Abstract / Summary
To summarize the early clinical experience with the Toumai® robotic system in remote urological surgery and to descriptively synthesize technical success, perioperative outcomes, and network performance, while accounting for the limited and heterogeneous evidence base. PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched from inception to July 1, 2026, for single-arm case series of Toumai®-assisted remote urological procedures. Two reviewers independently screened records and extracted data. Because of the small number of studies and substantial clinical and methodological heterogeneity, only technical success and Clavien-Dindo grade ≥ III complications were pooled using a random-effects model with Freeman-Tukey double arcsine transformation; all other outcomes were summarized descriptively. Heterogeneity was assessed with the I² statistic. Methodological quality was appraised with the Joanna Briggs Institute checklist for case series. The protocol was registered with PROSPERO (CRD420261472912). Six single-arm case series (95 patients; 10-37 per study) were included. Technical success was achieved in all 95 procedures (95/95, 100%), but this estimate may be influenced by possible selective publication or reporting and indication bias. No Clavien-Dindo grade ≥ III complications were reported among the 85 evaluable urological cases; complication data were not separately available for the urological subgroup in one study. Descriptive pooled estimates were 144.83 min (95% CI 109.11-180.56; I² = 93.4%) for operative time, 50.95 mL (95% CI 33.62-68.27; I² = 79.9%) for estimated blood loss, 4.57 days (95% CI 1.82-7.32; I² = 98.3%) for postoperative hospital stay, and 72.82 ms (95% CI 40.13-105.51; I² = 96.8%) for mean latency; these values should not be regarded as procedure-specific or broadly generalizable benchmarks. Console time and warm ischemia time were reported inconsistently and were therefore not pooled. Latency was reported as one-way signal delay in one study and round-trip latency in others; because these parameters are not directly comparable, they were not pooled. Master-slave distance ranged from 25 to 7,000 km, with a general tendency toward increased latency at longer distances. Dual-network redundancy and automatic failover were commonly used and managed reported network events without documented patient harm; however, causality cannot be established, and safety cannot be guaranteed. Mean latency remained within the range associated with acceptable performance in the reported literature, including on the 7,000 km transcontinental route. All procedures were performed by experienced robotic surgeons, limiting generalizability to trainees or less experienced operators. The available evidence suggests that Toumai®-assisted remote urological surgery is technically feasible and associated with preliminary short-term perioperative safety. However, the overall certainty of evidence is low because of the small number of single-arm case series, heterogeneous procedures and network conditions, incomplete subgroup reporting, possible selective publication or reporting, and substantial heterogeneity. Prospective, multicenter studies with standardized definitions of latency, network performance, complications, conversion, and longer-term oncological and functional outcomes are required.