First-in-human transcontinental telesurgery collaboration for high intensity-focused ultrasound: a new era in globalizing focal treatment for prostate cancer

The advent of telesurgery has opened a new frontier within minimally invasive surgery, allowing surgeons to complete procedures from a remote location and providing new opportunities for the delivery of care. Herein, we present the first clinical experience of telesurgery using high intensity-focused ultrasound (HIFU) for focal treatment of prostate cancer. The procedure was performed using the Focal One^® device (Focal One, Austin, TX, USA) on a 72-year-old with an ISUP Grade Group 2 prostate cancer from a single biopsy core that corresponds to a PIRADS 4 lesion in the left mid-apical region. A secure remote connection was established using the Software-Defined Wide Area Network (SD-WAN) infrastructure between the purpose-built virtual desktop for the console surgeon in Cleveland (OH, USA) and the operating room in Abu Dhabi (United Arab Emirates), spanning a total distance of 11,412 km (7091 miles). A total volume of 26.4 cm³ was ablated within 50 minutes of ablation time. Intraoperative blood loss was minimal, and there was no evidence of perioperative complications. With the total round-trip latency of 115 milliseconds, there remained no perceptible disruptions that were noted during the procedure. Notably, this collaborative effort marked a significant milestone that underscored the safety and feasibility of HIFU telesurgery for the management of localized, clinically significant prostate cancer. This remote surgery model using an already established network infrastructure, offers significant promise for expanding access to specialized, high-quality medical care, particularly in underserved regions.