Responsible adoption of robot-assisted surgery within health systems in middle-income countries: a narrative review...

Robot-assisted surgery (RAS) may expand minimally invasive capacity, but its adoption in middle-income countries is shaped by constraints not captured by platform-level comparisons, including foreign-currency exposure, imported consumables and technical support, limited reimbursement, scarce simulators and proctors, and geographic concentration of specialized care. This narrative review examined literature on surgical innovation, health technology assessment, implementation, economics, training, governance and equity. A targeted PubMed/MEDLINE literature search last updated on 15 July 2026 was supplemented by reference chaining and searches of official institutional and professional sources; the Scale for the Assessment of Narrative Review Articles (SANRA) informed reporting transparency. The synthesis positions the proposed framework alongside existing consensus guidance, national governance models and disease-specific standardized outcome sets. It translates these sources into three linked components: responsible-adoption domains; a minimum institutional dataset covering clinical, technical, economic, training, access and governance variables; and a decision matrix for pilot adoption, expansion, correction, pause, restriction, reallocation or discontinuation. The framework treats RAS as a complex health-system intervention and links procedure-specific incremental value to the real local comparator, lifecycle costs, team competence, technical reliability, patient-centered consent and equity effects of centralization. It proposes locally prespecified review triggers rather than universal thresholds. This author-developed synthesis is not a validated instrument, consensus guideline, formal health technology assessment or cost-effectiveness model. Its next step is content review, feasibility piloting, structured consensus and multicenter evaluation. Used with local regulation and procedure-specific evidence, it could support transparent, accountable decisions about where RAS may be introduced, expanded, limited or stopped.