Remote Telesurgery Versus Local Minimally Invasive Surgery: A Systematic Review of the Comparative Evidence Base.

BACKGROUND: Remote telesurgery allows surgeons to operate over a distance using robotic systems and advanced networks. This review aims to compare remote telesurgery with local minimally invasive surgery (MIS) regarding patient outcomes and system-level outcomes. METHODS: A PRISMA-compliant systematic review (PROSPERO CRD42023474196) searched six databases to 1 August 2025 for studies comparing remote telesurgery with local MIS in living patients. RESULTS: Among 5737 records, one retrospective cohort met the criteria. It compared 5G-enabled remote robotic pelvic fracture surgery (n = 80) with local robotic surgery (n = 80). Remote procedures had lower blood loss (20 vs. 50 mL) and shorter incisions (1.25 vs. 1.5 cm). Operative time did not significantly differ between groups (p = 0.177), and complications, hospital stay, and functional outcomes were similar. CONCLUSIONS: Comparative data on telesurgery remain limited, and healthcare system benefits are unproven. Future studies should incorporate direct comparisons and systematically evaluate system-level outcomes.