Bridging the gap: feasibility and future directions of robotic surgery in Sub-Saharan Africa-a narrative review

Abstract

Robotic surgery (RS) is expanding globally but remains nascent in Sub-Saharan Africa (SSA). Given constrained resources, training gaps, and infrastructure limitations, the feasibility and health-system value of RS in SSA require careful appraisal relative to open and laparoscopic surgery. We conducted a narrative review of RS feasibility, adoption, training, outcomes, and economics with a primary focus on SSA. Sources included PubMed, Embase, Scopus, Google Scholar, and gray literature from January 2010 to May 2025. Evidence was synthesized across themes (infrastructure, workforce, financing, outcomes, and implementation models), incorporating African data where available and using global studies for context. Adoption in SSA is concentrated in a few private centers in South Africa, with Egypt providing continental historical context and Rwanda emerging as a regional training hub. Dominant barriers include high capital and recurrent costs, supply-chain and maintenance needs, reliable power and connectivity requirements, and limited team-based training capacity. While global data consistently show advantages of RS over open surgery (e.g., reduced blood loss, complications, and length of stay), Africa-specific comparative data versus laparoscopy are limited and generally demonstrate longer operative times and greater blood loss without significant differences in conversion, length of stay, or overall morbidity. Promising pathways include centralized high-volume hubs, public-private and NGO partnerships with explicit maintenance and uptime guarantees, regional training pipelines (on-site simulation, fellowships, and telementoring/telesurgery), and staged financing models (shared ownership, refurbishment, and outcome-linked contracts). Emerging, potentially lower-cost platforms may improve affordability, but sustainable case volume and workforce development remain prerequisites. We propose pragmatic metrics to track implementation: procedural volume and mix, system uptime, conversion and complication rates, cost per case, and training outputs. RS is feasible in carefully selected SSA centers when aligned with health-system priorities, robust maintenance, and concentrated training. Given equipoise versus laparoscopy in current African data, early programs should be justified by access, training, and service-delivery goals rather than presumed clinical superiority. Prospective registries, context-specific economic evaluations, and procedure-specific comparative studies are needed to guide equitable and sustainable scale-up.

Keywords: Health systems; Robotic surgery; Sub-Saharan Africa; Technology adoption; Telementoring.