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OBJECTIVE: With increasing use of the robotics in the operating room, a need for effective credentialing guidelines has become necessary. We propose an algorithm that is robust and takes into account volume, outcomes and appropriateness of robotic usage.
METHODS: We reviewed the literature (MEDLINE) for ways of introducing and credentialing robotic use among surgeons. The following terms were queried: robot, robotic, surgery and credentialing. We provide our recommendations based on review of the literature, our institutional experience, as well as the experience of other medical centers around the US.
RESULTS: 43 manuscripts were identified in the published English language literature through December 2013. Two pathways for robotic training exist: residency- and non-residency-trained. In the US, JCAHO requires hospitals to credential and privilege physicians on their medical staff. Below we present our suggested guidelines for granting robotic privileges in a graduated fashion. A credentialing designee (CD) is appointed by the surgery department to oversee and review all requests. Residency trained surgeons must fulfill 20 cases with program directors’ attestation to obtain Full privileges. Non-residency trained surgeons are required to fulfill the following: simulation, didactics including online modules, wet labs (cadaver or animal) and observation of at least 2 cases for Provisional privileges.
To serve as a proctor, a robotic surgeon with Full privileges must complete 25 cases in the same specialty with good outcomes and be approved by the CD and the department chair. A minimum number of cases (10 suggested) is required to maintain competency. Cases are monitored via department QA committee review. Investigational uses of the robot require IRB approval. Complex operations (e.g Lobectomy) may require additional proctoring and QI review.
CONCLUSIONS: Safety concerns regarding use of the robot in the operating room must be paramount. Our privileging recommendations also take into account concerns regarding appropriate utilization, restraint of trade and state reporting ramifications. Our algorithm for granting privileges may serve as a basic guideline for institutions that wish to implement a robotic program.

Level	N of Cases	Proctored	Comments
Provisional	5	Yes	• Board-certified or -eligible • Completed ACGME/AOA residency • Holds MIS &/or open privileges in the same procedure
Conditional	> 10/year	No	• Provisional prerequisite • Full-Privileged robotic surgeon bedside
Full	> 10/year	No	• One year Conditional prerequisite • Pending review of outcomes and • Approval by CD and department chair