{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:16:48Z","timestamp":1788153408351,"version":"build-2803163510"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005639","name":"Universidade De S\u00e3o Paulo","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005639","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Robotic Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Telesurgery may help overcome geographic disparities in access to specialized surgical care. Although recent studies confirm the technical feasibility of robotic thoracic telesurgery, most reports originate from highly controlled settings, and practical implementation within public healthcare systems remains scarce. We describe the development and preliminary clinical application of a robotic thoracic telesurgery program in a middle-income country, reported as a proof-of-implementation case series rather than a statistically validated model. A robotic thoracic telesurgery program was developed connecting the University of S\u00e3o Paulo Medical School (FMUSP) and University Hospital (HU-USP), approximately 10 km apart, using the Toumai\u00ae platform over the institutional fiber-optic network. Development included infrastructure deployment, preclinical network validation (28 robotic surgeons), safety-protocol development, and team training, culminating in two remotely performed procedures under a pre-defined, manufacturer-limited case allocation. A robotic wedge resection for pulmonary metastasis and a robotic left upper trisegmentectomy with systematic lymphadenectomy were completed entirely under remote control, with the surgeon at FMUSP and the patient at HU-USP. Neither procedure had communication interruptions, packet loss, conversion events, or intraoperative complications; maximum latency did not exceed 12 milliseconds. Chest tubes were removed on postoperative day 1 in both patients, with discharge on day 1 and 2, respectively. This early experience supports the technical feasibility of introducing robotic thoracic telesurgery within a public healthcare system through a structured implementation pathway. Given the small sample, conclusions remain preliminary; the model\u2019s value lies not in extending distance, but in outlining a reproducible process for expanding access to specialized surgical expertise.<\/jats:p>","DOI":"10.1007\/s11701-026-03819-2","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:24:49Z","timestamp":1788150289000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation and preliminary clinical application of a robotic thoracic telesurgery program in a middle-income country: a structured pathway from simulation to clinical practice"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8577-8708","authenticated-orcid":false,"given":"Ricardo Mingarini","family":"Terra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0817-8180","authenticated-orcid":false,"given":"Pedro Henrique Xavier Nabuco","family":"de Araujo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0602-0569","authenticated-orcid":false,"given":"Marcos Naoyuki","family":"Samano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9012-854X","authenticated-orcid":false,"given":"Fabio Eiti Nishibe","family":"Minamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1900-8777","authenticated-orcid":false,"given":"Everson Luiz Almeida","family":"Artifon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8293-1508","authenticated-orcid":false,"given":"Jose Pinhata","family":"Otoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7243-5343","authenticated-orcid":false,"given":"Paulo Manuel","family":"Pego-Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"issue":"6854","key":"3819_CR1","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1038\/35096636","volume":"413","author":"J Marescaux","year":"2001","unstructured":"Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK (2001) Transatlantic robot-assisted telesurgery. Nature 413(6854):379\u2013380. https:\/\/doi.org\/10.1038\/35096636. Erratum: Nature 414(6865):710","journal-title":"Nature"},{"issue":"5","key":"3819_CR2","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.21037\/tlcr-2025-16","volume":"14","author":"X Xie","year":"2025","unstructured":"Xie X, Tian Y, Huang J, Luo Q, Chen T (2025) Surgery without distance: will 5G-based robot-assisted telesurgery redefine modern surgery? Transl Lung Cancer Res 14(5):1821\u20131829. https:\/\/doi.org\/10.21037\/tlcr-2025-16","journal-title":"Transl Lung Cancer Res"},{"issue":"12","key":"3819_CR3","doi-asserted-by":"publisher","first-page":"8823","DOI":"10.21037\/jtd-24-1605","volume":"16","author":"Y Tian","year":"2024","unstructured":"Tian Y, Lv H, Jumai A, Tuerhong T, Zhuang L, Huang J, Li J, Lu P, Tao G, Yamauchi Y, Flores RM, Teng H, Chen T, Luo Q (2024) Ultra-remote robot-assisted right upper lobectomy between the Shanghai and Kashi Prefectures: a case report. J Thorac Dis 16(12):8823\u20138830. https:\/\/doi.org\/10.21037\/jtd-24-1605","journal-title":"J Thorac Dis"},{"issue":"Supplement1","key":"3819_CR4","doi-asserted-by":"publisher","first-page":"i36","DOI":"10.1093\/ejcts\/ezaf455","volume":"68","author":"D Gonzalez-Rivas","year":"2026","unstructured":"Gonzalez-Rivas D, Bosinceanu ML, Li C, Hu Y, Zhu X, Zhao J (2026) First transcontinental single-port robotic thoracic surgery. Eur J Cardiothorac Surg 68(Supplement1):i36\u2013i40. https:\/\/doi.org\/10.1093\/ejcts\/ezaf455","journal-title":"Eur J Cardiothorac Surg"},{"issue":"1","key":"3819_CR5","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1007\/s11701-025-02523-x","volume":"19","author":"V Patel","year":"2025","unstructured":"Patel V, Saikali S, Kavoussi L, Leveillee R, Albala D, Parra-Davila E, Rogers T, Ozawa Y, Sharma R, Palmer K, Marquinez J, Orvieto M, Siddiqui A, Marescaux J, Sachdeva A, Oliva R, Coelho RF, Rocco B, Sighinolfi C, Roche M, Martino M, Ross S, Hung A, Forgione A, Abbas G, Zhang X, Aldousari S, Ahallal Y, Alvarenga-Bezerra V, Corder C, Moschovas M (2025) Best practices in telesurgery: framework and recommendations from the Society of Robotic Surgery (SRS) for safe and effective implementation. J Robot Surg 19(1):370. https:\/\/doi.org\/10.1007\/s11701-025-02523-x. Erratum: J Robot Surg 19(1):466. https:\/\/doi.org\/10.1007\/s11701-025-02622-9","journal-title":"J Robot Surg"},{"key":"3819_CR6","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1007\/s00595-026-03295-z","volume":"56","author":"M Mori","year":"2026","unstructured":"Mori M, Hirano S, Hakamada K et al (2026) Clinical practice guidelines for telesurgery, 2nd edition. Surg Today 56:1047\u20131065. https:\/\/doi.org\/10.1007\/s00595-026-03295-z","journal-title":"Surg Today"},{"key":"3819_CR7","doi-asserted-by":"publisher","first-page":"100926","DOI":"10.1016\/j.clinsp.2026.100926","volume":"81","author":"ELA Artifon","year":"2026","unstructured":"Artifon ELA, Kfouri F, Otoch JP, Kowalski LP, Nahas W, Ebaid G, Pego-Fernandes P, Baracat EC, Soares J\u00fanior JM, Ribeiro U Jr, Samano M, Terra R, Nabuco P, Kulcsar MAV, Anjos GD, Motta E, Abdalla RZ, Damous S, Belon A, Cerri GG (2026) Feasibility of robotic telesurgery over wired and private 5G networks within Brazil\u2019s public health system (SUS): a pilot study. 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Di\u00e1rio Oficial da Uni\u00e3o, Bras\u00edlia"}],"container-title":["Journal of Robotic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03819-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11701-026-03819-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11701-026-03819-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:24:50Z","timestamp":1788150290000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11701-026-03819-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3819"],"URL":"https:\/\/doi.org\/10.1007\/s11701-026-03819-2","relation":{},"ISSN":["1863-2491"],"issn-type":[{"value":"1863-2491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"assertion":[{"value":"15 July 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that the Toumai\u00ae robotic platform and associated surgical supplies used in this study were provided by MicroPort\u00ae (Medbot, Shanghai, China) at no cost. The authors have no other relevant financial or non-financial interests to disclose.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of HC-FMUSP (CAAE 94,555,325.3.0000.0076).","order":2,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from both individual participants included in the study.","order":3,"name":"Ethics","label":"Consent to Participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors affirm that human research participants provided informed consent for publication of the clinical data and images described in this article.","order":4,"name":"Ethics","label":"Consent to Publish","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"915"}}