Safety, economic implications, and health system integration of robotic cholecystectomy in African Surgical Centers: A structured narrative synthesis with policy perspectives

Abstract

Robotic platforms represent an advanced extension of minimally invasive surgery. Although widely adopted in high-income settings, their role in African surgical systems remains limited and unevenly documented. The aim of this study was to synthesize evidence on the clinical performance, economic implications, and implementation of robotic cholecystectomy in African contexts. A structured literature search was conducted in PubMed/MEDLINE, Scopus, African Journals Online, and Google Scholar for studies published between January 2015 and February 2026. Eligible sources included clinical, economic, implementation, and policy-focused reports relevant to African or comparable low- and middle-income settings. Given heterogeneity in study design and limited procedure-specific data, findings were synthesized narratively. Available evidence indicates that robotic cholecystectomy, when performed in adequately equipped tertiary centers, achieves perioperative outcomes similar o conventional laparoscopy. However, most studies are observational, single-center, and limited to short-term follow-up (30 to 90 days). Economic analyses consistently report substantially higher costs, including capital investment of approximately USD 1.5–2.5 million, annual maintenance exceeding USD 100,000, and increased per-procedure costs driven by disposable instruments and longer operative times. Implementation appears most feasible in institutions with multidisciplinary training structures and established technical support capacity. In conclusion, Robotic cholecystectomy is technically feasible in selected African institutions, but its sustainability depends on rigorous health technology assessment, financial alignment, workforce readiness, and transparent governance. It should be considered a selectively adoptable innovation rather than a universally scalable solution, with implementation guided by system priorities to avoid compromising access to essential surgical care.