title: The development of robotic surgery in the Middle East.
abstract: OBJECTIVE
  We provide an overview of the development of robotic surgery in the Middle East since its first introduction in April 2003 in the Kingdom of Saudi Arabia (KSA).
  
  
  METHODS
  We searched MEDLINE using 20 keywords/phrases and identified 44 reports, of which only 15 were relevant. Five of these articles were duplicated when using two different keywords. Therefore, no more than 10 articles were found that were relevant to the scope of this review.
  
  
  RESULTS
  After completing the MEDLINE search to identify articles related to robotic surgery in the Middle East, we noted that all of the nine case series (Level of evidence 3a) reported took place in the KSA, with no other reported series from other Middle-Eastern countries. To the best of our knowledge, there are no operating robotic surgery systems (da Vinci, Intuitive Surgical, CA, USA) in the Middle East other than in the KSA, Qatar and Egypt. The number of robotic surgery cases and newly adapted robotic procedures is increasing. Two major institutions in the KSA have expanded to robotic-assisted pyeloplasty in all of their cases since January 2005.
  
  
  CONCLUSIONS
  There are 10 da Vinci robots in the KSA, with over 35 trained surgeons, yet very few index cases. The cancer incidence rate, lack of practitioners' referrals, and demographic age distribution are all factors that contribute significantly to the few index cases reported. By consolidating the robotic surgery procedures in high-volume speciality centres, hospitals can increase their case loads by promoting the multidisciplinary use of the robotic system. Even though growth is relatively slow, we believe that robotic surgery is gaining momentum, and its benefits and innovation will soon be grasped in other countries in the Middle East.
authors.affiliation: Division of Urology, Department of Surgery, King Saud University, Princess Jouhara Al-Ibrahim Cancer Research Centre, King Khaled University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
authors.forename: Danny M
authors.initials: DM
authors.lastname: Rabah
authors.affiliation: Division of Urology, Department of Surgery, King Saud University, Princess Jouhara Al-Ibrahim Cancer Research Centre, King Khaled University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
authors.forename: Osman Zin
authors.initials: OZ
authors.lastname: Al-Abdin
keywords: ARM, anorectal malformation; Da Vinci; FDA, USA Food and Drug Administration; KSA; KSA, Kingdom of Saudi Arabia; Prostatectomy; QRSC, Qatar Robotic Surgery Centre; RARP, robotic-assisted radical prostatectomy; Robotic surgery; Robotics