Early clinical experience with the Toumai robotic system in general surgery: a systematic review of short-term outcomes and telesurgical applications

The Toumai Surgical Robot System is an emerging robotic platform with potential advantages related to cost and native telesurgical capability. This systematic review evaluated the early clinical experience with the Toumai system in general surgery, focusing on procedural characteristics, perioperative outcomes, and 5G remote applications. A PRISMA-compliant systematic review was conducted. MEDLINE/PubMed, EMBASE, the Cochrane Library, and Web of Science were searched through March 2026. Studies reporting general surgical procedures performed with the Toumai system and postoperative outcomes were included. Purely urological or gynaecological series, conference abstracts, narrative reviews, and preclinical studies were excluded. Risk of bias was assessed using ROBINS-I. Eight studies were included: four retrospective cohorts, three prospective clinical trials, and one case report. All were conducted in China and comprised 416 patients, of whom 329 were treated with a confirmed Toumai system; 87 patients came from a mixed-platform HPB cohort and were considered supportive, platform-non-specific evidence. Procedures included HPB surgery, gastric surgery, cholecystectomy, inguinal hernia repair, colorectal surgery, and one vascular resection. Conversions were infrequent, blood loss was low, and complications were predominantly Clavien–Dindo I–II, with no procedure-related mortality. One propensity-score-matched study found no significant short-term differences between Toumai and da Vinci Xi radical gastrectomy. Two prospective studies demonstrated 5G remote surgery for radical gastrectomy over 15 km and cholecystectomy over 70 km. On ROBINS-I assessment, most included studies were judged to be at moderate risk of bias. Early evidence suggests that the Toumai system is feasible and safe in the short term across selected general surgical procedures, with distinctive 5G telesurgical capability. Comparative effectiveness, generalisability, and cost-effectiveness remain unproven. Study Registration: A review protocol was registered in PROSPERO (CRD420261428858).