Prospective study of a structured robotic surgery training program in a public cancer hospital in Brazil

The implementation of robotic surgery represents a major advance for oncological surgical care, particularly in public health systems, but requires robust training and proctorship for established surgeons. To assess surgeon performance and clinical outcomes following a structured, proctored training program for robotic surgery in a Brazilian public cancer hospital. This prospective, randomized trial (ClinicalTrials.gov: NCT02292914, https://clinicaltrials.gov/ct2/show/NCT02292914 ) recruited 564 cancer patients (2014-2020) for either robotic (n = 326) or control (laparoscopic/open, n = 238) procedures. Sixteen surgeons (> 10 years oncology experience) underwent a standardized four-stage laboratory and perioperative proctored curriculum. Outcomes included operative duration, blood loss, lymph node yield, and intraoperative complications. Data were analyzed in IBM-SPSS v20.0 (chi-square, Fisher's exact, Mann-Whitney, paired t-test, GEE; p < 0.05). All surgeons completed the laboratory curriculum; eight met full operative certification criteria. Robotic procedures took longer than controls (mean 304.9 vs 259.1 min; p < 0.001), with significantly less blood loss (mean 266.2 vs 598.2 mL; p < 0.001). Lymph node yields and complication rates did not differ. Operative durations decreased with experience. Structured, proctored training enabled safe transition to robotic surgery in this high-volume public cancer center. The model is scalable and adaptable to other institutions and innovations in public hospitals.