang Mobile provided technical support to ensure stable 5G wireless signal transmission. To optimize signal quality, reduce latency (defined as the signal transmission time from the Beijing-based consoles to the patient cart), and enhance signal stability, our team installed distributed base stations (Huawei) near the consoles in Beijing and Liaoyang. Backend network link optimization was implemented to further ensure uninterrupted signal transmission. During the surgery, technicians in both Beijing and Liaoyang monitored network latency and packet loss rate (defined as the ratio of lost data packets to the total number of transmitted packets) in real time via the User Datagram Protocol (UDP). In the event of significant latency (latency >350 ms) or other network abnormalities, the telesurgery would be switched immediately to bedside robotic surgery.

Figure 1 Schematic diagram of the “5G wireless + wired network” model applied in our telesurgery system. The surgical console in Liaoyang was connected to a stable wired network, whereas the surgical consoles in Beijing relied on a 5G wireless network. Data transmission between Beijing and Liaoyang was implemented through a public network to support real-time communication during the telesurgery. CPE, Customer Premise Equipment.

Surgical preparation

The surgery was performed using the domestic Kangduo Surgical Robot-01 system (model: KD-SR-01; Suzhou Kangduo Robotics Co., Ltd., Suzhou, China), which comprises a patient cart, an imaging trolley, and multiple consoles. For this procedure, the patient cart and one console were placed at Liaoyang City Central Hospital, while the other two consoles and imaging platforms (equipped with remote communication workstations) were located at Peking Union Medical College Hospital (Beijing), with an intercity distance of approximately 700 km. The surgical team comprised three experienced surgeons: two operated the consoles in Beijing, and one operated the console in Liaoyang (Figure 2).

Figure 2 Intraoperative scene of the telesurgery. Two surgical consoles were deployed in the operating room of Peking Union Medical College Hospital (Beijing). The patient-side cart (equipped with surgical instruments and imaging modules) and the third surgical console were placed in Liaoyang City Center Hospital (Liaoyang), enabling remote surgical operation and monitoring. This image is published with the participants’ consent.

Surgical procedure

The multi-console remote robot-assisted radical nephrectomy based on the “5G wireless + wired network” model was performed via a transperitoneal approach, and was completed successfully without intraoperative complications. During the telesurgery, robotic control authority was transferred among the three surgeons as clinically required. The renal hilum was controlled using Hem-o-lok clips applied by the bedside assistant under real-time robotic visualization. The renal artery and vein were ligated and divided sequentially after confirmation of secure clip placement. The intraoperative duration was 210 minutes, with an intraoperative blood loss of 20 mL. The patient’s postoperative recovery was uneventful, and she was discharged on postoperative day 4. The pathologic diagnosis was clear cell renal carcinoma [World Health Organization (WHO) II], pT1bN0M0.

Signals from the surgical camera and consoles, as well as real-time video communication between surgeons, were transmitted stably throughout the procedure. The Beijing-based and Liaoyang-based consoles exhibited consistent control performance over the robotic arms, with no network disconnections or robotic system malfunctions observed intraoperatively. Key network performance indicators were as follows: network signal coverage rate and signal residency ratio both reached 100%; average network latency was 220 ms (with no data packet loss), and network jitter was less than 20 ms. Throughout the procedure, network latency was continuously monitored by technical staff in both Beijing and Liaoyang. The average latency of 220 ms remained well below the predefined safety threshold of 350 ms. At no point did latency exceed this threshold, and no episodes of signal interruption, packet loss, or video freezing occurred that required takeover by the local surgical team. Additionally, the real-time video transmission bit rate was maintained at 40 Mbps. In terms of network bandwidth, the Beijing side achieved 177 Mbps (downstream) and 101 Mbps (upstream), while the Liaoyang side achieved 146 Mbps (downstream) and 112 Mbps (upstream).

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee(s) and the Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.

Follow-up

The patient was followed up one year after the telesurgery, she recovered well and no adverse events or relapse occurred. The patient was highly satisfied with the telesurgery, she not only achieved favorable surgical outcome but also avoided the travel and associated expenses that would have been incurred if she had needed to seek surgical care at a distant specialty center.

Discussion

In this study, we reviewed previously reported cases of remote robot-assisted laparoscopic surgeries and found that robotic telesurgery has been successfully applied across multiple specialties, including urology, hepatobiliary surgery, gastrointestinal surgery, gynecology, and thoracic surgery (Table 1). Previous studies have indicated that single-console telesurgeries based on 5G wireless networks exhibit satisfactory performance in terms of latency and video quality; however, these procedures are generally less complex and solely dependent on 5G wireless signal transmission. In contrast, this case demonstrates the application of multi-console telesurgery integrated with the “5G wireless + wired network” model to a complex procedure under diverse network conditions, highlighting its potential for future robotic telesurgery. Currently, the vast majority of telesurgeries adopt a single-console configuration. While this approach meets the basic requirements of robotic telesurgery, it has significant limitations compared to multi-console systems (16). First, multi-console systems facilitate multidisciplinary collaboration on a unified robotic platform. Due to safety considerations, previously reported telesurgeries have been primarily restricted to animal experiments, cadaveric studies, and relatively simple human procedures (3,5,7). Second, with the increasing adoption of surgical robots and advancements in network technology, the multi-console robotic system can be effectively deployed in complex surgeries requiring multidisciplinary teamwork. Third, multi-console telesurgeries offer greater clinical safety by significantly reducing the risks associated with single-console malfunctions (17). In our procedure, three surgeons from Beijing and Liaoyang achieved seamless collaboration, which not only reduced the travel burden on surgical experts in this instance but also highlights the potential feasibility of complex multidisciplinary telesurgeries.

Table 1

The summary of the robotic laparoscopic telesurgery

Year of procedures Procedures Number of subjects Test subject Procedure duration (min) Number of master console Distance (km) Latency (ms) Network Nation Surgical platform Ref.
2018 Hepatectomy 1 Porcine 60 1 48 <150 5G China KangDuo Robotic Surgery System (4)
2020 Left nephrectomy, partial hepatectomy, cholecystectomy, cystectomy 1 Porcine 120 1 3,000 264 5G China Micro Hand Surgical Robot System (12)
2021 Radical nephrectomy 29 Human 67 1 187 176 5G China Micro Hand Surgical Robot System (7)
2022 Radical cystectomy 1 Human 300 1 3,000 254 5G China Micro Hand Surgical Robot System (13)
2023 Thoracoscopic lobectomy and mediastinal lymph node dissection 1 Porcine 60 1 0.5 125 5G China Toumai Surgical Robot System (6)
2023 Total hysterectomy 1 Human 62 1 4,000 162 5G China Toumai Surgical Robot System (14)
2022 Spermatic vein ligation 2 Human 43 1 3,800 130 5G China Toumai Surgical Robot System (11)
2023 Cutting, dissection, pick-and-place and ring tower transfer 1 Tissue NP 1 300 368 5G + wired Greece Double Delta Robot System (15)
2023 Pyeloplasty 1 Human 106 2 6 271 5G + wired China KangDuo Surgical Robot System (9)

NP, not provided.

The core advantage of robotic telesurgery lies in its capacity to enable high-speed, low-latency communication between the robotic system and surgeons, supporting real-time control and feedback. This technology facilitates more precise and efficient surgical procedures, ultimately improving patient outcomes and expanding the application scope of robotic telesurgery. For example, in battlefield scenarios where wired network deployment is challenging, 5G networks allow surgeons to perform telesurgeries from rear bases (18). Currently, the average latency of most 5G-based telesurgeries is approximately 200 ms, which is slightly longer than that of wired network-based telesurgeries (15,16,19,20). The integration of 5G wireless and wired networks ensures reliable connectivity while expanding the application of robotic telesurgery.

Globally, most regions lack high-quality 5G signals that meet the requirements of robotic telesurgery, limiting the deployment of surgical robots to specific hospitals. This infrastructure gap is particularly pronounced in low- and middle-income countries, where stable electricity and reliable internet connectivity remain significant barriers to telesurgery adoption, as highlighted in a recent review by Bart (21). Connecting the patient cart via a wired network can maximize the functional utility of robotic systems. Fan et al. previously employed the “5G wireless + wired network” model for double-J stent insertion; however, the short inter-site distance and relative simplicity of this procedure may not fully validate the actual effectiveness of this network model (9). To verify whether experts in first-tier cities with high-speed 5G networks can perform telesurgery for patients in regions like Liaoyang (where stable 5G coverage may be unavailable), we connected the surgeon consoles in large city (Beijing) to a 5G network and the patient cart in small city (Liaoyang) to a wired network. Our “5G wireless + wired network” model achieved an average latency of 220 ms, which falls within the clinically optimal range for telesurgery and ensures procedural safety. This hybrid approach aligns with Bart et al.’s suggestion that telesurgery implementation strategies must account for variable network conditions to ensure broader accessibility (21). Furthermore, if surgeons in high-level hospitals can perform telesurgeries for patients within a 700-km radius, this approach could cover patients in central, eastern, and parts of western China. Thus, the “5G wireless + wired network” coverage model holds significant practical value for the promotion of robotic telesurgery.

There are several limitations of the robotic telesurgery. First, a smooth 5G network is an essential prerequisite for conducting telesurgeries, a latency ≥300 ms can impair surgical dexterity, yet such network conditions are unavailable in many regions worldwide (15,22). Second, as telesurgery is still in the developmental stage, potential network disruptions and robotic system malfunctions may pose risks to patient safety. Additionally, the requirement for a skilled surgical team to be present at the patient cart limits the widespread promotion of telesurgery (23).

Conclusions

The multi-console robotic system plays a crucial role in ensuring surgical safety, facilitating complex surgeries requiring multidisciplinary collaboration, and supporting surgical education. This case demonstrates that the “5G wireless + wired network” model can effectively balance experts’ need to perform telesurgeries under variable conditions and the clinical requirement for minimized latency, offering a feasible solution for current telesurgical scenarios. Future research and development efforts should focus on three key directions: further reducing network latency, improving the stability of robotic systems and network connections to mitigate risks of intraoperative malfunctions, and conducting larger prospective studies to validate these findings. These efforts will further promote the widespread application of remote robotic surgery and optimize its role in addressing the uneven distribution of surgical expertise.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0058/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0058/prf

Funding: The study was funded by the National Key R&D Program of China (No. 2023YFC2413400) and CAMS Innovation Fund for Medical Sciences (No. 2024-I2M-C&T-B-020).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-1-0058/coif). N.L. is an employee of China Mobile Communications Group Co., Ltd. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee(s) and the Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from the patient for the publication of this case report. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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Cite this article as: Ye Z, Ding Y, Xu W, Xie Y, Qin M, Fan J, Cui L, Li N, Qiao X, Fang Y, Ji Z, Yang Y, Dong J. “5G wireless + wired network”-based multi-console robotic telesurgery: adaptability to complex surgical procedures and diverse network infrastructures—a case report. Transl Androl Urol 2026;15(4):140. doi: 10.21037/tau-2026-1-0058

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