Alexandre Mottrie

Pioneering telesurgery in gynecology: the first European case of total hysterectomy

Abstract This report describes the first European clinical case of robot-assisted telesurgery in gynecology using the Toumai® Endoscopic Surgery System. A 34-year-old woman with recurrent cervical glandular intraepithelial neoplasia underwent a total hysterectomy with bilateral salpingectomy. The procedure was performed remotely between two institutions in Belgium, approximately 20 km apart. The remote surgeon operated from a dedicated console, while the patient and the surgical team were on site. The operation was completed successfully without intraoperative complications or conversion. Total operative time was 74 min, with a console time of 47 min. The mean latency was 20 ms with a jitter < 10 ms, with high image quality and no connection issues. Postoperative recovery was uneventful, and the patient was discharged on day 2. At the 18-day follow-up, no complications were observed. Subjective feedback highlighted a high level of satisfaction among the patient and surgical staff, with the remote surgeon reporting a slightly reduced sense of control, mitigated by the on-site stand-by surgeon. Poor audio quality was noted as a minor issue. This first experience confirms that telesurgery in gynecology is technically feasible and safe, even using a standard network connection. Although further improvements and larger studies are needed, this experience supports telesurgery as a promising tool to expand access to expert surgical care.