Robotic surgery in Italian hospitals

Robotic-assisted surgery has become an increasingly established component of contemporary hospital practice, yet its integration into healthcare systems remains heterogeneous and often shaped by local resources, institutional ambition, reimbursement constraints, and variable governance models. The current debate should therefore move beyond the binary question of whether robotic surgery is superior to laparoscopy or open surgery, and should instead address how robotic programs can be implemented, monitored, financed, and governed responsibly within real hospital systems.

This Associazione Chirurghi Ospedalieri Italiani position paper proposes a practical framework for the value-based governance of robotic surgery in Italian hospitals. The document does not advocate unrestricted technological expansion, nor does it interpret robotic surgery as intrinsically superior across all procedures. Rather, it argues that robotic-assisted surgery should be considered a high-complexity surgical program requiring defined indications, institutional competence, procedural volume, structured training, credentialing, team-based preparation, prospective outcome monitoring, registry participation, and periodic reassessment. The article emphasizes that the value of robotic surgery cannot be evaluated solely through acquisition costs, operative time, or isolated perioperative endpoints. Conversion avoidance, access to complex minimally invasive surgery, technical reproducibility, patient selection, length of stay, postoperative recovery, training scalability, surgeon ergonomics, operating room organization, and digital readiness should be considered within a broader health-system perspective. At the same time, economic sustainability requires value-based procurement, appropriate reimbursement models, avoidance of low-volume fragmentation, and transparent accountability. Associazione Chirurghi Ospedalieri Italiani supports a governance model in which robotic surgery is clinically appropriate, institutionally mature, economically sustainable, continuously monitored, and equitably accessible. The future of robotic surgery in Italian hospitals will depend not only on technological availability, but on the capacity of surgeons, managers, regional authorities, payers, and policy-makers to align innovation with evidence, accountability, equity, and measurable patient-centered value.