Effectiveness of tele-proctoring in robotic surgery: systematic review of different robotic platforms

Funding Sponsor

Arizona State University

Second Author's Department

Chemistry Department

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https://doi.org/10.1007/s00345-025-05924-7

All Authors

Rehab Meckawy Marwa Saady Mahmoud Meckawy Mohamad Awni Estwani Alaa Din Masri Nouf Khalifeh Marcio Covas Moschovas

Document Type

Research Article

Publication Title

World Journal of Urology

Publication Date

12-1-2025

doi

10.1007/s00345-025-05924-7

Abstract

Purpose: This systematic review evaluates the effectiveness of teleproctoring in robotic surgery across clinical and lab settings by analyzing proctor and trainee performance, proctoring tools, and surgical outcomes. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted on July 24, 2024, targeting peer-reviewed studies on teleproctoring methods in advanced elective robotic surgeries. Included studies involved verbal remote mentoring, telestration, teleconferencing, and ghost surgery tools focused on surgeons. Exclusions applied to laparoscopic, minor, emergency surgeries, non-surgeon trainees, and setups without direct surgical control. From 2,510 screened articles, 11 met inclusion criteria. Quality assessment used an adapted tool combining STROBE, CONSORT, TIDieR, ACROBAT-NRSI, and QATSDD checklists. Results: Of the 11 studies, 8 were from high-income countries (6 USA, 2 Japan) and 1 from Brazil. The da Vinci system predominated (8 studies), with others using AESOP, Japanese pneumatically-driven, and custom platforms. Wired internet showed lower latency (1.4 ms) than wireless (7.4 ms), and high bandwidth improved image quality. Communication redundancy via multiple carriers reduced interruptions. Five live surgery studies (7–120 patients) showed no significant differences between teleproctored and on-site mentoring in operative time, narcotic use, hospital stay, or recovery. Complications were infrequent and manageable. In six lab studies, 3D ghost instruments were rated more effective than 2D telestration despite higher latency. Teleproctoring improved intermediate-difficulty training tasks. Certified proctors and standardized protocols remain inconsistently available globally. Conclusion: Teleproctoring effectively enhances robotic surgery training and patient outcomes by enabling expert mentorship remotely. Reliable technology and standardized protocols are essential for broader adoption, especially in underserved areas. Trial registration: PROSPERO: CRD42024517403

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