Equivalent Certificate Training Program for Gynecologic Robotic Surgery: A Multicenter Feasibility Study

To evaluate the feasibility, safety, and short-term effectiveness of a society-led, proctor-guided Equivalent Certificate program designed to support the supervised initiation of robot-assisted gynecologic surgery in Japan.

A multicenter pilot program was conducted across four academic institutions. Fourteen surgeons without prior da Vinci console experience were enrolled. The training pathway included: (1) manufacturer-provided e-learning, on-site system training, and written assessment; (2) institution-based, proctor-supervised training with mandatory simulator proficiency (≥ 80 points across 10 tasks) and at least five bedside assistant cases; (3) standardized proctor evaluation of technical readiness using a 5-point Likert scale; and (4) post-case assessment following each surgeon's first console case. Upon completion of all requirements, participants received an equivalency-based Certificate of da Vinci System Training issued by Intuitive Surgical.

Eleven surgeons completed the full program and performed at least one robotic procedure. No intraoperative complications or proctor takeovers occurred. Proctor evaluations demonstrated satisfactory performance across all assessed skill domains, with mean scores ranging from 3.09 to 4.55 out of 5. Instrument insertion and exchange received the highest ratings (mean 4.55), while third-arm control showed relatively lower scores (mean 3.09), consistent with known early learning challenges. The overall composite score was 3.79, indicating performance approaching a "well done" level under supervised conditions.

This feasibility study suggests that a structured, society-led Equivalent Certificate program is a feasible and safe approach for the supervised introduction of robot-assisted gynecologic surgery. By integrating manufacturer-aligned education with institution-based proctor supervision and objective performance benchmarks, this framework may serve as a complementary training pathway as robotic surgery education continues to evolve in Japan.