Barriers and recommendations for the implementation of robot-assisted minimally invasive surgery in Africa.

Robotic surgery offers several advantages to the African setting, including shorter hospital stays, faster return to work, and increased overall productivity. However, its adoption has been limited by several factors. This review aims to present the barriers to implementation, and recommendations for integrating robotic surgery into the African healthcare system. Use of robotic surgery in Africa is primarily limited to Egypt and South Africa. Barriers faced by other countries were categorized into economic, infrastructural, systemic, and training-related. They include limited healthcare budgets, initial costs of robotic systems, patients' inability to afford robotic procedures, out-of-pocket healthcare financing, inadequate power supply, limited internet connectivity, poor healthcare leadership, and insufficient surgeon training facilities. Public-private partnerships, provision of loans and subsidies, introduction of cheaper robotic systems, and local manufacturing of robotic equipment will serve as cost-effective innovations. It is also important to improve healthcare financing and strengthen healthcare leadership across Africa. To address the lack of surgeon training facilities, remote assistance for surgeon training can be used to create a mentor-mentee relationship between robotic surgeons in any part of the world and surgical trainees in Africa to facilitate knowledge transfer. Prior investment in electricity and network infrastructure is however necessary. Establishment of fellowships to provide early exposure to robotic surgery should also be explored. AI-integrated robotic surgery can also enhance precision and safety, and provide tailored training tools for surgeons. Similar barriers to the adoption of surgical robotics are faced across Africa. By implementing the provided recommendations, robotic surgery can still be widely adopted in African settings, despite the delay.