Barriers to Introducing New Transformative Surgical Technology in Australian Healthcare: A Comprehensive Review and Guide

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overall, the paper is well put together, with clear and proper use of the English language.

The introduction could potentially benefit from the following suggestions:

• I would advise the authors to be more specific about the targeted transformative technologies, as it is not entirely clear if they refer solely to the Da Vinci platform or new technologies overall.
• I would recommend that the authors add more data about the approval process, such as average duration and rejection rate.
• I suggest that the authors clarify why the robotic platforms are wider spread in private settings, as it is not entirely clear if it is due to installment costs or lack of training.

            The Material and method section could be improved by using more than one search engine, as well as more diverse key words. Additionally, some words seem to be misspelled, such as urolog$, surg$, adopt$ etc.

            The Barries section could be improved by:

• Adding in the Medical professionals part more precise data, such as average learning curve duration and cases needed to safely use the robotic platforms.
• Adding in the Government part a flowchart that illustrates the needed steps from the initial application to the final approval and wide implementation of a device, focusing on the average time period needed for each step to be completed.
• Adding in the Healthcare Services part a flowchart that illustrates the steps implemented in order to adopt a new technology into the general hospital use.

Lastly, I recommend that the authors add a Discussion and a Limitations section, in order to add thoroughness to the proposed research protocol and manuscript presentation.

           

 

Author Response

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Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for permitting me to review this manuscript 

 

In this review the authors focus on the developement of new surgical techniques in australia and surf and describe barriers and enumerate a five step consecutive pathways 

some paragraphs lacks reference I suggest minimum 1 or two  per paragraph 

 

 

Author Response

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Reviewer 3 Report

Comments and Suggestions for Authors

Authors provide a detailed analysis on how regulatory entities in Australia adopt new medical technologies. The propose a five-phase guide to new surgical technology implementation in the Australian healthcare. A comment about the third step is mandatory. Authors refer to robotic surgery (RS) and its adoption in the introduction of the paper. RS diffusion is a strong example of how EBM may fail. Up to date, EBM in favor of RS is very limited basing on first reports, RS should have been abandoned. Indeed, surgeon comfort with RS, increasing experience and later technical developments gave clearly an advantage over standard laparoscopic procedures. Twenty years later after its inception, we start to see real clinical benefits for the patients and, only now, EBM may eventually confirm the usefulness of RS. At the beginning, clinical studies focused only on non-inferiority or superiority of RS in regard to patient-oriented outcomes. However, from the very start, it was clear that the surgeon could perform the same surgical procedures with less fatigue leaving behind exhaustion choices and improving the "productivity". Therefore, I agree that EBM should be the pillar but EBM should be based on clinical studies correctly finalized 

Author Response

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Reviewer 4 Report

Comments and Suggestions for Authors This manuscript aims to explore barriers to adopting new surgical technology in Australia and proposes a five-phase implementation guide. While the topic is relevant, the manuscript has several significant weaknesses in terms of scientific rigor, originality, methodology, and clarity. The following concerns must be addressed before the paper can be considered for publication. The manuscript summarizes existing regulatory frameworks and general challenges in adopting medical technology without offering substantial new insights. The proposed five-phase system is a repackaging of well-known processes rather than an innovative contribution to the field. The literature review lacks transparency. The inclusion/exclusion criteria are not clearly justified, and it is unclear how the sources were selected or evaluated. The review heavily relies on government and organizational websites, which may not be sufficient for a rigorous academic study. There is no systematic approach, making the findings anecdotal rather than evidence-based. While the manuscript identifies key barriers, it fails to provide an in-depth critical analysis. The discussion is largely descriptive and lacks engagement with broader policy, economic and ethical considerations. Important stakeholder perspectives (e.g., financial decision-makers, industry innovators, regulatory policymakers) are not sufficiently analyzed. Several claims are made without adequate references or supporting data. The manuscript suggests that its five-phase guide will streamline surgical technology adoption, but no real-world validation or case studies are provided to support this assertion. The manuscript lacks a clear logical flow, with certain sections appearing repetitive. Some technical terms are used inconsistently, and key concepts are introduced without proper definitions. The writing style is verbose and overly descriptive, making it difficult to follow key arguments. The manuscript lacks a formal limitations section, which is necessary given the speculative nature of the proposed framework. There is no discussion of global comparisons - how does Australia’s regulatory landscape compare with other countries? The authors repeatedly mention financial barriers but provide no quantitative cost analysis to support claims. Based on the above concerns, I cannot recommend this manuscript for publication in its current form. A substantial revision is required, including:

• A more rigorous and structured methodological approach to the literature review.
• A clearer articulation of the study’s novel contribution.
• A deeper, evidence-based analysis of the barriers, including perspectives from various stakeholders.
• A more concise and structured presentation of findings.

Without these major improvements, the manuscript does not meet the standards of a high-impact scientific publication. Comments on the Quality of English Language

None

Author Response

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