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This review maps that journey systematically, defining a six-rung Digital Surgical Spectrum \u2014 from passive live broadcast to artificial-intelligence-augmented autonomous surgery \u2014 grounding each stage in published clinical evidence across multiple surgical domains. We demonstrate that each rung of this spectrum is no longer theoretical. Live broadcasts have reached audiences across multiple countries. Tele-proctoring was validated at scale during the COVID-19 pandemic, and tele-mentoring has been shown in systematic review to produce a safety and efficacy profile broadly comparable to on-site supervision. True remote tele-surgery has been accomplished over distances exceeding 8,000\u00a0km with latencies well within established procedure specific safety thresholds. We also present a case timeline and an Institutional Readiness Framework specifying the technical, regulatory, and other prerequisites for each rung, organized visually as a Digital Surgical Spectrum. Importantly, nuances such as the performance paradox of observed surgery, consent frameworks, cybersecurity risk, regulatory fragmentation, and the threat of entrenching rather than correcting global surgical inequity are examined. As the field advances, the growth of tele-surgical technologies will depend on international regulatory harmonization and equity-centered deployment, supported by prospective multi-specialty outcome registries.<\/jats:p>","DOI":"10.1007\/s11701-026-03962-w","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:11:54Z","timestamp":1791864714000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From the operating room to the cloud: the evolving continuum from live surgical broadcasting to remote tele-surgery"],"prefix":"10.1007","volume":"20","author":[{"given":"Priyank","family":"Yadav","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husam H.","family":"Balkhy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan S.","family":"Gundeti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"3962_CR1","unstructured":"Fornell D (2026) Longest-distance robotic cardiac telesurgery ever performed over 12,500 miles. 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The authors received no financial compensation related to this review and have no other competing interests to declare.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1100"}}