We never went back to the Moon. I wrote this sentence on November 10, 2020, in a page in this web entitled “A Little Bit of History“, on the history of surgical robotics. Of course, right now, and back since 1969, that statement is no longer entirely true. NASA’s Artemis program is taking humans back to the Moon, driven by new scientific, technological and geopolitical objectives. But the original message still stands: a technology can be technically feasible without becoming clinically or commercially relevant.
Tele-surgery was what prompted me to write the sentence. More than twenty years have passed since the Lindbergh Operation in 2001, when Prof. Jacques Marescaux performed the first transatlantic robotic surgery between New York and Strasbourg with the Zeus robot. The procedure required a dedicated fiber-optic connection and achieved an impressive communication latency of around 155 ms, demonstrating that remote robotic surgery was technically possible (back in 2001, no smartphones, no social media, no cloud services and no 5G networks, Google was 3 years-old). The Lindbergh operation was estimated to have cost over US$1 million in telecommunications alone, largely because it required a dedicated ATM fiber connection. It was a remarkable proof of concept, but economically impractical for routine clinical use. The fact is that tele-surgery was abandoned.
Fast forward to today, and Toumai® (MicroPort MedBot) has made tele-surgery one of its major strategic priorities. In just the last two years we have seen an extraordinary number of milestones (Spanish bias, sorry):
- Spain’s first robotic telesurgery between two HM Group Hospitals in Madrid*.
- Europe’s first 5G-enabled telesurgery in general surgery.
- Spain’s first cross-border telesurgery, with the surgeon operating from Belgium.
- A world-record intercontinental procedure between Shanghai and Casablanca (over 12,000 km).
- The first telesurgery using the Starlink low-Earth-orbit satellite network (June 8, 2026), with a one-way latency of approximately 60 ms.
- Routine clinical telesurgery programs now expanding in Brazil and other countries.
And compare the technical details:
So, the question remains: Is telesurgery truly useful?
Today, a remote procedure still requires an experienced surgical team physically present with the patient. The local team must position the patient, place the trocars, manage unexpected events, and, if communication fails, immediately take over. In other words, the technology extends the surgeon’s hands, but not the entire operating room. From my perspective, the greatest value of telesurgery today is probably not routine surgery. Rather, it lies in elite surgery, where a patient wishes to be operated on by a specific expert without travelling, or where an internationally recognized surgeon can assist another team during particularly complex cases.
Beyond that, telesurgery has undeniable value as a technological benchmark. Every successful remote operation validates advances in robotics, communication networks, cybersecurity, and system reliability. It is a proof of what is technically possible.
One of the original motivations behind NASA’s investment in telemedicine and robotic surgery was the possibility of treating astronauts during long-duration space missions. As distances increase (from Earth to the Moon, Mars, or beyond) communication delays become too long for real-time telesurgery. Under those conditions, another solution will be required.
Have you seen the new OTTAVA™ concept? A surgical table with robotic arms integrated into it. Robotic platforms are becoming more intelligent, more integrated, and they are increasingly learning to perform tasks with less direct human control. For me, telesurgery is not the destination. It is a demonstration of the technologies that will eventually make autonomous surgery possible, because surgical autonomy is inevitable.
Technology keeps moving forward. So does surgical robotics.
J Granell. Aug 2, 2026
* You may reasonably ask why the patient was not simply operated on at the other hospital. That is a fair question. The real significance of these procedures, however, lies not in that individual case, but in demonstrating a future model of care. Under the leadership of Dr. Juan Abarca Cidón, HM Hospitales has placed Spain at the forefront of clinical telesurgery in Europe, exploring how connected surgical networks may one day allow expertise—not surgeons—to travel. I believe that is the true value of these pioneering experiences.