Robotic surgery: A call for evidence in value-based health systems

Abstract

Robotic-assisted surgery (RAS) is being implemented at a pace, challenging the capacity of our health systems to appraise its long-term value. In April 2025, the UK’s National Institute for Health and Care Excellence (NICE) opened an early value assessment (EVA) pathway to help meet this challenge, resulting in conditional approvals and 3 year window for evidence generation to address specific evidence gaps¹. The conditional approvals were for 11 robotic platforms (five soft tissue and six orthopaedic), on a path that allows new health technologies that do not have a complete evidence base to be used within the NHS while evidence generated. This dual signal (implementation and conditional approval) illustrates the tension between technological momentum and, in formal terms, an unproven health economic case. The 3 year timeline for evidence generation puts an onus on industry collaboration for this first phase, probably signalling the need for a full evidence base of early, mid-term, and late clinical outcome and quality of life data.