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

Abstract

The implementation of robot-assisted laparoscopic surgery (RALS) requires structured educational models to ensure safety, efficacy, and procedural standardization. Among these, proctoring, where experienced robotic surgeons support peers during their early procedures, plays a pivotal role. However, specific evidence in the current literature remains limited. This study aimed to evaluate the modalities, perceived value, and educational relevance of proctoring in RALS. A nationwide, five-part survey was administered to 16 Italian urologists who were proctored by a single experienced robotic surgeon across 100 consecutive procedures. Respondents represented diverse geographical areas and institutional settings. The questionnaire investigated demographics, general perceptions of proctoring, its role during the initiation of robotic programs and new procedures adoption, and previous surgical experience. Data were analyzed descriptively and visualized using Likert plots, heatmaps, and pie charts. All surgeons rated the proctor's physical presence as critical, especially during early cases and new robotic procedures. Proctoring was considered essential for enhancing surgical safety, standardizing techniques, improving operative time management, and fostering effective team dynamics. It was highly valued for developing technical skills. Additional elements such as face-to-face interaction, preoperative planning, and dual-console availability were seen as valuable. The suggested number of proctored cases was 10-20 for initial training and 5-10 for new procedures. Limitations include small sample size and self-reported data. Structured proctoring is essential for safe and consistent RALS education. In-house mentorship programs should be systematically integrated into robotic surgery pathways to support autonomy and institutional consistency.

Keywords: Proctoring; Robot assistance; Robotic platform; Telesurgery; Urology.