Robotic surgery in Ireland: national governance framework and a guide to good practice

and methods: Robotic-assisted surgery has become a cornerstone of modern surgical innovation, offering enhanced precision, minimal invasiveness, and improved recovery compared with conventional techniques. Its rapid adoption across multiple specialties in Ireland has brought substantial benefits for patients but also challenges regarding surgeon training, programme oversight, and patient safety. Until recently, Ireland lacked a unified national governance framework for robotic surgery. In recognition of this, the Royal College of Surgeons in Ireland (RCSI) established the National Robotic Surgery Leads Group in 2023, tasked with creating national standards for governance, training, and safe practice.

This paper outlines the framework developed by the Leads Group, presenting a model that balances innovation with robust clinical governance. Central to this approach is the establishment of hospital-based Robotic Surgery Governance Committees (RSGCs), responsible for credentialing, training oversight, and monitoring key safety indicators. Training is structured around vendor-led pathways, mentorship, modular component training, and telementoring, with hybrid approaches recommended to optimise safety. Safety monitoring includes key performance indicators such as case volume, console times, transfusion rates, conversion to open surgery, ICU admissions, and morbidity and mortality outcomes. Additional considerations addressed include recognition of surgeon vulnerability during the early learning curve, emergency preparedness, case-mix management, consent processes, and the safe introduction of new robotic platforms.

A national survey of all robotic surgeons in Ireland, with a 76 % response rate, demonstrated overwhelming support for the establishment of RSGCs and KPI monitoring. This framework represents Ireland's first national governance model for robotic surgery and positions the country as a leader in fostering a culture of safety, innovation, and excellence in surgical care.