Remote Robotic Surgery Across 1400 Kilometers by Xijing Hospital

The Medical Dilemma on the Gobi Desert

Jiuquan Satellite Launch Center is a crucial base for China's space industry. Located at the western end of the Hexi Corridor, the area is arid with relatively limited medical resources. When a family member of a base technician was diagnosed with uterine fibroids, they faced a practical choice: travel 1400 kilometers to Xi'an for treatment, or receive care locally?

"The patient's fibroid was 8 cm in diameter with an unusual location, pressing against major blood vessels," Professor Liu Shujuan noted during the preoperative assessment. "Conventional open surgery is highly invasive, while the local hospital's laparoscopic technology is insufficient for such a complex case."

More critically, as the family member of a space industry employee, the patient had long resided in the harsh Gobi environment. A sudden long-distance transfer posed additional health risks. Moreover, the technician's special work duties meant that prolonged absence for caregiving would disrupt crucial research tasks.

5G Technology Builds a Surgical Skyway

To address this challenge, Xijing Hospital and Jiuquan Satellite Launch Center Hospital decided to trial an innovative solution: 5G remote robotic surgery.

The Toumai® single-port surgical robotic system, independently developed in China, was employed for this procedure. Unlike multi-port robots, the single-port system requires only one incision of about 2.5 cm through which all surgical instruments enter the body, resulting in minimal trauma and faster recovery.

However, remote surgery presents three major technical hurdles:

Network latency: signal transmission time across 1400 kilometers.

Operational precision: the robot must accurately replicate the surgeon's movements.

Emergency response: swift contingency mechanisms for unforeseen events.

The technical team implemented a 5G private network plus optical fiber backup solution, reducing end-to-end latency to under 150 milliseconds. Simultaneously, a motion scaling algorithm was integrated (the surgeon moves 1 cm, the robotic arm moves 1 mm), ensuring millimeter-level precision.

Preoperative: Exhaustive Preparation

To guarantee the surgery's success, the two hospitals conducted a full month of preparation.

July 1-7: case data transmission and multidisciplinary consultation. Experts from Xijing Hospital's departments of Gynecology, Anesthesiology and Radiology remotely collaborated with the Jiuquan team via a telemedicine system to analyze the patient's CT and MRI images and formulate a detailed surgical plan.

July 8-15: equipment calibration and network testing. The technical teams performed 12 simulated surgery tests between the two sites, accumulating over 50 hours of testing that covered full-process validation of instrument response, image transmission and voice communication.

July 16-25: personnel training and contingency plans. Six medical staff from Jiuquan Hospital traveled to Xi'an for on-site training. Concurrently, Xijing Hospital dispatched a backup team to Jiuquan in advance to prepare for potential technical failures.

"We formulated a three-tier contingency plan," the director of Xijing Hospital's Medical Administration Department explained. "Tier 1: continue remotely; Tier 2: the Jiuquan backup team takes over; Tier 3: convert to conventional laparoscopic surgery. Fortunately, none of these tiers were ultimately needed."

Intraoperative: Precise Execution

On surgery day, both operating rooms activated simultaneously.

Xi'an control center: Professor Liu Shujuan sat in an ergonomic control chair, observing the surgical field through a glasses-free 3D display. Holding control sticks with her hands and operating auxiliary functions such as electrocautery with foot pedals, while her assistant monitored vital signs data in real time.

Jiuquan operating room: the patient was under anesthesia, with the robotic arms entering the abdominal cavity via the single incision. The local medical team managed patient positioning, instrument exchange and other auxiliary tasks. The anesthesiologist deployed from Xijing Hospital ensured stable patient vital signs.

10:00 surgery commences. Under Professor Liu's control, the robotic arms precisely dissected adhesions surrounding the fibroid. The high-definition images, magnified 10x, revealed even minute blood vessels with clarity.

10:23 critical phase. The fibroid was pressed against a significant blood vessel, requiring extreme caution during dissection. Professor Liu adjusted the operating mode, activating the tremor filtration function, rendering the robotic arm movements even steadier.

10:47 fibroid removal. The intact fibroid was placed into a retrieval bag and removed through the single incision. Intraoperative blood loss was only 30 ml, far below the average 100-200 ml for traditional surgery.

11:15 suturing completed. The robotic arm used barbed suture material for wound closure, achieving even spacing and appropriate tension. The entire surgery lasted 75 minutes.

Postoperative: Rapid Recovery

Thanks to the minimally invasive advantage of single-port robotics, the patient's recovery was markedly accelerated:

2 hours post-op: regained consciousness, able to communicate simply.

6 hours post-op: began oral hydration, performed bed exercises.

24 hours post-op: ambulated, pain score 2 out of 10.

3 days post-op: discharged home.

"Compared to the expected 7-10 day hospitalization for open surgery we feared, she was home in just 3 days," a family member stated. "And there's only one tiny incision, barely noticeable."

Crucially, the patient avoided the 1400-kilometer journey, and family members did not need to take leave for caregiving, minimizing disruption to work and life.

Technological Breakthroughs and Significance

This surgery achieved multiple breakthroughs.

At the technical level: it validated the feasibility of single-port robotic systems for remote surgery; established a standardized protocol for ultra-long-distance (1400 km) 5G surgery; and developed a remote surgery contingency plan system applicable to remote regions.

At the medical level: it demonstrated that complex gynecological surgery can be safely performed remotely; provided a high-quality medical solution for special regions (border areas, bases, remote villages); and formed a replicable model of "expert remote lead plus local team support."

At the societal level: it mitigated the imbalance in distribution of quality medical resources; reduced the time and economic costs of patient care; and provided a new approach to medical security for personnel in special industries (space, national defense, border construction).

Future Outlook

Following this success, Xijing Hospital plans to extend the remote surgery model to more areas:

August 2024: completed the first remote robotic radical prostatectomy.

September 2024: collaborated with a border area hospital in Xinjiang to conduct remote hepatobiliary surgery.

October 2024: initiated the "Western Remote Surgery Collaborative Network," aiming to cover 20 hospitals across five northwestern provinces and regions.

"Our goal is not just to perform a few landmark surgeries," Professor Liu Shujuan expressed. "It's to establish a sustainable, scalable and replicable remote medical system, enabling more patients in remote areas to access top-tier medical services right where they live."

As 5G networks become more pervasive and surgical robotics technology continues to mature, remote surgery is transitioning from "innovative attempt" to "routine option." When technology overcomes geographical barriers, the ideal of medical equity is gradually becoming reality.

On the Gobi Desert, space explorers push the boundaries of the cosmos; in the operating room, medical practitioners expand the possibilities of life. These two seemingly parallel trajectories converge wonderfully under the connectivity of remote surgery technology, both representing humanity's courageous endeavor to transcend its own limits and reach towards ever more distant frontiers.