[Pioneering Application of a Domestically Developed Single-Arm Single-Port Robotic System in Ultra-Remote Telesurgery: A Clinical Report of Two Gynecological Oncology Cases].

Objective: To evaluate the feasibility and safety of a domestically developed, single-arm single-port robotic system for performing complex gynecological surgeries under extreme conditions, such as ultra-remote locations and high-altitude environments. Methods: In November and December 2024, a surgeon on the campus of West China Second Hospital, Sichuan University in Chengdu remotely manipulated a domestically developed single-arm, single-port robotic surgical system via a high-speed, low-latency communication network to perform two telesurgical procedures. The first procedure was a transumbilical single-port robot-assisted laparoscopic total hysterectomy, bilateral salpingectomy, and left ovarian cystectomy on a patient with multiple uterine fibroids at the Maternity and Child Health Hospital of Xizang Autonomous Region (distance between Chengdu and Lhasa > 2000 km and altitude difference >3000 m). The second procedure was a transumbilical single-port robot-assisted laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy on a patient with FIGO stage IA endometrial cancer at Zhujiang Hospital, Southern Medical University in Guangzhou (the distance between Chengdu and Guangzhou > 1500 km). Perioperative data were collected and analyzed. Results: Both procedures were successfully completed without conversion to laparotomy or the use of additional auxiliary ports. The operative times for the Chengdu-Lhasa and Chengdu-Guangzhou surgeries were 90 minutes and 135 minutes, respectively, with estimated blood loss ≤ 50 mL in both cases. The intraoperative bidirectional network latency remained around 40 ms, and the total end-to-end latency was less than 60 ms. The surgeon reported no perceptible delay in instrumental response. Both patients recovered well postoperatively, and no surgery-related complications or disease recurrence were observed during follow-up until July 2025. Conclusion: This study provides preliminary evidence supporting the feasibility and safety of a domestically developed single-arm, single-port robotic system for performing complex gynecological surgeries in ultra-remote and high-altitude settings. This technical approach offers a promising solution to address geographic disparities in access to high-quality medical resources and demonstrates significant potential for improving the availability of advanced minimally invasive surgery in remote areas and regions of special settings.