Safety, efficacy and scope of telerobotic surgery with the SS Innovations MantraSync: A case report with workflow and outcomes

BACKGROUND: Telerobotic surgery allows expert surgical care delivery across large distances using robotic systems and high-speed, low-latency networks. However, concerns regarding technical safety, clinical workflow and outcomes - particularly in settings without on-site surgical expertise - limit its global adoption. OBJECTIVE: To evaluate the feasibility, safety, efficacy, workflow and technical requirements of long-distance telerobotic cholecystectomy in India using the indigenous SS Innovations (SSI) MantraSync robotic system and Multiprotocol Label Switching (MPLS)-based dedicated connectivity. PATIENTS AND METHODS: Two female patients underwent an elective telerobotic cholecystectomy with the surgeon located at Gurugram and the patient at Guwahati, separated by ~ 1950 km. A pre-established surgical workflow with a modified surgical safety checklist was followed. A strict contingency protocol, multilayered network security and backup conversion plans were implemented. Technical requirements included a dedicated 40 Mbps MPLS line, ultra-low latency video and control data paths and the RASCOW2 protocol for stable streaming. Perioperative and network parameters were prospectively recorded. RESULTS: Both surgeries were completed successfully without intraoperative complications, conversions or technical failures. Console times were 51 and 30 mins, blood loss was minimal (10-15 mL), Visual Analogue Scale pain score at 24 h was 1-2 and uneventful discharge occurred on day 2. Network transmission latency was 35-40 ms, round-trip latency 250-260 ms, with jitter <10 ms and packet loss <0.1%. All values were within recommended global benchmarks for telerobotic safety (<320 ms round-trip). Functional handover to local control was verified and could be achieved in 2-3 min if needed. CONCLUSION: Telerobotic cholecystectomy using the SSI MantraSync platform and a robust network infrastructure is safe, feasible and effective, with technical and clinical outcomes comparable to in-person robotic surgery. Adherence to multidisciplinary workflow, safety checklists and redundancy protocols is critical. These results support expanded adoption of telerobotic surgery in resource-limited and remote environments, enabling broader access to advanced surgical care.