Ruben Olivares, MD, discusses remote robot–assisted HIFU for prostate cancer

Urologists from Cleveland Clinic recently collaborated across borders to perform the world’s first remotely conducted robot–assisted high-intensity focused ultrasound (HIFU) focal therapy procedure for prostate cancer.¹

Remote operation for the HIFU procedure was conducted by Ruben Olivares, MD, of Cleveland Clinic’s main campus, who was more than 7000 miles away from the procedure that was performed at Cleveland Clinic Abu Dhabi. In a recent interview with Urology Times, Olivares highlighted several key technological and logistical challenges. A primary concern was establishing trust in the connectivity to ensure no loss in visualization or connection, and no delays that could alter the surgical approach. Patient safety was paramount, necessitating strict patient confidentiality and encrypted information transfer to prevent personal data breaches. Fluid, real-time communication with the remote center was also critical to ensure seamless execution, mirroring an in-clinic procedure.

The extensive planning phase involved testing various connectivity networks, collaborating with cybersecurity teams, and navigating legal and ethical frameworks. Olivares emphasized the importance of having a back-up plan to ensure patient safety, drawing parallels to the early days of robotic surgery where open instruments were kept ready for conversion. For this remote HIFU procedure, a fully capable local team was on standby to take over if needed. Overcoming time zone differences and achieving low latency through cybersecurity efforts and network testing were also significant challenges. Despite the complexities and the historical difficulties of telesurgery, the procedure was a success with no adverse events.

REFERENCE

1. Cleveland Clinic Abu Dhabi performs world’s first robotic-assisted, transcontinental ultrasound focal therapy procedure for prostate cancer. News release. Cleveland Clinic Abu Dhabi. April 16, 2025. Accessed April 17, 2025. https://www.mediaoffice.abudhabi/en/health/cleveland-clinic-abu-dhabi-performs-worlds-first-robotic-assisted-transcontinental-ultrasound-focal-therapy-procedure-for-prostate-cancer/