From expectations to experiences: a systematic review of patient and public perspectives on robotic surgery

The adoption of robotic-assisted surgery (RAS) provides opportunities for improved clinical and patient-reported outcomes. However, there are patient and public misconceptions regarding robotic surgery, its associated risks, and surgeon involvement. It is the surgical community's responsibility to empower and educate patients regarding emerging technologies to improve understanding and shared decision-making. This systematic review aimed to summarize the current understanding, perceptions, expectations, preferences, and experiences of patients and the public with RAS as identified in all primary quantitative, qualitative, and mixed-methods studies and across all surgical specialities. Using the PRISMA 2020 guideline, a mixed-methods systematic review was undertaken with searches conducted in Medline, Embase, and Cochrane Library databases from conception to November 2024. Each study was evaluated regarding its design and methodology. Data quality was reviewed in accordance with the Critical Appraisal Skills Programme Checklist for quantitative and qualitative data, respectively. A narrative synthesis was undertaken using the principles of content analysis to identify emerging themes. Of the 7889 references identified, twelve quantitative, four qualitative, and two mixed-methods studies were included, assessing 2789 patients and 1244 members of the public. All studies were retrospective and assessed cohorts across five specialities, including gynecology, colorectal, urology, orthopedic, and cardiothoracic surgery. Six themes were identified: factual knowledge, awareness, preference, perception and expectations, experiences, and willingness to pay. Patients and the public hold diverse views on robotic-assisted surgery, influenced by multiple factors and various misconceptions. Structured pre-operative education programs generally lead to high satisfaction rates, along with increased knowledge and awareness.