Is remote live urologic surgery a reality? Evidences from a systematic review of the literature


Introduction and objectives

The possibility of performing remote-surgery has been the goal to achieve, since the early development of the first surgical robotic platforms. This systematic review aims to analyse the state of the art in the field and to provide an overview of the possible growth of this technology.


All English language publications on Telementoring and Telesurgery for minimally invasive urologic procedures were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019).


Our electronic search identified a total of 124 papers in PubMed, Scopus, and Web of Science. Of these, 81 publications were identified for detailed review, which yielded 22 included in the present systematic review. Our results showed that remote surgery has been under-utilised until today, mostly due to the lack of appropriate telecommunication technologies.


Remote live surgery is a growing technology that is catalyzing incremental interest. Despite not being yet reliable today on a regular basis in its most advanced applications, thanks to the advent of novel data-transmission technologies, telepresence might become a critical educational methodology, highly impacting the global healthcare system

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  1. 1.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097

    Article  Google Scholar 

  2. 2.

    Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H (2011) Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxford Centre for Evidence-Based Medicine. Accessed 5 Nov 2019

  3. 3.

    Janetschek G, Bartsch G, Kavoussi LR (1998) Transcontinental interactive laparoscopic telesurgery between the United States and Europe. J Urol 160(4):1413

    CAS  Article  Google Scholar 

  4. 4.

    Bauer JJ, Lee BR, Bishoff JT, Janetschek G, Bunyaratavej P, Kamolpronwijit W, Ratchanon S, O'Kelley S, Cadeddu JA, Micali S (2000) International surgical telementoring using a robotic arm: our experience. Telemed J 6(1):25–31

    Article  Google Scholar 

  5. 5.

    Lee BR, Png DJ, Liew L, Fabrizio M, Li MK, Jarrett JW, Kavoussi LR (2000) Laparoscopic telesurgery between the United States and Singapore. Ann Acad Med Singap 29(5):665–668

    CAS  PubMed  Google Scholar 

  6. 6.

    Micali S, Virgili G, Vannozzi E, Grassi N, Jarrett T, Bauer J, Vespasiani G, Kavoussi L (2000) Feasibility of telementoring between Baltimore (USA) and Rome (Italy): the first five cases. J Endourol 14(6):493–496

    CAS  Article  Google Scholar 

  7. 7.

    Bauer J, Lee BR, Stoianovici D, Bishoff JT, Micali S, Micali F, Kavoussi LR (2001) Remote percutaneous renal access using a new automated telesurgical robotic system. Telemed J E-Health 7(4):341–346

    CAS  Article  Google Scholar 

  8. 8.

    Rassweiler J, Frede T, Seemann O, Stock C, Sentker L (2001) Telesurgical laparoscopic radical prostatectomy—initial experience. Eur Urol 40(1):75–83

    CAS  Article  Google Scholar 

  9. 9.

    Bove P, Stoianovici D, Micali S, Patriciu A, Grassi N, Jarrett TW, Vespasiani G, Kavoussi LR (2003) Is telesurgery a new reality? Our experience with laparoscopic and percutaneous procedures. J Endourol 17(3):137–142

    Article  Google Scholar 

  10. 10.

    Challacombe B, Patriciu A, Glass J, Aron M, Jarrett T, Kim F, Pinto P, Stoianovici D, Smeeton N, Tiptaft R (2005) A randomised controlled trial of human versus telerobotic access to the kidney during percutaneous nephrolithotomy. Comput Aided Surg 10(3):165–171

    Article  Google Scholar 

  11. 11.

    Rodrigues N Jr, Mitre NAI, Lima SVC, Fugita OE, Lopes Lima M, Stoianovici D, Patriciu A, Kavoussi LR (2003) Telementoring between Brazil and the United States: initial experience. J Endourol 17(4):217–220

    Article  Google Scholar 

  12. 12.

    Luke PP, Girvan AR, Al Omar M, Beasley KA, Carson M (2004) Laparoscopic robotic pyeloplasty using the Zeus Telesurgical System. Can J Urol 11(5):2396–2400

    PubMed  Google Scholar 

  13. 13.

    Challacombe B, Kandaswamy R, Dasgupta P, Mamode N (2005) Telementoring facilitates independent hand-assisted laparoscopic living donor nephrectomy. In: Transplantation proceedings. Elsevier

  14. 14.

    Agarwal R, Levinson AW, Allaf M, Makarov DV, Nason A, Su L-M (2007) The RoboConsultant: telementoring and remote presence in the operating room during minimally invasive urologic surgeries using a novel mobile robotic interface. Urology 70(5):970–974

    Article  Google Scholar 

  15. 15.

    Nguan CY, Morady R, Wang C, Harrison D, Browning D, Rayman R, Luke PP (2008) Robotic pyeloplasty using internet protocol and satellite network-based telesurgery. Int J Med Robot 4(1):10–14

    CAS  Article  Google Scholar 

  16. 16.

    Shivji S, Metcalfe P, Khan A, Bratu I (2011) Pediatric surgery telehealth: patient and clinician satisfaction. Pediatr Surg Int 27(5):523–526

    Article  Google Scholar 

  17. 17.

    Anderson SM, Kapp BB, Angell JM, Abd TT, Thompson NJ, Ritenour CWM, Issa MM (2013) Remote monitoring and supervision of urology residents utilizing integrated endourology suites—a prospective study of patients' opinions. J Endourol 27(1):96–100

    Article  Google Scholar 

  18. 18.

    Hinata N, Miyake H, Kurahashi T, Ando M, Furukawa J, Ishimura T, Tanaka K, Fujisawa M (2014) Novel telementoring system for robot-assisted radical prostatectomy: impact on the learning curve. Urology 83(5):1088–1092

    Article  Google Scholar 

  19. 19.

    Safir IJ, Shrewsberry AB, Issa IM, Ogan K, Ritenour CWM, Sullivan J, Issa MM (2015) Impact of remote monitoring and supervision on resident training using new ACGME milestone criteria. Can J Urol 22(5):7959–7964

    PubMed  Google Scholar 

  20. 20.

    Shin DH, Dalag L, Azhar RA, Santomauro M, Satkunasivam R, Metcalfe C, Dunn M, Berger A, Djaladat H, Nguyen M (2015) A novel interface for the telementoring of robotic surgery. BJU Int 116(2):302–308

    Article  Google Scholar 

  21. 21.

    Xu S, Perez M, Yang K, Perrenot C, Felblinger J, Hubert J (2015) Effect of latency training on surgical performance in simulated robotic telesurgery procedures. Int J Med Robot 11(3):290–295

    Article  Google Scholar 

  22. 22.

    Hougen HY, Lobo JM, Corey T, Jones R, Rheuban K, Schenkman NS, Krupski TL (2016) Optimizing and validating the technical infrastructure of a novel tele-cystoscopy system. Int Neurourol J 22(7):397–404

    Google Scholar 

  23. 23.

    Perez M, Xu S, Chauhan S, Tanaka A, Simpson K, AbdulMuhsin H, Smith R (2016) Impact of delay on telesurgical performance: study on the robotic simulator dV-Trainer. Int J Comput Assist Radiol Surg 11(4):581–587

    Article  Google Scholar 

  24. 24.

    Antonelli A, Carrieri G, Porreca A, Veneziano D, Artibani W (2018) Live surgery: is operating at home the way forward? Eur Urol 74(4):403–404

    Article  Google Scholar 

  25. 25.

    World Health Organization (2006) The world health report 2006: working together for health. World Health Organization, Geneva

    Google Scholar 

  26. 26.

    Ciaramella S (2019) Health care orgaizations work to combat the doctor shortage. Chamber Business news

  27. 27.

    Cocci A, Patruno G, Gandaglia G et al (2016) Urology residency training in Italy : results of the first national survey. Eur Urol Focus.

    Article  PubMed  Google Scholar 

  28. 28.

    Carrion DM, RodriguezSocarrás ME, Mantica G et al (2019) Current status of urology surgical training in Europe: an ESRU–ESU–ESUT collaborative study. WJUrol.

    Article  Google Scholar 

  29. 29.

    Veneziano D, Minervini A, Beatty J, Fornara P, Gozen A, Greco F, Langenhuijsen JF, Lunelli L, Overgaauw D, Rassweiler J, Rocco B, Sanchez Salas R, Shariat S, Sweet RM, Simone G, Springer C, Tuccio A, Cleynenbreugel B, Weibl P, Cozzupoli P (2016) Construct, content and face validity of the Camera Handling Trainer (CHT): a new E-blus training task for 30° laparoscope navigation skills. World J Urol.

    Article  PubMed  Google Scholar 

  30. 30.

    Veneziano D, Ploumidis A, Proietti S, Tokas T, Kamphuis G, Tripepi G, Cleynenbreugel B, Gozen A, Breda A, Palou J, Sarica K, Liatsikos E, Ahmed K, Somani BK, on behalf of the European School of Urology training group (2018) Evolution and Uptake of the Endoscopic Stone Treatment Step 1 (EST-s1) protocol: establishment, validation and assessment in a collaboration by the European School of Urology and the Uro-Technology and Urolithiasis Sections. Eur Urol.

    Article  PubMed  Google Scholar 

  31. 31.

    Somani BK, Van Cleynenbreugel B, Gozen A, Palou J, Barmoshe S, Biyani S, Gaya JM, Hellawell G, Pini G, Faba RO, Sanchez Salas R, Macek P, Skolarikos A, Wagner C, Eret V, Haensel S, Siena G, Schmidt M, Klitsch M, Vesely S, Ploumidis A, Proietti S, Kamphuis G, Tokas T, Geraghty R, Veneziano D (2018) The European Urology Residents Education Programme Hands-on Training Format: 4 years of hands-on training improvements from the European School of Urology. Eur Urol Focus.

    Article  PubMed  Google Scholar 

  32. 32.

    Veneziano D, Ploumidis A, Proietti S, Tokas T, Kamphuis G, Tripepi G, Cleynenbreugel B, Gozen A, Breda A, Palou J, Sarica K, Liatsikos E, Ahmed K, Somani BK, ESU Training Group (2019) Validation of the endoscopic stone treatment step 1 (EST-s1): a novel EAU training and assessment tool for basic endoscopic stone treatment skills-a collaborative work by ESU, ESUT and EULIS. World J Urol.

    Article  PubMed  Google Scholar 

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Author information





DV: Manuscript writing, Protocol development. AT: Project development. JGR: Manuscript editing. AD: Manuscript editing. ZO: Manuscript editing. BKS: Manuscript editing. NM: Data collection. GF: Protocol development. GC: Data collection and management.

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Correspondence to Domenico Veneziano.

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Veneziano, D., Tafuri, A., Rivas, J.G. et al. Is remote live urologic surgery a reality? Evidences from a systematic review of the literature. World J Urol 38, 2367–2376 (2020).

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  • Live surgery
  • Telementoring
  • Teleassistance
  • Teletraining
  • Telesurgery
  • Telepresence
  • Remote