Surgeon in London Removes Gibraltar Patient’s Prostate by Remote-Controlled Robot in U.K. First

Paul Buxton was already under anesthesia on the Rock of Gibraltar when his surgeon sat down at a console more than 1,500 miles away in central London.

In a darkened control room at The London Clinic off Harley Street, urological surgeon Prokar Dasgupta slipped his hands into a pair of controllers and focused on a 3D screen. On his monitor, Buxton’s prostate appeared magnified and brightly lit. On the operating table in Gibraltar’s St. Bernard’s Hospital, four robotic arms hovered over the 62-year-old’s abdomen, responding in near real time.

“The lag is so small it actually fools my brain into thinking I’m in Gibraltar,” Dasgupta said later.

On Feb. 11, Dasgupta remotely removed Buxton’s cancerous prostate using a Chinese-built Toumai surgical robot connected over high-speed telecom links. A second “official” remote operation on a 52-year-old patient followed on March 4, along with another prostate removal the same day. The London Clinic and Gibraltar Health Authority say the procedures were completed successfully and mark the United Kingdom’s first long-distance robot-assisted telesurgeries.

A 2,400-kilometer operating room

The operations connected a surgeon at The London Clinic’s Robotic Centre of Excellence in Harley Street with the Toumai system installed in the Kusuma Robotic Surgery Suite at St. Bernard’s, Gibraltar’s only acute hospital. The two sites are roughly 2,400 kilometers (about 1,500 miles) apart.

Engineers reported round-trip latency between London and Gibraltar of 48 to 60 milliseconds—less than a tenth of a second—on a dedicated fiber-optic link with 5G backup.

Hospital officials in both locations have described the link as a milestone for British medicine and for the small British Overseas Territory at the mouth of the Mediterranean.

“The distance between London and Gibraltar is approximately 2,400 kilometers, and I am advised that this represents the furthest distance over which remote telesurgery has ever been successfully carried out in Europe,” Gibraltar Health Minister Gemma Arias-Vásquez told local media.

She called the operation “a landmark moment” that would allow residents to access “world-leading specialist care… without the disruption of traveling abroad.”

A patient who volunteered to make history

Buxton, who moved from Burnham-on-Sea in Somerset to Gibraltar almost 40 years ago and runs a transport firm, learned he had prostate cancer shortly after Christmas. He expected to travel to the United Kingdom and join a waiting list for surgery through the National Health Service. Instead, he was offered the chance to become the first patient in a trial of remote robotic surgery jointly run by The London Clinic and the Gibraltar Health Authority.

He agreed immediately.

“For me it was a no-brainer,” Buxton said in an interview.

He said he felt “fantastic” within four days of the procedure and called it “a privilege to be part of medical history.”

How the system works—and how it fails safely

The technology behind the operations is designed to make the distance largely invisible in the operating room. The Toumai system, developed by Shanghai MicroPort MedBot, is a multi-port laparoscopic robot with four articulated arms and a high-definition 3D camera. The surgeon controls the instruments from a console, translating wrist and finger movements into precise motions inside the patient’s body.

For the London–Gibraltar link, U.S.-based technology services company Presidio built a network architecture that routes video and control signals over dedicated high-speed fiber between the two sites, with 5G mobile networks as a backup. Data are encrypted, and engineers say the system includes multiple layers of redundancy.

In Gibraltar, a full surgical team stood by at St. Bernard’s throughout the operations, including local consultant surgeons and anesthetists trained on the robot. If the connection failed or latency exceeded safe limits, they were prepared to take over control of the robot locally or convert to open surgery.

“Remote systems must always be an extension of local capability, not a replacement,” Dasgupta said. “You have to have a team on site that can step in if anything unexpected happens.”

The London Clinic said it became the first hospital in the United Kingdom to successfully carry out remote robot-assisted telesurgery on a patient abroad when Buxton’s operation was completed on Feb. 11. The hospital later characterized that first case as a successful trial ahead of the official March 4 procedure, when another Gibraltar patient in his early 50s underwent a similar operation controlled from London.

Building a robotic surgery program in Gibraltar

For Gibraltar, the operations are part of a broader effort to expand local surgical capacity. In January, the Gibraltar Health Authority launched a robotic-assisted surgery program at St. Bernard’s, describing it as “a major advancement” for patient care.

That program is centered on the Kusuma Robotic Surgery Suite, financed in part by a £500,000 grant from Kusuma Trust Gibraltar, a local philanthropic foundation, and donations from Prostate Cancer Gibraltar.

Before the robotic suite opened, many patients needing complex procedures had to travel to the U.K. or Spain. Officials say the ability to connect virtually with overseas experts could allow more care to be delivered on the Rock while also building skills among local staff.

Remote surgery’s long arc—and what’s new here

Globally, remote surgery is not new. In 2001, a French surgical team performed a laparoscopic gallbladder removal on a patient in Strasbourg while operating from New York using an early robotic system, in a demonstration dubbed “Operation Lindbergh.” Canadian surgeons have carried out long-distance operations over several hundred kilometers, and in recent years transcontinental procedures have linked Europe, North America, Africa and Asia.

In 2025, for example, an Indian surgeon remotely operated a bariatric robot in Indore, India, from Strasbourg, France, and a Florida-based urologist controlled a robot in Angola to perform a prostatectomy. Chinese teams using the Toumai system have also carried out experimental telesurgeries over thousands of kilometers via 5G and satellite links.

What distinguishes the London–Gibraltar cases is not a world record for distance, but their place in European and British practice. They appear to be the longest-distance clinical telesurgeries completed from a U.K. hospital and, according to Gibraltar’s government, the furthest such procedure yet carried out in Europe in routine care rather than a limited trial setting.

Questions of regulation, cybersecurity and trust

The surgeries also bring a Chinese-developed teleoperated surgical platform into high-profile use in a British setting at a time when Western governments are scrutinizing reliance on Chinese technology in critical infrastructure.

Toumai’s “remote” capability received regulatory clearance from China’s National Medical Products Administration in 2025, billed by its manufacturer as the first commercial approval for a remote surgical robot anywhere. In Europe and the U.K., the system is covered under general medical device rules rather than a telesurgery-specific category, and details of any additional cybersecurity or data-handling requirements have not been made public.

In parallel, NHS England has adopted a 10-year plan to expand robotic-assisted surgery in the public system, aiming to increase annual volumes from about 70,000 procedures in 2023–24 to roughly 500,000 by 2035. Long-distance telesurgery is only briefly referenced in public documents, but the model of surgeons in major centers supporting smaller hospitals remotely aligns with the broad direction.

Specialists say there are technical and ethical constraints. Studies have suggested that latencies under 100 to 200 milliseconds are generally acceptable for laparoscopic telesurgery, but the need for reliable, low-lag connections, strong encryption and resilient backup systems introduces new points of failure.

In cross-border operations, questions arise about which jurisdiction’s regulations and malpractice rules apply if something goes wrong, and how informed consent should address cyber risks alongside clinical ones.

Public attitudes are another factor. Some patients, like Buxton, are comfortable becoming early adopters. Others may be uneasy with the idea of a surgeon in another country controlling foreign-built machinery over long-distance networks.

Dasgupta, who was born in India and later became the United Kingdom’s first professor of robotic surgery and urology, has been involved in research on public views of robotics and artificial intelligence in healthcare. He has described the Gibraltar project as an example of “responsible AI,” although the system is fully teleoperated and does not make autonomous decisions.

Next test: live broadcast to a major urology congress

A third remote prostatectomy linking London and Gibraltar is scheduled to be broadcast live to thousands of urologists at the European Association of Urology congress in London on March 14, further testing both the technology and the medical community’s appetite for stretching the operating room across borders.

From his home in Gibraltar, Buxton says it changed how he thinks about care on the Rock.

“Forty years ago, if you wanted something like this, you had to go away,” he said. “Now, the person doing the cutting might be in London, but you wake up in your own hospital, with your family just down the road.”