Scaling robotic surgery: the role, responsibilities and challenges of robotic proctorship in colorectal surgery

The adoption of robotic-assisted surgery (RAS) in colorectal procedures is growing rapidly, driven by advancements in technology and recognition of its clinical benefits. The dissemination of RAS technology relies heavily on robotic proctors, who are tasked with training and guiding their peers in adopting these advanced techniques. Despite their critical role, there is limited understanding of the training, responsibilities, and challenges faced by robotic proctors. A qualitative study was conducted using focus groups to understand the experiences, challenges, and training approaches of robotic colorectal surgery proctors in the UK and Ireland. Established proctors were invited to participate in the focus groups and to share insights into their practices, training methods, and the current state of robotic proctorship. The data were analysed thematically using NVivo software. Ten expert robotic surgeons participated in our study, with the majority working with Intuitive Surgical^® platforms (n = 9, 90%). Over 60% had been robotic trainers for more than 6 years and 60% were considered high-volume proctors, having proctored over 30 surgeons, and conducted more than 20 proctored cases annually. Thematic analysis revealed eight interconnected themes: proctor selection, proctor responsibilities, proctored training, accreditation, challenges, industry-proctor partnerships, emerging technologies, and network and support. Robotic proctoring is essential for scaling RAS adoption, however, it is a complex arena, with significant gaps in training frameworks and support systems. Establishing standardised guidelines and professional support structures is critical to ensure consistency, quality, and safety in robotic surgical training.