Shanghai, China — After rigorous and sufficient technical justification, animal experiment plus the scientific ethics argumentation, on October 25^th, the world’s first ultra-remote 5G pediatric surgery - robot-assisted laparoscopic bilateral gonadectomy, was jointly completed by 3 institutions spanning a distance of 2000 kilometers, i.e. the National Children’s Medical Center (Shanghai), the Shanghai Jiaotong University School of Medicine Associated Shanghai Children’s Medical Center and its associated Hainan hospital (Sanya Woman and Children’s Hospital). The surgery was done successfully with the assistance of the China-made Toumai^® Four-Arm Laparoscopic Robot (the Toumai^® Robot).

Dr. Jie Sun, Director of the Urology Department of Shanghai Children’s Medical Center, performed the remote operation for the surgery, while the surgical team led by the Chief Physician Xiangyu Zou, Dr. Guoyu Tong and the nursing team led by Jingjing Wang provided on-site collaboration and support. The successful completion of this surgery represents not only the latest outcome of Toumai^® Robot in exploring more remote surgical application scenarios and expanding the application of clinical procedures, but also an important clinical practice of the hospital to conduct research on rare patients and remote surgery. It signifies the rapid development of minimally invasive surgical robot surgery in the hospital and the world’s first breakthrough in minimally invasive diagnosis and treatment with 5G remote technology.

This 7-year-old child was admitted to the Behavioral Development Department of Shanghai Children’s Medical Center Hainan Hospital (Sanya Woman and Children’s Hospital) due to “delayed physical development and learning skills disorders”. A series of examinations found chromosomal abnormalities (46, XY), and PE test revealed female genitalia of the child without any male sexuality. Judging from the mismatch between the child’s chromosomes and the appearance of the external genitalia, as well as various auxiliary examinations, the diagnosis of 46XY and DSD was confirmed, and timely surgery was warranted, or else there was a risk of cancer.

Given the uniqueness of the condition, the hospital specifically convened a multidisciplinary team (MDT) consultation and organized a team of experts from departments of Urology, Endocrinology, Developmental Behavior/Psychology, Pathology, and Social Engineering to jointly discuss cases with the child’s guardians. By taking into account the gender determination willingness and social adaptability of the child and the parents and based on the principle of facilitating the physical and mental growth of the child, as well as maximizing the interests of all parties in the family, the hospital determined that femaleness correction was more reasonable with better prognosis, and therefore decided to perform corresponding correction to the child’s gonads and reproductive tract. To this end, experts developed a detailed treatment plan and invited Director Jie Sun to perform the ultra-remote 5G bilateral gonadectomy assisted by Toumai^® Robot to reduce surgical trauma of the child.

After gonadal dissociation, vascular disconnection and genital tube disconnection, the whole procedure was successfully completed in less than 40 minutes, with almost no visible bleeding. With the technological benefits of low latency master-slave control, high bandwidth network communication, and high stability system architecture design of the Toumai^® Robot, the surgery successfully overcame the impact of various environmental factors such as surges, temperature, and weather on the cross-ocean signal transmission. The whole process experienced no signal lagging, and the remote operation time difference was controlled at the millisecond level. The real-time communication was delivered between the treating surgeon and the on-site support surgical team. After surgery, no obvious discomfort was observed, and the child would continue to receive hormone regulation and psychological counseling in various outpatient departments, and if necessary, behavioral rehabilitation treatment could be provided.

Director Jie Sun said that the application of surgical robot technology in clinical surgery may eliminate doctors’ hand shaking, increase surgical accuracy and stability, improve surgical efficiency, reduce surgical risks, and improve surgical efficacy. Especially in minimally invasive surgery that requires precise manipulation, the effectiveness of surgical robot is even more prominent, with only 5ml of bleeding in the child during the surgery, that’s almost no blood loss.

Moreover, Director Jie Sun also pointed out that the “high bandwidth” of Toumai^® Robot’s 5G surgical technology allowed high-definition 3D images to be presented in a timely manner, and the “low latency” ensured hand-eye coordination during operation. During the surgical process, the rotatable wrist surgical instrument presented high sensitivity with accurate control, dissociation, and removal, which was highly helpful for the surgeons with an experience better than traditional techniques. In contrast to traditional surgery, the surgeons may eliminate many daily influencing factors and focus on completing the sophisticated surgical operation. The use of remote surgery prevented the patient or the surgeon from long-distance travel, and to some extent, reduced the burden on both the patient and the surgeon.

This 5G remote robot surgery is a successful practice of Shanghai Children’s Medical Center to continuously explore the 5G telesurgery as it focuses on the functional positioning of becoming the National Medical Center and the High-Ranking Hospital at the Provincial Level. It solves the problem of uneven regional distribution of medical resources through digital technology, allowing patients to access more convenient, more accurate, and safer smart medical services, while it further plays a leading role in the pilot trial of domestic state-of-art medical equipment, continuously exploring and innovating in smart medicine, and expanding the application boundaries of remote diagnosis and treatment.

Dr. Li Hong, Vice President of Shanghai Children’s Medical Center, stated that the clinical application of surgical robots has become an important technological trend in modern medicine. Besides China-made laparoscopic surgical robot, the Center would introduce orthopedic robots and ultrasound robots to accelerate spreading of the “national quality” medical resources down across the grassroot through telesurgery.

Dr. Zhaohui Lu, President of Shanghai Children’s Medical Center, stated that after the successful completion of this remote surgery, he was looking forward to the new normal of 5G+ diagnosis and treatment in the field of pediatrics, gynecology, and obstetrics, allowing Hainan people to conveniently access the equal Shanghai medical services by eliminating the physical distance between Shanghai and Hainan through 5G technology.

Mr. Yu Liu, Executive Vice President and Chief Commercial Officer of the MicroPort^® MedBot^®, stated that it was an honor for Toumai^® Robot to be able to assist Director Jie Sun in relieving the pain of the child by his skillful operation, finding the child’s gender identity and relieving the child’s family of the trouble. As the representative of the domestic surgical robot companies, MicroPort^® MedBot^® is currently in possession of the richest 5G ultra-remote surgical practice experience worldwide, having completed over 50 cases of remote surgeries and experiment in urology, general surgery, thoracic surgery, and gynecology, covering a maximum surgical distance of over 5,000 kilometers and setting several global first records, including radical prostatectomy, radical nephrectomy, adrenalectomy, radical resection of bladder cancer, hepatectomy, resection of pancreatic tail tumor with spleen preserved, radical gastrectomy, hysterectomy, lobectomy, animal surgery experiments and other highly difficult and complex operations. In addition, Toumai® Robot also completed the world’s first plateau 5G remote laparoscopic robot surgery experiment in Tibet. In the future, we will continue our cooperation with top domestic hospitals in further exploration of the 5G remote surgery application scenarios, driving forward the medical technology innovation and progress to improve medical quality and benefit more patients.