Shakir, T;
Lingam, G;
Boal, M;
Chand, M;
Francis, N;
(2025)
Standardising robotic system setup: an international expert consensus.
Surgical Endoscopy
10.1007/s00464-025-12144-y.
(In press).
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Abstract
BACKGROUND: Robotic surgery has witnessed rapid growth and development, with a concomitant training requirement. However, educational methods can vary, for example, industry or clinician led. This can result in heterogeneous training. This study aimed to develop a standardised method for the setup and docking of a robotic platform through expert consensus. METHODS: A steering committee of robotic surgeons, surgical care practitioners, and industry representatives formulated initial statements for an online Delphi consensus. The process involved three rounds of voting, with consensus defined as over 80% agreement. Participants included members of societal robotics subcommittees and experienced robotic surgical mentors from 13 countries. The consensus statements were divided into five categories: pre-operative considerations, port placement, driving in and docking, instruments and changes, and undocking and driving out. RESULTS: 57 invitations, alongside a social media advertisement, resulted in 63 responses in round one. Rounds two and three had 54 and 52 responses, respectively (85.7% and 96.3% inter-round response rates). Respondents were from 13 countries, with 73% consultants/attendings, 19% surgical care practitioners/first assistants, and 8% fellows. 73% operate in multiple anatomical regions, primarily pelvic, lower, and upper abdominal. Most respondents had significant robotic experience, with 61.9% involved in over 500 cases. The importance of pre-operative considerations included the necessity of naming components, understanding vision cart functions, and emergency undocking procedures. Standardised port placement and docking techniques were established to ensure optimal access and safety. The use of reverse communication to ensure safety with instrument insertion and changes was emphasised with high levels of consensus. CONCLUSION: The consensus identified best practices in hardware knowledge, emergency undocking, port placement, docking, instrument handling, and undocking procedures. This aims to standardise training protocols and has the potential to form part of assessment and accreditation. Further research is required to validate these findings.
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