**2. History and current status of telesurgery development**

#### **2.1 History of the development of telesurgery abroad**

As a country with advanced medical care, the United States has conducted early research in the field of telemedicine, and basic research such as teleconsultation in multiple hospitals and televideo medical education has been conducted before entering into formal research on telesurgery. Since the 1990s, telemedicine for surgical procedures has developed rapidly, and a large number of research results have been reported. The first real-time teleconsultation for telesurgery was reported in 1992 in which a standard telephone network was used to transfer pathology slides between surgical procedures and to give real-time pathology diagnosis by a remote pathologist, but only 37% of the 35 cases received diagnostic help due to the limited network technology and medical level at that time [1]. In the same year, Satava et al. used the SRI remote operating system to directly control the movement of the mechanical needle tip to perform part of the operation and developed the famous da Vinci robot based on this operating system [2], which was the beginning of telesurgical robotics and the turning point of telesurgery.

In the 1990s, based on the continuous exploration of telesurgery, some foreign countries have mastered the key of technology in telesurgery, from the initial remote simple operation to the basic formation of telesurgery system, and began to try the real meaning of independent telesurgery. In 2001, the first real telesurgery was completed, namely the famous "Charles Lindbergh surgery" [3]. The patient was a 68-year-old woman with gallbladder stones in Strasbourg, France, and the surgeon was operating 7000 km away in New York, USA. A special dedicated network was applied to transfer signals between the surgeries, and the data transmission was stable during the surgery, with smooth transmission of operational and imaging signals and low network latency maintained. This is a milestone in telesurgery, and it validates the feasibility of telesurgery technology.

#### **2.2 History of telesurgery development in China**

Medical resources in China are unevenly distributed. Highly qualified surgeons and advanced medical equipment are basically distributed in large- and medium-sized cities, while rural and remote areas are significantly lagging behind, and there are obvious geographical differences. Many patients in need of surgery are unable to receive timely and high-quality surgical treatment, which seriously threatens their lives and
