The RoboDev Guideline: Key Requirements and Recommendations for Developing and Expanding Global Robotic Surgical Programmes

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Background: Robot-assisted surgery (RAS) is expanding rapidly across surgical specialities, yet adoption across the globe remains variable. There is growing recognition to expand RAS across all healthcare settings, to ensure equity of access and improve clinical outcomes for all patients. Facilitating the expansion of RAS requires the development of high-quality, durable and sustainable RAS programmes. The aim of the RoboDev study was to develop a universal, globally applicable guideline to aid development and expansion of RAS programmes. Methods: The RoboDev study was conducted as an international, multistakeholder Delphi process consisting of four phases: (1) scoping review and item generation, (2) questionnaire design and pre-testing, (3) accelerated two-round Delphi survey, and (4) consensus meetings. Participants were stratified by World Bank income classification. Recommendations achieving ≥80% agreement were retained. A subset of participants subsequently evaluated the final recommendations using the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Spill-over effects, and Equity). Results: A total of 1,000 participants completed Round 1 and 812 completed Round 2 of the Delphi, representing HIC (59.5%), UMIC (16.6%), LMIC (18.7%), and LIC (1.6%) stakeholders. From 245 initial statements across eight domains, 194 recommendations achieved global consensus. Tailored adaptations were added for each income group, resulting in 197 recommendations for HICs, 207 for UMICs, 206 for LMICs, and 216 for LICs. Training, infrastructure readiness, and multidisciplinary engagement showed the greatest variation across settings. APEASE evaluation confirmed overall acceptability, practicality, and equity, with LIC participants reporting the highest spill-over and equity benefits. Conclusion: The RoboDev study has developed the first global, evidence-based, and context-sensitive guidelines for building and expanding robot-assisted surgical programmes. By combining universal principles with context-specific adaptations, these recommendations provide a roadmap for equitable and sustainable expansion of robotic surgery worldwide. Adoption of these guidelines has the potential to improve patient outcomes, strengthen surgical systems and ensure that the benefits of robotic innovation are shared equitably across all global contexts.

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