Lawal Abdulwahab,1,2 Akin-Adewale Rolake3

¹Department of Surgery, University of Ilorin Teaching Hospital, Nigeria
²MCON Research Institute, Nigeria
³College of Health Sciences, University of Ilorin, Nigeria

DOI: 10.5281/zenodo.19237244

The use of robotics in surgery has seen a dramatic increase in many parts of the world and also across various surgical specialties. Procedures like prostatectomy, hysterectomy, and complex head and neck surgeries are currently being performed with surgical robots. Robotic surgery is the use of advanced robotic equipment to carry out surgical procedures in a highly precise and specific manner. Surgeons enjoy a 3-dimensional (3-D) high-definition view of the surgical site with approximately 10–15 times magnification, giving them the opportunity to be completely immersed in the surgical field.

Robotic surgery falls under the umbrella term popularly known as Minimally Invasive Surgery (MIS). There are other forms of MIS like laparoscopy, which was invented long before robotic surgery. The use of robotics to carry out surgical procedures is one of the greatest surgical innovations of the past three decades. This invention has caused a decrease in surgical trauma and incision-related complications such as surgical site infections, pain, and hernia, and an overall better post-surgery outcome for patients.

These robots are used to carry out laparoscopic/laparo-endoscopic surgeries, and are becoming increasingly more common in developed countries of the world. The United States is noted to perform the greatest number of robotic surgeries of any country in the world. In contrast, only Egypt and South Africa have majorly adopted robotic surgery, and there has been no recent documented use in Nigeria. However, laparoscopic procedures are used across various hospitals in Nigeria, but only in limited specialties.

The possibilities of robotic surgery becoming mainstream in Nigeria and Africa as a whole do not seem promising in the nearest future due to certain factors. The low financing of the healthcare sector in most African countries is the greatest factor responsible for the slow adoption of this innovation. Africa is a region that accounts for a disproportionate share of the global disease burden but allocates the least amount of resources to healthcare. Health spending per capita in Africa was an average of $80 in 2016 compared to $400 in more developed regions.

Health financing in Africa is mainly from low government spending, underdeveloped insurance schemes and donor funding. In Nigeria's current budget, only about 1.17 trillion Naira was allocated to the healthcare sector, out of a total budget of 20.5 trillion Naira, constituting a meagre 5.75% of the total budget, contrary to the recommended 15%.

Robotic surgery is an expensive venture, as a lot of financial resources are needed to acquire these advanced machines and equally maintain them in optimal conditions. Current robotic surgical systems are very large and take up a lot of space in the operating theatre. Resources are also needed to train healthcare practitioners on the usage and management of these machines. Implementing a new robotic surgical platform will cost over one million USD and an additional $3,000 to $5,000 per surgery. The average cost of performing robotic surgery is approximately $12,340 plus $5,880, equating to costs that represent a very expensive surgery for most Nigerians, where out-of-pocket payment is the most common means of payment.

Another important factor limiting robotic surgery in Africa is the shortage of surgeons and deficient training systems. The surgical residency training programme in Nigeria and most parts of Africa does not have standardised training on robotics. Training often utilises 3-D models; however, this novel technology is not easily accessible in developing and underdeveloped African countries. Remote telesurgery is a new innovation aimed at bridging the learning gap in remote areas, but factors like poor network connectivity and lack of power supply mostly compromise this learning platform, especially in more remote areas.

The current brain drain in some African countries like Nigeria has contributed to scarcity of doctors, surgeons included. The migration of surgeons out of Africa to more developed climes has worsened the already poor doctor-to-patient ratio. A study done in east central and southern African region reveals that there are only 1,690 practicing surgeons, yielding a regional ratio of 0.53 surgeons per 100,000 population.

Robotic surgery is not impossible in Africa. However, it currently remains too expensive for healthcare facilities and patients alike. It is hoped that in the nearest future there will be more producers of these machines in the industry, who will manufacture newer generation robotics that are cheaper and affordable for use in Nigeria and other African countries, and that governments will be willing to allocate more resources to healthcare to facilitate innovations like robotics, which are definitively more beneficial to both patients and surgeons in the long run.

Declaration of competing interest: The authors declare no conflicting interest.

Corresponding author: Lawal Abdulwahab Oluwatomisin, Department of Surgery, University of Ilorin Teaching Hospital, Nigeria. Email: Abdulwahablawal007@gmail.com

Previously published as: Lawal, A., & Akin-Adewale, R. (2025). Concepts of robotic surgery in Africa: the prospects for surgical advancement in Nigeria. Impact Surgery, 2(7), 247–249. https://doi.org/10.62463/surgery.111

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References

  1. Ashrafian H, Clancy O, Grover V, Darzi A. The evolution of robotic surgery: surgical and anaesthetic aspects. Br J Anaesth. 2017;119:i72–i84. doi:10.1093/bja/aex383
  2. Hübner M, Diana M, Zanetti G, et al. Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon. Arch Surg. 2011;146:1240–1245.
  3. Sheetz KH, Claflin J, Dimick JB. Trends in the Adoption of Robotic Surgery for Common Surgical Procedures. JAMA Netw Open. 2020;3(1):e1918911. doi:10.1001/jamanetworkopen
  4. Oyebamiji TA. Robotic Surgery in Nigeria; an uncertain possibility. Int Surg J. 2020;7:3876-9.
  5. Gouda HN, Charlson F, Sorsdahl K, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: results from the Global Burden of Disease Study 2017. Lancet Glob Health. 2019;7:e1375–87.
  6. Wagstaff A, Flores G, Smitz M-F, et al. Progress on impoverishing health spending in 122 countries: a retrospective observational study. Lancet Glob Health. 2018;6:e180–92.
  7. Chang AY, Cowling K, Micah AE, et al. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050. Lancet. 2019;393(10187):2233–60.
  8. World Health Organization. State of health financing in the African region. Geneva: WHO; 2013.
  9. Khorgami Z, Li WT, Jackson TN, et al. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery. Surg Endosc. 2019;33(7):2217-2221. doi:10.1007/s00464-018-6507-3
  10. McBride K, Steffens D, Stanislaus C, et al. Detailed cost of robotic-assisted surgery in the Australian public health sector. BMC Health Serv Res. 2021;21:108. doi:10.1186/s12913-021-06105-z