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. 2025 May 15;19(1):218.
doi: 10.1007/s11701-025-02356-8.

Robotic surgery governance structures: a systematic review

Eoghan Burke  1 , Michael Devine  2 , Patricia Harkins  3 , Sarah Fenn  4 , Mohammad Faraz Khan  4 , Barry B McGuire  5
Affiliations

Robotic surgery governance structures: a systematic review

Eoghan Burke et al. J Robot Surg. .

Abstract

Since the Food and Drug Administration in the United States approved the first robotic platform for use in humans in 2000, there has been a steady increase in the popularity of robotic approaches to surgery. Robotic-assisted surgery (RAS) offers enhanced 3D visualisation of the operative field and increased flexibility and agility of the instruments, amongst other benefits. However, robotic platforms are complex systems and there is evidence that they may be associated with increased patient risk, particularly in the initial learning curve of a surgeon's robotic training. To ensure the continued safe use of RAS, adequate governance policies must be in place to regulate training, ensure patient safety and maximise the benefits of RAS programs. This systematic review synthesises all available evidence on RAS governance structures internationally for the first time. It was conducted and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. This systematic review identified, for the first time, three guidelines offering recommendations on the Governance Structures for RAS programs. We extracted the key recommendations to provide a holistic set of guidelines. Through consensus, we offer recommendations for the composition of a RAS governance committee, the frequency with which the committee should sit, and the remit of the committee, including training, granting of privileges, quality assurance and continued professional development. We also stress future research needs in RAS team credentialing and vendor-agnostic training pathways. These recommendations may serve as a template for establishing future RAS programs.

Keywords: Governance structures; Privileges; Robotic-assisted surgery; Training.

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Conflict of interest statement

Declarations. Competing interest: All authors report that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for study selection
Fig. 2
Fig. 2
Recommendations for the composition of a RAS governance group
Fig. 3
Fig. 3
Suggested remit of a RAS governance group
Fig. 4
Fig. 4
Graduated training program towards independent RAS. Focus on surgeon and team training with both technical and non-technical skills acquisition
See this image and copyright information in PMC

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