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.

This Letter to the Editor responds to the recent publication by Patel et al. (J Robot Surg. Jul 11;19(1):370, 2025), which outlines a framework and recommendations for telesurgery. Their work identifies the most suitable network connections and the need for redundancy systems to reduce network failures, while also prompting further reflections on additional implications. In particular, it led us to consider the exclusive challenges of telesurgery, which we identified primarily in a new category of complications related to network connectivity, alongside the well-established clinical and technical complications of traditional and robotic surgery. This correspondence further emphasizes the ongoing transformation of surgery from a direct interaction between surgeon and patient to a coordinated team-based practice involving assistants, machines, and technical specialists. By addressing these emerging challenges, this commentary highlights the necessity of re-evaluating safety assumptions in telesurgical practice.

Immune checkpoint inhibitors (ICIs) have reshaped melanoma care, yielding durable remissions even in high-risk stages. As survival improves, fertility becomes a key survivorship concern for young women, yet the reproductive safety of ICIs remains insufficiently characterised. We performed a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis synthesizing preclinical and clinical evidence to evaluate the rationale for fertility preservation (FP) prior to checkpoint inhibitor therapy. Preclinical models of PD-1/CTLA-4 blockade demonstrate ovarian immune activation, cytokine release (e.g., TNF-α), and follicular loss. Conversely, human data are limited to correlative analyses suggesting potential declines in ovarian reserve markers. In conclusion, while prospective studies are required to definitively quantify risk, proactive fertility preservation counselling should be routinely offered prior to treatment initiation to safeguard reproductive autonomy without compromising oncologic safety.