SAGES tool for assessing robotic surgery systems (STARSS)

Abstract

Background: Robotic-assisted surgery (RAS) has transformed surgical practice, offering improved ergonomics, enhanced visualization, and improved dexterity. However, as new RAS technology and systems are developed, stakeholders including surgeons, hospital administrators, and regulators face challenges in evaluating system features and selecting appropriate platforms. Thus, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Robotics Committee aimed to develop a tool for assessing robotic surgery systems. Methods: Using a literature review and iterative feedback from SAGES robotic committee members, the relevant categories and corresponding specific metrics for evaluation of RAS systems were first defined. The final tool included categories and metrics agreed upon by > 80% of committee members. To determine the applicability and usability of this tool, the tool was applied to the evaluation of FDA-cleared robotic systems in the US and any needed changes were implemented. Results: The SAGES Tool for Assessing Robotic Surgery Systems (STARSS) that is a structured evaluation framework designed to facilitate the comparison of RAS systems was developed. The tool includes metrics spanning seven categories: General Information, Software Information, Hardware Information, Usability, Safety Features, Ergonomic Capabilities, and Training and Certification. Its application to Food and Drug Administration (FDA)-cleared RAS platforms is presented. Conclusions: STARSS enables systematic comparison of RAS systems by capturing technical capabilities, workflow integration, safety considerations, ergonomic support, and training infrastructure. It highlights both strengths and gaps in current platforms and can help guide clinical adoption, procurement decisions, research, and future system development.