The legal and ethical considerations in cross-border telesurgical procedures

Abstract

Telesurgery, or remote surgery, represents a transformative fusion of medicine and technology, enabling surgeons to perform procedures on patients located miles away using robotic systems and advanced telecommunications. However, its widespread adoption remains limited, with fewer than 50 documented fully remote telesurgical procedures in the past two decades. While robotic-assisted surgery is increasingly common - accounting for over 1.2 million procedures in 2019 - true cross-border telesurgery is rare due to technological, legal, and ethical barriers. The lack of a unified regulatory framework presents jurisdiction, licensing, liability, and data security challenges, particularly when procedures span international borders. The absence of standardized legal mechanisms creates uncertainty, especially in surgical complications or malpractice claims. A global regulatory framework should address these challenges, incorporating mutual recognition of medical licenses, standardized liability agreements, and uniform data protection protocols aligned with General Data Protection Regulation and Health Insurance Portability and Accountability Act. Additionally, real-time 5G-enabled monitoring systems could mitigate latency issues, reducing the risk of surgical errors due to connectivity disruptions. Ethically, telesurgery raises concerns regarding informed consent, equitable access, and accountability. Language barriers, differing cultural attitudes toward robotic surgery, and disparities in healthcare infrastructure complicate ethical oversight. Establishing an international telesurgical ethics board could ensure adherence to standardized consent procedures and promote equitable access through global partnerships. Investment in telesurgical training programs and AI-driven risk mitigation strategies could enhance patient safety. While technological advancements will continue to drive telesurgery's growth, addressing these legal and ethical considerations through harmonized global regulations and strategic policy interventions is crucial for sustainable and equitable integration into modern healthcare.

Keywords: 5G networks; artificial intelligence; cross-border healthcare; robotic surgery; telesurgery.

Figure 1.

Major hurdles in cross-border telesurgery and their interconnected legal and ethical challenges. Our flowchart outlines the major hurdles in cross-border telesurgery and the interconnected legal and ethical challenges – source: Authors’ creations.

Figure 2.

Illustration of a cross-border telesurgical setup. The surgeon operates remotely using a console, while the patient undergoes surgery via robotic arms. The system is connected through a high-speed 5G wired network (1200 km). Control signals: Commands from the surgeon are transmitted to the robotic arms. Real-time video feed: The surgeon’s screen displays live visuals from the patient’s body. Data transmission: Continuous exchange of information ensures precision and responsiveness – source: https://www.fightingprostatecancer.org/blog/2024/2/12/pr35oyplc56su0k7gpl1xm5jkq92oj.