Mixed Reality (MR) surgery for telepresence has not been successfully implemented yet due to the lack of security and the high processing time required. In particular, the need for authentication during and after the real-time video transmission is not addressed adequately. This paper aims to increase the security and privacy by preventing unauthorized access into the telepresence system before and after the surgery by proposing real-time authentication with low processing time. The proposed system consists of an enhanced Multi-factor SMS-based one-time session password (OTSP) and an IRIS biometric authentication technique. The results of this work demonstrate a successful overcoming of several limitations of the previous state of the art solution. For instance, the average processing time is reduced from 81 ms to only 57 ms. The proposed solution also increases the protection from hacking to the system, i.e., the accuracy, to 80% compared to the accuracy of 53% for the previous solution. Besides, the proposed system is more resistance against several attacks by an attack-proof of 84.36% compared to 45.2% of the state of the art solution. Moreover, our solution reduced the required storage capacity and cost to the half. As a result, our proposed system is more robust against various kinds of attacks. The proposed system could be used effectively in surgical telepresence authentication with less time, cost overhead and higher security.