Innovative design and validation of a multi-link telesurgical robotic system for emergency scenarios in square pod hospitals

Background　Under the complex circumstances of combat trauma, forward medical facilities often lack the necessary equipment, facilities, or space to perform definitive surgical procedures. Extending advanced medical technologies to frontline battlefields and rapidly deploying rear-area specialists' treatment capabilities to forward treatment units constitute crucial approaches for effectively enhancing combat trauma care capabilities while reducing mortality and disability rates caused by battlefield injuries. Objective　To explore the technological breakthroughs and application prospects of remote robot-assisted interactive surgery based on multi-link aggregation transmission system in the surgical team module of the Square Cabin Hospital. Methods　The technical indicators related to the first closed reduction and internal fixation of femoral neck fracture using telerobotic-assisted interactive surgery within the surgical group module of the Cube Hospital on 20 December 2024 were analyzed, including the delay time of telerobotic surgery, surgical pinning time, and bleeding volume. Results　A 51-year-old male patient with fracture of the right femoral neck due to a traumatic injury was operated precisely by frontline military doctors relying on expert tele-guidance, tele-planning and tele-surveillance. The remote center was established at a Medical Center of Chinese PLA General Hospital (network communication distance: 2 652 km), and the surgical procedure was performed via closed reduction and minimally invasive screw fixation for femoral neck fracture. The overall total delay of the surgery was 85 ms, with no packet loss. The expert remote planning took 10 minutes; the robotic system assisted in the insertion of three screws, with an average time of 10 minutes per screw. The intraoperative blood loss was 10 mL, and intraoperative fluoroscopy confirmed satisfactory reduction. The patient did not experience postoperative complications such as incision infection. Conclusion　The first remote robotic-assisted interactive surgery for fracture trauma in mobile cabin hospital settings have been achieved successfully. The system, built on a multi-link aggregation transmission framework, integrates various information systems within the mobile cabin hospital to enable comprehensive diagnosis and treatment of injured personnel, significantly enhancing treatment efficacy.