What happens when the network fails? A response to telesurgery recommendations and a proposal for a new class of intraoperative complications in telesurgery.

This Letter to the Editor responds to the recent publication by Patel et al. (J Robot Surg. Jul 11;19(1):370, 2025), which outlines a framework and recommendations for telesurgery. Their work identifies the most suitable network connections and the need for redundancy systems to reduce network failures, while also prompting further reflections on additional implications. In particular, it led us to consider the exclusive challenges of telesurgery, which we identified primarily in a new category of complications related to network connectivity, alongside the well-established clinical and technical complications of traditional and robotic surgery. This correspondence further emphasizes the ongoing transformation of surgery from a direct interaction between surgeon and patient to a coordinated team-based practice involving assistants, machines, and technical specialists. By addressing these emerging challenges, this commentary highlights the necessity of re-evaluating safety assumptions in telesurgical practice.