Robotics is a branch of artificial intelligence that studies the design and construction of equipment capable of performing specific tasks of the human being through programmed and mechanized processes1. It has been implemented in different areas, including medicine, specifically in the surgical field; robotic surgery is nothing more than a procedure performed through a computer, which an experienced surgeon directs. It is currently considered the future of surgery worldwide due to its significant impacts and the multiple advances presented in the last decades2,3. In the mid-1980s, it began with the production of robots, one of them called Zeus, whose construction was completed in 1995. Two years later, they finished the prototype called “Mona,” a precursor robot of the currently known Da Vinci, which uses the master-slave system, which emerged in 1999 and is considered the most advanced robot so far. This robot has the validation of the Foods and Drugs Administration (FDA) obtained in 2000 for performing procedures in abdominal surgery laparoscopically4. There are 3 types of robotic systems for the surgical field that are in use; active, semi-active, and master-slave systems. Active systems work autonomously, performing tasks preprogrammed by the surgeon. Semiactive systems allow elements of the surgeon to be combined with preprogrammed features, and the master-slave system lacks preprogrammed elements of autonomy; that is, they depend entirely on the surgeon5. Worldwide, there are many comments on the relevance of robotic surgery. Therefore, an overview of the advantages and disadvantages of using this technology in surgical procedures is essential (Table 1)6. Table 1 - Advantages and disadvantages of using robotic surgery6. Advantages Disadvantages Three-dimensional vision, with an image up to 20 times sharper Decrease in the surgeon’s haptics Greater precision in the movements, which are ordered by the surgeon In places where robotic surgery is not usually practiced, it may have a longer surgical time compared with laparoscopic surgery or open surgery It grants greater freedom of movement, allowing greater ease at the time of sutures and tying knots Higher maintenance cost and requires a greater learning curve Decreases time of stay, reincorporation in a period of <7 d approximately Decrease in the hiring of human talent specialized in the surgical area, therefore, a higher unemployment rate It shortens the time of convalescence, because of the reduction of intraoperative complications Surgical procedures remotely Low incidence at the operative site The surgical areas are composed of multiple specialties and subspecialties, having robust criteria for indicating a surgical procedure. That is why it is important to know the indications of robotic surgery, consider the type of procedure, and offer a fast, effective, safe, and reproducible surgical procedure. Currently, no international guidelines expose the absolute indications for robotic surgery; however, in Table 2, we will disclose the surgical procedures most frequently performed by the Da Vinci surgical system (endorsed by the FDA)7. Table 2 - Most frequent procedures performed with Da Vinci. Surgical Specialty Procedures Gynecological surgery Hysterectomy, colposacropexy, myomectomy, and verse-vaginal fistula repair Urological surgery Prostatectomy, nephrectomy, kidney transplantation, ureteropelvic obstruction, and cystectomy General surgery Cholecystectomy, colorectal surgery, bariatric surgery, pancreatic surgery, hepatectomy, and adrenalectomy Head and neck surgery Transoral surgery, parathyroidectomy, and thyroidectomy Considering the above context and affirming the importance of implementing new surgical systems for the performance of robotic surgery, we searched for the research carried out in Latin America and, more specifically, in Colombia related to robotic surgery. Internationally, the most used surgical system is the Da Vinci System robot. The country in Latin America with the most significant number of this surgical system is Brazil, with 37, standing out as the Latin American country with the highest insertion of this type of technology8. Colombia currently has only 5 of these types of systems. They are distributed in institutions (Clínica de Marly, Fundación Santa Fe de Bogotá, Instituto Nacional de Cancerología, Clínica Shaio, and Clínica Los Nogales), located only in the city of Bogotá D.C. However, despite a low number of robots, and a “recent” arrival (2012) of this type of technology, this is one of the few countries in Latin America that uses this technology daily in its surgical procedures and also performs constant training for its employees in robotic surgery8,9. In Latin America, the robotic surgery system has not been implemented in the same way as in the United States and Europe. This situation is due to the cost demanded by the purchase of robotic devices, maintenance, and operational equipment that must be trained to manage these. All this added to the health system structure in Latin America, which does not have sufficient economic resources for health services10,11. In the case of Colombia, the health system is minimal; the mandatory health plan and health promotion entities have coverage for conventional open surgery procedures, and minimally invasive procedures only include traditional laparoscopy. Therefore, the insertion of the Da Vinci robotic system had to be paid for directly by the 5 hospitals that have this device without government help. Hence, its use is minimal and is exclusive for particular procedures, prepaid medicine, or insurance policies. This may be one of the reasons why Colombia has not imported more robotic devices12. Also, in Colombia in 2021, a study conducted by the University of the Andes showed the cost-effectiveness of robotic surgery versus conventional laparoscopic surgery in treating prostate cancer at the Shaio Clinic Foundation. This article found that the robotic-assisted surgical procedure had a higher cost than the value of traditional laparoscopic surgery, being Colombian Peso 15,855,460 and Colombian Peso 11,237,419, respectively. They even commented that the costs could be much higher if the acquisition, the maintenance of the Robot, and the supplies of a surgical procedure are added12. Regarding effectiveness, they focused on perioperative outcomes and showed that robotic-mediated surgery was more effective than conventional laparoscopic surgery but mentioned that the difference was not so great. Despite this, it is essential to emphasize that robotic-assisted surgery presented a higher safety profile concerning transfusion requirements, since there was a reduction in blood loss during prostatectomy and also had a great positive impact, as it presented fewer infections of the operative site due to the use of small incisions and the smaller extension of exposed area12. Despite the high costs demanded by surgical robots, it has been shown that the procedures have similar and even shorter times between laparoscopic surgery versus robotics, in the same way, differences have been observed in terms of complications and mortality, obtaining better results with the interventions carried out by this new technology, lowering those rates. In addition, a retrospective study was brought up, which was carried out in Mexico, in 2020, “Robotic-assisted gastric bypass versus laparoscopic in super obesity (body mass index ≥50 kg/m2) 4-year experience of a center,” which was published in the Mexican journal of endoscopic surgery, which aimed to “Demonstrate the benefits of robotic technology in the execution of gastric derivative in patients with super obesity,” finally it was found that robotic surgery brings great advantages in the surgical area, in this case, the Da Vinci robotic system was used and showed to reduce surgical time, transoperative complications, and days of in-hospital stay compared with conventional laparoscopic surgery. The study also mentions that it was not found statistically significant in the other objectives but also concludes that there is a trend toward better results in patients undergoing robotic surgery. This proves that robotic surgery is a breakthrough for medicine13. With the above, we can show that this technology, relatively new, continues to represent the future of surgery and its different branches which have been increasing, since it has had a rapid development and inclusion in various countries around the world, demonstrating its advantages and improvements in traditional surgical techniques and their respective teachings; however, at the Latin American level, the number of equipment available to execute this surgical practice is still scarce, with greater emphasis on Colombia where, as mentioned above, they only have 5 of them, which demonstrates the importance of making progress where it is possible to carry out machinery that is cost effective, thus facilitating the affordability of these equipment, allowing to continue with the growth of this technique and benefiting a larger population. In the same way, it is crucial to generate new research protocols that allow improving and polishing the actions carried out by these robots, improving their efficiency and effectiveness when implementing them compared with traditional techniques, covering more areas of surgery, exploring from wider fields to areas that require greater accuracy and care, which even show greater difficulty for the surgeon, thus perfecting this surgical technique. In conclusion, it is important to join forces to create medical laws that allow robotic surgery to be included within the mandatory health plan to strengthen knowledge, increase the learning curve, and respond to the new surgical demands posed by the international community. Ethical approval None. Sources of funding None. Author contribution All authors equally contributed to the analysis and writing of the manuscript. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Department of Surgery, Carlos Roberto Huembes Hospital, Universidad Nacional Autonoma de Nicaragua, Managua. email: [email protected]