Liability in Telesurgery: Navigating Legal, Ethical, and Cross-Border Challenges in the Era of Global Surgical Care

The rapid evolution of telesurgery and advanced telemedicine technologies has expanded access to specialized surgical care while introducing complex legal, ethical, and regulatory challenges. This narrative review examines liability considerations associated with telesurgical practice, with particular attention to cross-border care, professional negligence, product liability, and the interaction between human and technological actors. Beyond legal accountability, the review highlights the central role of bioethical considerations, including patient autonomy, transparency, and equity, and explores how these principles are strained by physical distance, technological mediation, and jurisdictional fragmentation. Issues related to informed consent are examined in depth, particularly the adequacy of disclosure regarding technological risks, system failures, data transmission vulnerabilities, and the distribution of responsibility among clinicians, institutions, and technology providers. By synthesizing international legal frameworks, policy approaches, and ethical analyses, this review underscores recurring structural challenges in existing liability models and identifies areas where current consent practices may be insufficient for telesurgical contexts. The findings aim to inform clinicians, policymakers, and regulators seeking to support ethically sound, legally robust, and patient-centered implementation of telesurgery.