Implementing robotic surgery in South African training institutions: fiddling while Rome burns

The Editor of the SAJS invited a commentary on the article "Embracing the future: the necessity of implementing robotic surgery in South African training institutions" by Forgan and Lazarus, in which they defend the decision of the Provincial Government of the Western Cape to purchase da Vinci Robots for both Tygerberg and Groote Schuur Hospitals.The Lancet Commission on Global Surgery recognised that novel technologies are key enablers to realise the goal of scaling up and strengthening surgical care worldwide. Yet, introducing novel, complex, and expensive technology in lower-resourced settings, such as South Africa, requires a carefully considered and detailed evaluation of its potential to improve health outcomes and quality of life, or to offer solutions to unmet medical technology needs. In lowerresourced settings, the focus should be on frugal innovation, i.e. doing better with less. Despite the wide adoption of robot-assisted surgery, the economic efficiency and affordability of robotic surgery in diverse clinical areas have not yet been well documented.