To evaluate the clinical application and adaptability of domestic high-end endoscopic systems and associated minimally invasive surgical instruments within a multicenter, multilevel demonstration network, and to analyze the coordinated operation mechanism of central demonstration, primary-level adoption, and enterprise service support.

A three-tier structure comprising central demonstration sites, primary-level demonstration sites, and hospitals participating in the baseline survey was established across six major regions of China and three major specialties from November 2022 to October 2025. The network included 10 central demonstration sites and 11 primary-level demonstration sites. The baseline survey covered 320 medical institutions in 27 provinces, autonomous regions, and municipalities, including 263 tertiary hospitals and 57 secondary hospitals. Baseline data were used to compare equipment configuration and training capacity between different hospital levels. Data collected during the demonstration period were used to summarize representative procedures, primary-level adoption, training coverage, and platform operation.

The configuration rates of fluorescence endoscopic systems, three-dimensional endoscopic systems, and three-dimensional reconstruction software differed significantly between tertiary and secondary hospitals (all P<0.001). All secondary hospitals lacked independent training capabilities for fluorescence endoscopy systems and 4K fluorescence endoscopy systems. During the demonstration period, more than 35,000 minimally invasive endoscopic procedures were performed across the three specialties. Representative procedures, including precision pulmonary segmentectomy, precision left hemihepatectomy, precision pancreatoduodenectomy, radical prostatectomy, and partial nephrectomy, were routinely performed at the central demonstration sites. The reported technical completion rates for the main procedures remained above 97%. Several primary-level demonstration sites showed increases in endoscopic surgical volume, the proportion of minimally invasive procedures, or local procedure adoption. At Qinhuangdao Second Hospital, the proportion of endoscopic surgery increased from less than 10% to approximately 40%; the laparoscopic prostate cancer radical surgery at Weiyuan County People's Hospital was realized from non-existence to existence. The digital platform had 3,156 registered users, covered 1,627 medical institutions, and hosted more than 1,000 surgical videos.

Domestic high-end endoscopic systems and associated minimally invasive surgical instruments have accumulated multicenter, multilevel application experience within the demonstration network. Central hospitals conducted complex-procedure demonstrations and developed standardized practices, primary-level hospitals adopted routine procedures, and enterprises provided equipment installation, training, maintenance, and feedback-based improvement. Clinical adaptability depends on the coordinated implementation of procedure selection, personnel training, service support, and data collection.