Doctor and patient 50 kilometers apart: Xinhua Hospital completes remote robotic prostate cancer surgery and promotes routine practice

As large hospitals adopt multi-campus models, technology is empowering doctors and patients to bridge physical distances. On October 29, in an operating room at the Fengxian campus of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, a robot-assisted radical prostatectomy was underway. At the operating table was a newly configured laparoscopic surgical robot, and lying on the table was an elderly male patient diagnosed with prostate cancer. The lead surgeon was not on site; at that moment, Professor Cui Xingang, director of the Department of Urology and discipline leader at Xinhua Hospital, was sitting at a console at the Yangpu campus of Xinhua Hospital 50 kilometers away, remotely controlling the robotic arms to complete the surgery. At the Yangpu campus, Cui Xingang pressed his eyes close to the eyepieces and operated the master control handles with both hands; the subtle movements of his wrists and fingers were captured in real time by the system and translated into precise operations at the ends of the robotic arms. Directors Gan Sishun and Chu Jian of the Department of Urology collaborated at his side, jointly keeping a close watch on the 3D view and the surgical field images. A large screen to one side of the console was split into two feeds: one showing the panoramic view of the operating room at the Fengxian campus, and the other showing a magnified, stereoscopic intraoperative view of the surgical field. As the doctor's hand movements swung, the remote robotic arms sequentially completed dissection, ligation and anastomosis inside the patient's body. "The patient's home is in Fengxian; in the past, to see us for treatment, he had to cross most of Shanghai to get to Yangpu," Cui Xingang said. This patient had sought care for progressive difficulty urinating accompanied by gross hematuria, was diagnosed with prostate cancer by biopsy, and had clear indications for robotic surgery. Previously, such patients either had to travel dozens of kilometers to the Yangpu campus to undergo robot-assisted radical prostatectomy, or could only receive traditional laparoscopic surgery in Fengxian. What made this surgery special was the "reversal" of the remote direction. Previously, although the Fengxian campus was equipped with a robotic surgeon console, the bedside robotic arm system had not yet been deployed there, and most remote surgeries between the two campuses were "doctor in Fengxian, patient in Yangpu"—when Cui Xingang went to Fengxian for clinic visits and ward rounds, in order not to delay scheduled surgeries, he would remotely operate the robotic arms on the operating table in Yangpu from the console in Fengxian. Now that the bedside robotic arm system has been deployed in Fengxian, for the first time a doctor was stationed in Yangpu while the patient underwent surgery in Fengxian, and the Fengxian campus thus gained the capacity to receive and perform robotic surgery. In the operating room at the Fengxian campus, head nurse Xu Xiao led the nursing team in completing a full-process rehearsal in advance, implementing item by item the patient positioning, establishment of the sterile barrier, docking of the robotic arms, and preparation of emergency drugs and instruments. The first assistant doctor and the circulating nurse worked around the bedside robotic arm system, responsible for camera docking, instrument replacement, exposure of the surgical field, and monitoring of the airway and vital signs. Two-way high-definition audio and video, real-time images of the surgical field, and patient anesthesia and monitoring data were transmitted between the two campuses through a dedicated encrypted channel with millisecond-level latency, and the teams at both ends operated in sync accordingly. This was not the first remote robotic surgery conducted between the two campuses of Xinhua Hospital. As the first hospital in Shanghai to explore normalized remote surgery across multiple campuses of a single hospital, Xinhua Hospital has incorporated cross-campus robotic surgery into its daily scheduling rather than treating it as an occasional demonstration. This time, from docking of the robotic arms to completion of the vesicourethral anastomosis, the entire surgery lasted 76 minutes, with intraoperative blood loss of about 30 milliliters. After surgery, the patient quickly regained consciousness in the anesthesia recovery room, was in good spirits, and said he "felt very good." It is reported that the Department of Urology at Xinhua Hospital will continue to deepen the normalized remote surgery mechanism of "one hospital, multiple campuses," enabling experts in Yangpu to remotely perform surgery for patients with prostate cancer and other urological tumors in Fengxian and more distant areas, and to conduct remote robotic surgery training and mentoring for international peers, so that high-quality medical resources can benefit more patients.