A national cross-sectional analysis of stakeholder views regarding the practice and governance of robotic surgery

The study objective was to explore the views of key national stakeholders regarding the practice and governance of robotic surgery in Ireland. A literature review and analysis by two expert robotic surgeons was used to design a customised questionnaire, interrogating respondent perceptions of key robotic surgical areas, including surgical practice, governance, audit and key performance indicators (KPIs). The questionnaire was disseminated via specialty representatives, inviting responses from robotic surgeons, senior trainees, bedside assistants, clinical nurse managers, hospital management and industry partners. The responses were compiled and analysed, with thematic analysis applied to free-text data. Responses were received from 87 stakeholders, with representation from all invited professional groups, surgical specialties and national geographical regions. The largest respondent cohort was consultant robotic surgeons (n = 61); estimated response rate 76.3%. Most respondents were in favour of proctorship/mentorship arrangements for early-career surgeons, with support expressed for external proctors (80.5%, n = 70), internal proctors (88.5%, n = 77) and peer-to-peer mentoring (87.4%, n = 76). The minimum average number of robotic cases necessary for a trained surgeon to maintain competency was most frequently perceived as 1 per fortnight (39.3%, n = 24), or 1 per week (37.7%, n = 23). The recording of KPIs was believed to be important at both unit level [93.1% (n = 81) agree] and surgeon level (94.3% (n = 82) agree). Ninety-five percent of respondents (n = 83), thought institutions should have robotic governance committees. Strong support [83.9% (n = 73)] was expressed for the creation of a national guideline or governance document for the practice of robotic surgery. This national, pan-specialty robotic surgery stakeholder survey is the first of its kind. It identifies strong national support for continued advances in the training and governance of robotic surgery, with consensus for institutional oversight of robotic surgery and the development of a national guidelines for the conduct of robotic surgery.