Robotic surgery governance structures: a systematic review

Area of Science:

• Surgical Innovation
• Medical Governance
• Healthcare Policy

Background:

• Robotic-assisted surgery (RAS) has grown in popularity since its FDA approval in 2000, offering benefits like enhanced visualization and instrument dexterity.
• Despite advantages, RAS complexity poses patient risks, especially during surgeon training and the initial learning curve.
• Effective governance is crucial for regulating training, ensuring patient safety, and maximizing the benefits of RAS programs.

Purpose of the Study:

• To systematically review and synthesize international evidence on governance structures for robotic-assisted surgery (RAS) programs.
• To identify existing guidelines and extract key recommendations for establishing robust RAS governance.
• To propose a consensus-based framework for RAS governance committees, addressing composition, meeting frequency, and scope of responsibilities.

Main Methods:

• Systematic literature review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
• Identification and extraction of key recommendations from all available international guidelines on RAS governance structures.
• Consensus-building to formulate recommendations for RAS governance committee composition, meeting frequency, and remit.

Main Results:

• This systematic review identified three guidelines providing recommendations for RAS governance structures.
• Key recommendations were extracted to form a holistic set of guidelines for RAS program governance.
• Consensus was reached on recommendations for governance committee composition, meeting frequency, and remit, including training, credentialing, quality assurance, and professional development.

Conclusions:

• Established governance structures are essential for the safe and effective implementation of robotic-assisted surgery programs.
• The proposed recommendations for RAS governance committees can serve as a template for developing new and improving existing programs.
• Future research should focus on RAS team credentialing and the development of vendor-agnostic training pathways to further enhance safety and standardization.