Proctoring in robot-assisted urologic surgery: insights from a multicenter survey

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robot-assisted laparoscopic surgery (RALS) implementation necessitates structured educational frameworks for safety and standardization.
• Proctoring, a form of peer mentorship by experienced surgeons, is vital for RALS but lacks extensive evidence.
• Limited literature exists on the specific modalities, perceived value, and educational impact of proctoring in RALS.

Purpose of the Study:

• To evaluate the modalities and perceived educational value of proctoring in robot-assisted laparoscopic surgery (RALS).
• To assess the role of proctoring in initiating RALS programs and adopting new robotic procedures.
• To determine optimal proctoring case numbers for initial training and new procedure introduction.

Main Methods:

• A nationwide, five-part survey was distributed to 16 Italian urologists undergoing proctoring.
• Proctoring involved a single experienced robotic surgeon overseeing 100 consecutive procedures.
• Data analysis included descriptive statistics and visualizations (Likert plots, heatmaps, pie charts).

Main Results:

• All surveyed surgeons deemed the proctor's physical presence critical, particularly in early and new procedure cases.
• Proctoring was essential for improving surgical safety, technique standardization, operative time, and team dynamics.
• Proctoring was highly valued for technical skill development, with face-to-face interaction and preoperative planning also beneficial.

Conclusions:

• Structured proctoring is indispensable for safe and consistent RALS education.
• In-house mentorship programs should be integrated into robotic surgery training pathways.
• Systematic proctoring supports surgeon autonomy and institutional consistency in RALS.