Marco Montesi, Marcio Covas Moschovas, Shady Saikali, Yu Ozawa, Nicoletta Testori, Rohan Sharma, Saleh Bubishate, Travis Rogers, Maria C Sighinolfi, Bernardo Rocco, Vipul R Patel
Teleassisted preceptoring is technically feasible and may enhance surgical training. Its limited clinical adoption appears to be driven primarily by ethical, regulatory, economic, and credentialing barriers rather than technological constraints. Well-designed clinical trials, standardized training frameworks, and international regulatory models are needed to support broader implementation and evaluate its impact on surgical education and patient care.
BACKGROUND AND OBJECTIVE: Telesurgery has advanced with improvements in robotic platforms and communication technologies. While full telesurgery has demonstrated technical feasibility, the use of telesurgical systems to enhance telepreceptoring, particularly through teleassistance, remains limited in clinical practice. A systematic synthesis of the existing evidence is needed to clarify its feasibility, limitations, and potential role in surgical training.
METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. MEDLINE and Scopus were searched through November 12, 2025, using predefined keywords related to teleproctoring, telepreceptoring, teleassistance, and telesurgery. Studies were included if they described teleassisted telepreceptoring, defined as remote surgical supervision with optional, reversible operative control, and reported technical, safety, surgical, or training-related outcomes.
RESULTS: Four studies met the inclusion criteria, two human clinical series and two animal (porcine) experimental studies. The human clinical series demonstrated that remote experts could provide meaningful operative assistance with low complication rates and successful task completion. The animal experimental studies showed that teleassisted supervision remained reliable at communication delays below 150 ms, while higher latency impaired guidance and emergency response. Modern robotic platforms enabled rapid console switching and shared control, supporting the technical feasibility of teleassistance. However, structured clinical programs implementing this model in humans remain absent.
CONCLUSIONS: Teleassisted preceptoring is technically feasible and may enhance surgical training. Its limited clinical adoption appears to be driven primarily by ethical, regulatory, economic, and credentialing barriers rather than technological constraints. Well-designed clinical trials, standardized training frameworks, and international regulatory models are needed to support broader implementation and evaluate its impact on surgical education and patient care.