Robotic thoracic surgery training in the UK and Republic of Ireland: national survey of trainee exposure, preparedness, and barriers

Robotic-assisted thoracic surgery (RATS) is increasingly being incorporated into contemporary practice across the United Kingdom (UK) and Republic of Ireland (ROI). However, national data on trainee exposure and preparedness is lacking. This study is the first to evaluate cardiothoracic trainees' experiences and perceptions of training for RATS nationally. A multicentre, cross-sectional survey study was conducted between June and October 2025 of cardiothoracic trainees (ST1-ST8), post-certificate fellows, and equivalent trust appointed doctors. A 30-item, web-based questionnaire assessed institutional exposure, simulation access, operative console experience, and perceived barriers to RATS training. Quantitative data were analysed using descriptive statistics; while free-text responses underwent inductive thematic analysis. Eighty-two responses were received from all 14 training deaneries. RATS was performed in 71% (58/82) of respondents' units; however only 16% (9/58) reported a structured training programme in place. Dual console systems were absent or unused in 43% (25/58) of robotic units. Over half (54%, 32/59) of respondents had not fully performed a single RATS procedure. Most respondents (83%, 68/82) agreed that more robotic training is required before the completion of training. Key barriers to training included lack of dual-console utilisation, operative exposure limited to bedside assisting only, and restricted simulation access. Despite widespread adoption of RATS, opportunities for structured training remain inconsistent across the UK and ROI. National standards should be developed to incorporate structured robotic training within the cardiothoracic curriculum, including access to simulation, routine dual-console use, and competency-based progression from bedside assistant to primary operator.