Clinical practice guidelines for telesurgery, 2nd Edition

Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.