Robot-assisted Radical Prostatectomy in the Brazilian Unified Health System (SUS): A Landmark in Surgical Public Health

The recent decision by the Brazilian Ministry of Health to incorporate robot-assisted radical prostatectomy (RARP) into the Brazilian Unified Health System (SUS) for clinically localized or locally advanced prostate cancer represents a landmark in the evolution of surgical care.For the first time, one of the world's most advanced and high-cost surgical technologies has been formally integrated into a universal public health system, positioning Brazil as a pioneer in equitable access to surgical innovation in Latin America.Integrating high-cost technology such as RARP into a universal system like SUS extends far beyond clinical outcomes; it establishes surgical innovation as a driver of industrial policy, knowledge transfer, and local capacity building.Beyond representing technological progress, this decision underscores SUS's ability, the largest universal, tax-funded health system globally, to integrate cutting-edge surgical technologies while maintaining its principles of universality, equity, and integrality (1).The National Commission for the Incorporation of Technologies into SUS (CONITEC) thoroughly evaluated clinical, economic, and societal evidence through public consultation No. 50/2025, which received 149 contributions from patient groups, professional associations, and civil society, with 99.3% supporting incorporation.This alignment with patient-centered values, emphasizing quality of life, culminated in the publication of Portaria SECTICS/MS No. 72/2025 (2).Implementation, however, will not be immediate or uniform.Robotic platforms require substantial investment, specialized training, and sustainable maintenance.Effective integration will depend on regionalization and concentration of procedures in high-volume centers, where public-private partnerships will be essential.Portaria SECTICS/MS No. 72/2025 allows 180 days for operationalization, a timeline that will test federal, state, and institutional capacities.A hub-and-spoke model, concentrating RARP in accredited reference centers, may optimize resources while ensuring safety and quality.This formal recognition transforms RARP from a technology previously confined to private institutions and select university hospitals into a standard of care progressively available across the world's largest universal