Gaba Faiza, Ash Karen, Blyuss Oleg, Chandrasekaran Dhivya, Nobbenhuis Marielle, Ind Thomas, Brockbank Elly
Department of Gynaecological Oncology, University College Hospital, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK.
Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK.
Diseases. 2025 Jan 6;13(1):9. doi: 10.3390/diseases13010009.
BACKGROUND/OBJECTIVES: For healthcare institutions developing a robotic programme, delivering value for patients, clinicians, and payers is key. However, the impact on the surgeon, training pathways, and logistics are often overlooked. We conducted a study on the impact of robotic surgery on surgeons, access to robotic surgical training, and factors associated with developing a successful robotic programme.
In our international mixed-methods study, a customised web-based survey was circulated to gynaecological oncologists. The Wilcoxon rank-sum test and Fisher's exact test, tested the hypothesis of the differences in continuous and categorical variables. Multiple linear regression was used to model the effect of variables on outcomes adjusting for gender, age, and postgraduate experience. Outcomes included situational awareness, surgeon fatigue/stress, and the surgical learning curve. Qualitative data were collected via in-depth semi-structured interviews using an inductive theoretical framework to explore access to surgical training and logistical considerations in the development of a successful robotic programme.
In total, 94%, 45%, and 48% of survey respondents (n = 152) stated that robotic surgery was less physically tiring/mentally tiring/stressful in comparison to laparoscopic surgery. Our data suggest gender differences in the robotics learning curve with men six times more likely to state robotic surgery had negatively impacted their situational awareness in the operating theatre (OR = 6.35, ≤ 0.001) and 2.5 times more likely to state it had negatively impacted their surgical ability due to lack of haptic feedback in comparison to women (OR = 2.62, = 0.046). Women were more risk-averse in case selection, but there were no self-reported differences in the intra-operative complication rates between male and female surgeons (OR = 1, = 0.1). In total, 22/25 robotically trained surgeons interviewed did not follow a structured curriculum of learning. Low and middle income country centres had less access to robotic surgery. The success of robotic programmes was measured by the number of cases performed per annum, with 74% of survey respondents stating that introducing robotics increased the proportion of surgeries performed by minimal access surgery. There was a distinct lack of knowledge on the environmental impact of robotic surgery.
Whilst robotic surgery is considered a landmark innovation in surgery, it must be responsibly implemented through effective training and waste minimisation, which must be a key metric in measuring the success of robotic programmes.
背景/目标：对于开展机器人手术项目的医疗机构而言，为患者、临床医生和付款人创造价值是关键。然而，机器人手术对外科医生、培训途径和后勤保障的影响常常被忽视。我们开展了一项关于机器人手术对外科医生的影响、机器人手术培训的获取情况以及与成功开展机器人手术项目相关因素的研究。
在我们的国际混合方法研究中，向妇科肿瘤学家发放了一份定制的基于网络的调查问卷。采用Wilcoxon秩和检验和Fisher精确检验来检验连续变量和分类变量差异的假设。使用多元线性回归对变量对结局的影响进行建模，并对性别、年龄和研究生经历进行校正。结局包括态势感知、外科医生疲劳/压力以及手术学习曲线。通过深入的半结构化访谈收集定性数据，采用归纳理论框架来探讨获取手术培训的情况以及成功开展机器人手术项目中的后勤保障考虑因素。
总共94%、45%和48%的调查受访者（n = 152）表示，与腹腔镜手术相比，机器人手术在体力上/精神上更不累/压力更小。我们的数据表明，在机器人手术学习曲线方面存在性别差异，男性表示机器人手术对其在手术室的态势感知产生负面影响的可能性是女性的6倍（OR = 6.35，P≤0.001），表示由于缺乏触觉反馈机器人手术对其手术能力产生负面影响的可能性是女性的2.5倍（OR = 2.62，P = 0.046）。女性在病例选择上更倾向于规避风险，但男性和女性外科医生自我报告的术中并发症发生率没有差异（OR = 1，P = 0.1）。总共22/25名接受机器人手术培训的外科医生在接受访谈时表示没有遵循结构化的学习课程。低收入和中等收入国家的中心获取机器人手术的机会较少。机器人手术项目的成功通过每年开展的病例数来衡量，74%的调查受访者表示引入机器人手术增加了微创手术的比例。明显缺乏关于机器人手术对环境影响的知识。
虽然机器人手术被认为是外科手术中的一项里程碑式创新，但必须通过有效的培训和最大限度减少浪费来负责任地实施，而这必须是衡量机器人手术项目成功与否的关键指标。
