Surgeons engaged in telesurgery, particularly hand surgery, in Antarctica face a unique set of challenges and responsibilities. Operating in extreme environments, there is a responsibility to provide essential surgical care to individuals in remote locations. The harsh conditions of Antarctica amplify the significance of their role, as access to immediate medical assistance is severely limited. We discuss the challenges and experience of the Australian Antarctic Medical Division and the Hobart Plastic and Reconstructive Surgery Unit in providing this vital surgical service. Telesurgery in this context demands a meticulous approach due to the physical and technological constraints of the region. Surgeons must navigate through communication delays and potential technical glitches, emphasising the need for advanced telecommunication systems and robust contingency plans. Ensuring the success of tele-surgical interventions in Antarctica requires a fusion of surgical expertise and adaptability to unforeseen circumstances. Moreover, the responsibility extends beyond the surgical procedure itself. Surgeons must possess a comprehensive understanding of the unique medical challenges posed by the Antarctic environment, including frostbite, hypothermia, and other climate-related complications. Preparation and collaboration with interdisciplinary on-ground teams become paramount to address pre- and post-operative care effectively. The responsibility of the surgical team extends far beyond the operating room. Their duty encompasses technical proficiency, adaptability to extreme conditions, and a holistic approach to patient care in an environment where every decision is critical to the well-being of individuals in this remote and challenging locale.