In recent days, the Esther Koplowitz Foundation has highlighted the 20th anniversary of robotic surgery at Hospital Clínico San Carlos in Madrid.
A robotic surgical system is an extraordinarily expensive piece of equipment for any hospital. Yet there are different ways to make such technology available to patients. One of them is philanthropy.
I have personally witnessed how transformative these initiatives can be. In 2013, a grateful and wealthy patient donated a da Vinci surgical system to the Department of Otolaryngology–Head and Neck Surgery lead by Christian von Buchwald at Rigshospitalet in Copenhagen. That donation enabled the launch of a Transoral Robotic Surgery (TORS) program in a department that already functioned as Denmark’s national referral center for Head&Neck Cancer. The impact on patient care, training, and innovation was immediate.
In year 2005 the Koplovitz Foundation donated the first da Vinci robot to be incorporated in the Spanich public health care system.
In Spain, the Esther Koplowitz Foundation played a similarly important role. In 2006, it donated a da Vinci Standard system to Hospital Clínico San Carlos. Although the first da Vinci system in Spain had arrived in 2005 at Puigvert Foundation in Barcelona, this became the first surgical robot incorporated into the Spanish public healthcare system.
Today, twenty years later, this milestone deserves celebration. But anniversaries are also opportunities for reflection.
A donated robotic platform is not simply a gift. It is a responsibility. Particularly in the early years of robotic surgery, when access to the technology was extremely limited and acquisition costs were difficult to justify. Every robotic system represented a valuable and scarce resource. Hospitals had an obligation to ensure that the technology was used appropriately, efficiently, and for procedures where it could generate meaningful clinical value.
The history of robotic surgery worldwide has taught us that technology alone does not guarantee success. Successful programs require careful case selection, multidisciplinary collaboration, structured training pathways, institutional commitment, and long-term strategic planning. Without these elements, even the most advanced equipment risks underutilization or inefficient use.
This lesson remains relevant today. The challenge is no longer whether robotic surgery works. The evidence supporting robotic approaches in several specialties is well established. The challenge is how hospitals organize and govern robotic programs to maximize value for patients and healthcare systems. Building a successful TORS program requires more than purchasing a robot; it requires leadership, training, multidisciplinary cooperation, and a clear vision of how robotic surgery fits within the broader cancer pathway.
In May 2022, I had the privilege of serving as proctor during the launch of the current TORS program at Hospital Clínico San Carlos. It was encouraging to see a major academic institution embracing a technique that has become an important component of contemporary Head&Neck surgical oncology.
Looking forward, the discussion should not focus solely on acquiring more robots. The real challenge is ensuring that robotic surgery programs are managed effectively and sustainably (see ours at Hospital Rey Juan Carlos).
Madrid’s large tertiary hospitals continue to face a paradox. All of them remain under-equipped relative to their clinical volume and complexity, yet increasing the number of robotic systems without addressing organizational inefficiencies would simply lead to waste. Investment and governance must go hand in hand.
Advanced technology only achieves its true value when it is accompanied by thoughtful leadership, appropriate indications, robust training, and efficient management.
J Granell. Jun 26, 2026
P.S. History never stops. As we celebrate twenty years since the arrival of the first robotic platform in the Spanish public healthcare system, another important milestone is to be announced tomorrow.