Robotic surgery: for quality training and equitable access1
Press release from the French National Academy of Medicine
October 10, 2025
A pioneer in laparoscopic surgery, France has quickly adopted robotics, with more than 300 robots currently in use in public and private healthcare facilities.
Robotic surgery offers increased precision, improving the quality of minimally invasive surgery procedures and potentially reducing hospital stays, the number of visits to intensive care units, and readmissions. It thus provides real benefits to patients. It also improves ergonomics for surgeons, reducing laparoscopy musculoskeletal induced disorders.
Breakthrough solution in visceral surgery (urological, digestive, gynecological, thoracic), robotics remains underused (30 to 90% residual open surgery, depending on the center and specialty) due to its cost, limited reimbursement, and lack of structured training.
Currently, in the absence of specific reimbursement, the additional cost of using the robot is absorbed by public hospital budgets or, in the private sector, by fees passed on to patients.
While medico-economic analyses of robot use confirm additional costs during the initial hospitalization, they often fail to assess secondary benefits in the medium and long term.
One company was for a long time the main producer of robots, but new companies are emerging, and the use of robots in surgery is also spreading to orthopedics, endovascular surgery, neurosurgery, etc.
The extension of robotic surgery use and the diversification of its industrial sector raise public health (quality of training), economic (healthcare spending), training implementation (training equipment; initial training, particularly for interns and operating room nurses; continuing education), liability, and certification issues.
Although each manufacturer offers user familiarization with its equipment, this exposes to the risk of conflicts of interest and to the lack of formal academic validation. In addition, these flash training courses turn out too short to claim to train a surgeon and guarantee quality practice, as already pointed out [1].
According to the recommendations of the French Haute Autorité de Santé (HAS) [2], learning surgery, particularly robotics, requires specific, structured training outside the operating room, making extensive use of simulation.
University training centers for surgical robotics have proven their effectiveness in acquiring the technical skills essential for real-life surgical practice, but they are few in number in Europe as they require large and expensive technical facilities.
To guarantee the population optimal and equitable access to robotic surgery, when appropriate, and in view of the increasing number of players, the issues of responsibility, and the importance of ensuring high-quality training for surgical teams, the French National Academy of Medicine recommends that:
– Standardized university courses be put in place, with recognized certification exams, to ensure high-quality initial and continuing training for surgical teams.
– A public-private partnership with a dedicated fund be created to finance training centers with coordination at the national or even European level, for example through the Federation of European Academies of Medicine, to support the development and maintenance of these training centers.
– Collaboration between health economists, clinicians and payers should enable a comprehensive medical-economic evaluation of robotic surgery, covering the entire care pathway and not only the initial hospitalization, to achieve an appropriate financial support.
References
– Hubert J., Vouhe P., Poitout D., Report 21-13, Training surgeons/surgical teams in robot-assisted surgery. Current status. Proposals for improvements, Bull Acad Natl Med, 2022, 206, 167-178 https://doi.org/10.1016/j.banm.2021.12.008
– HAS, Good practices in healthcare simulation, March 2024 (www.has-sante.fr)
[1] Press release from the Academy’s Rapid Communication Platform
(www.has-sante.fr)
Bull Acad Natl Med 2025;209:pp-pp. Doi :
