Objective: To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and nontechnical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery. Background: It has now been over 2 decades since the first successful case of telesurgery and since this time, there have been significant technological and telecommunications advancements. Methods: A systematic review of the literature was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Details of the protocol for this systematic review were registered on PROSPERO (CRD42024511530). Results: In total, 102 unique references were allocated into 5 categories: technical, cybersecurity, ethical, financial, and regulatory considerations to discuss key themes. The vast majority of references were related to technical considerations, which have demonstrated the feasibility of telesurgery. The nontechnical considerations have a paucity of literature and a lack of guidance on telesurgery which appears to still be the major barriers to telesurgery. Conclusions: Telesurgery presents many interdisciplinary challenges, encompassing both important technical and nontechnical (such as cybersecurity, ethical, financial, and regulatory) considerations. Further research, collaboration between stakeholders, a collaborative community of experts, and the development of comprehensive consensus frameworks are essential steps toward the widespread adoption of telesurgery.

Introduction: In the last two decades, several Da Vinci robotic platforms have been released in the market, revolutionizing the field of robotic-assisted surgery (¹, ²). The system has seen numerous modifications, with several Da Vinci® robotic models being introduced, each featuring ongoing technological advancements in ergonomics, instrumentation, high-definition imaging, EndoWrist™ technology, and single-port surgery capabilities (³, ⁴). Building on this, the new generation Da Vinci 5 robot promises significant hardware and software improvements, with the potential for enhanced operative performance (², ⁵). In this video, we will illustrate several technical advancements of the Da Vinci 5.

Background: The growing prevalence of obesity, particularly morbid obesity (BMI > 40 kg/m²), presents unique challenges in surgical management. In robotic-assisted radical prostatectomy (RARP) for prostate cancer, morbid obesity is associated with longer operative times, increased blood loss, and complex nerve-sparing procedures. These challenges may impact functional and oncological outcomes, making it essential to understand how high BMI affects RARP results. However, data on outcomes for patients with morbid obesity remain limited. Methods: We retrospectively reviewed 14,444 patients who underwent RARP by a single surgeon from 2008 to 2023. A total of 183 patients with morbid obesity (BMI > 40 kg/m²) were matched 1:1 with 183 normal-weight patients (BMI 18.5–24.9 kg/m²) using propensity-score matching based on age, PSA levels, clinical staging, ISUP grade, comorbidities, and baseline urinary and sexual function scores. We compared perioperative variables, complications, and oncological and functional outcomes between groups. Results: Patients with morbid obesity had longer console times (median 90 vs. 75 min, p < 0.001) and higher rates of estimated blood loss over 100 mL (39% vs. 22%, p = 0.001). Full nerve-sparing was less frequent in this group (16.9% vs. 38.8%, p < 0.001), and postoperative lymphocele formation rates were higher (12.7% vs. 6.0%, p = 0.021). While patients with morbid obesity demonstrated a higher incidence of pT3a disease (34.4% vs. 20.2%, p = 0.015), no significant differences were observed in BCR and PSM (24% vs. 18%, p = 0.25) or functional outcomes, such as potency and urinary continence, at 12 and 24 months after operation. Conclusions: RARP in patients with morbid obesity is safe and feasible, with low rates of complications and no observed differences in functional and oncological outcomes compared to normal-weight patients. Further studies are needed to assess long-term outcomes in this growing patient population.