Telesurgery: a lever for equity in access to healthcare worldwide

Editorial

Professor Jacques Marescaux

Interview of the month

Telesurgery: a lever for equity in access to healthcare worldwide

Professor Jacques Marescaux
President and Founder of IRCAD

Professor Marescaux, you are the pioneer of telesurgery. Could you tell us about its evolution since the first remote operation in the world (the Lindbergh Operation), which you and your IRCAD team performed between New York and Strasbourg in September 2001?

Pr. Jacques Marescaux : That first remote operation received wide media coverage but was not immediately followed by real development. Telesurgery remained limited to pilot projects and remote training experiences. The robots were not advanced enough and, above all, communication infrastructures were not stable enough to guarantee latency-free transmission, while communication costs were exorbitant. For example, it cost one million dollars to lease a high-speed intercontinental fiber optic cable for six months.

From 2010 onwards, with the rise of robot-assisted surgery, telementoring and “dual-console” procedures (two surgeons operating together from different locations) began to gain ground. But the real technological acceleration only came after 2020, when the COVID-19 pandemic triggered global reflection on telemedicine, including telesurgery. Investments in telecommunications infrastructure led to the development of ultra-stable 5G and fiber optic networks, as well as reinforced cybersecurity systems.

The year 2025 marks a true global turning point in the history of telesurgery. The annual Congress of the Society of Robotic Surgery (SRS), which we hosted at IRCAD France in Strasbourg this July, established that telesurgery is now a mature technology, clinically proven and ready to transform healthcare systems. In particular, eight telesurgeries were successfully carried out live in just four days, connecting IRCAD France to hospitals in China, India, Japan, and Kazakhstan, and even including a world first in remote cardiac surgery performed by the IRCAD India team.

This series of operations demonstrates the robustness of new digital infrastructures (dedicated fiber optics, 5G, and secure U.S., Japanese, Chinese, and Indian connections), which provide telesurgery with the highest possible levels of safety and precision. All these procedures were performed with unprecedented technical fluidity thanks to next-generation surgical robots and growing compatibility between different robotic surgery systems. In 2001, it took us six years of preparation to perform a single telesurgery. In 2025, we were able to carry out eight telesurgeries in a single week—geographical barriers have vanished.

You mention the potential of telesurgery to transform healthcare systems. What are your perspectives on this topic?

Pr. J.M.: Today, millions of patients around the world live hundreds or even thousands of kilometers away from the facilities that could provide the treatment they need. Inequalities in access to care are glaring. Telesurgery can serve as a true lever for equity in healthcare, bringing surgical expertise remotely to patients in regions where human and material resources are insufficient.

The management of ischemic stroke is a striking example of the role telesurgery could play in improving equity of access. Currently, less than 3% of patients worldwide receive the appropriate treatment—the surgical removal of the clot (thrombectomy)—within the required two-hour window. The challenge is enormous, as every minute without intervention destroys nearly 2 million neurons, meaning that treatment delays directly determine a patient’s chances of survival and recovery without neurological disability.

In areas lacking neurosurgeons, clot removal could be performed as an emergency procedure using a robot installed in the local hospital, operated remotely by an expert surgeon.

It is with this vision of vital emergency care that I have engaged IRCAD in a project dedicated to stroke treatment, in collaboration with XCath, a young American company that will soon establish itself at the institute in Strasbourg. XCath develops robotic systems for performing high-precision remote interventions on cerebral and cardiovascular vessels. The aim is for a neurosurgeon, located far from the patient, to remove the clot in real time by remotely guiding micro-robotic instruments through the brain, using extremely precise control interfaces and a high-speed connection linking the two sites.

This model of neurological emergency care could rapidly evolve into a “control tower” structure, in which a team of expert neurosurgeons would be on call to supervise remotely performed procedures across hospitals located in regions with a shortage of specialists (sparsely populated areas, emerging countries, etc.).

This project fits into a broader vision driven by IRCAD: to open up and standardize access to critical care worldwide by equipping local “satellite” hospitals with robotic systems connected to international centers of excellence. Such a model could become one of the pillars of a future global robotic healthcare platform.

How do you envision the large-scale implementation of telesurgery? Have you identified any potential obstacles that still need to be overcome, and if so, what solutions would you propose?

Pr. J.M.:

From a technological standpoint, telesurgery is indeed ready for large-scale deployment, with robotic solutions and communication systems now well adapted. However, everything still needs to be built in terms of governance, and three main obstacles remain from a regulatory, legal, and financial perspective.

• On the regulatory side, each country has its own rules regarding licensing, approval of medical devices, and certification of healthcare facilities. At present, there is no international framework allowing a surgeon licensed in their home country to operate remotely on a patient located in another country. Solutions could include the creation of a “cross-border medical visa” for surgeons performing remote operations. For locally implemented satellite centers, certification could be established according to internationally recognized standards, for example under the aegis of the World Health Organization (WHO). One could also imagine bilateral or multilateral agreements between countries or groups of countries (such as the EU and Brazil) through specific conventions.
• From a legal standpoint, the notion of medical liability still needs to be clarified between the local surgeon, who introduces the instruments into the patient’s body, and the remote surgeon, who controls them. One possible solution would be to establish a shared responsibility protocol: the local surgeon would be responsible for instrument placement and the operating environment, while the remote surgeon would be accountable for the surgical maneuvers performed. This protocol could be paired with the patient’s informed consent, which would clearly define the roles of both teams.
• Finally, the financial model remains to be designed. Today, telesurgery demonstrations are offered free of charge by surgeons and robotics companies, but this is not sustainable. It is essential to compensate the remote surgeon and the local team, cover the cost of robotic equipment and its maintenance, as well as telecommunications expenses. One option, the “Expert Surgeon” model, would treat the remote surgeon as an external service provider, billing the local hospital or the health insurer (public or private), who would also cover the costs of robotic systems and telecommunications. Another option, a “Turnkey Platform” model, would view the expert surgeon’s home institution as the external provider, billing the local hospital or insurer for a comprehensive package that might include the remote procedure, robotic equipment, and connectivity.

Addressing these regulatory, legal, and financial hurdles will clearly take time. Yet time is precisely what is lacking in certain parts of the world, where telesurgery may be the only way to introduce a measure of healthcare equity. This is why action must begin now. In this spirit, the WHO’s Director of Innovation announced during the 2025 SRS Congress the launch of a global initiative, jointly led by WHO, IRCAD, and SRS.

This humanitarian, non-profit partnership focuses on deploying telesurgery in developing countries, where surgeons are scarce and distances immense.

The aim is to create remote surgery networks within selected local hospitals by training their teams, facilitating the installation of surgical robots, and coordinating regular telesurgical missions (two to three days per year per expert surgeon).

IRCAD will play a key role by providing initial and ongoing training to local teams through its network of nine centers worldwide.

This unprecedented WHO–SRS–IRCAD alliance perfectly illustrates IRCAD’s mission: to make cutting-edge technologies accessible in underserved regions, helping to foster the emergence of a more equitable, connected, and universal medicine.

About IRCAD:

Founded in 1994 by Professor Jacques Marescaux, IRCAD is an institute dedicated to training and research in minimally invasive surgery. The Strasbourg-based institute is an internationally renowned center, recognized for the excellence of its training programs—both onsite, with nearly 8,800 surgeons from around the world trained each year in Strasbourg, and online, through Websurg, a completely free e-university with more than 470,000 members worldwide.

More information here https://www.ircad.fr/fr/

We hope you enjoyed this 20th edition of the IRCAD newsletter.
For any request for information, subscription, or unsubscription:

FINN Partners – sante@finnpartners.com