Multiple perceptions of robotic-assisted surgery among surgeons and patients: a cross-sectional study

The general public's perception of robotic surgery - A scoping review

INTRODUCTION

Robotic surgery is typically characterized by the telemanipulation of robotic arms controlled by a surgeon via a command system. Medical technology advancements have caused variations in how robotic surgery is conceptualised. It is important to ascertain the public's perception of robotic surgery, as this impacts decision making.

METHODS

A study protocol was developed in accordance with the PRISMA guidelines. All original research articles, abstracts, conference proceedings or grey literature were eligible. The Medline (Pubmed), Scopus, and Cochrane Databases, Google Scholar, white and green statement papers, and international guidelines were searched. A preliminary search identified key terms. Title and abstract screening was conducted. Full texts were appraised for eligibility. An inductive extraction process was utilized, grouping data into themes by content analysis, and developing a coding framework. Heterogeneity limited pooling of data and prevented aggregated data analysis. Therefore, NVivo software was used to augment this qualitative process and develop a meta-synthesis.

RESULTS

The search yielded 8818 articles across the bibliographic databases. After inclusion of the grey literature 132 full text manuscripts were assessed. 35 of which were included. Three main themes were identified from the coding framework: understanding of robotic surgery, acceptance of robotic surgery, and perceptions of robotic surgery. Micro-construct subthemes included 'understanding of robotic autonomy, surgeon role, and outcomes', 'determinants of understanding', 'sources of information', 'intention to use', and 'determinants of acceptance'. Robotic surgery is perceived as a risky modality by the general public. They have a limited understanding of this surgical approach and the extent of autonomy a robotic system has. Sex, age, and residence are important factors effecting the degree of understanding and intention to undergo robotic surgery.

CONCLUSION

Robotic surgery is perceived as a risky procedure by the general public. They have limited understanding of the modality, and low rates of acceptance to undergo it fearing greater complications.

The era of telesurgery: insights from ultra-long-distance Asia to Middle East human telesurgery robotic assisted radical prostatectomy

To show the feasibility of performing human telesurgery robotic-assisted radical prostatectomy (RARP) between two countries using low-latency ultra-long-distance connectivity. This study described the outcomes of performing RARP on a man in his 60's with localized intermediate-risk prostatic adenocarcinoma located in Kuwait City while the surgeon (SA) was approximately 7000 kilometers (Km) away at Toumai robotic surgical system (TRSS) headquarters in Shanghai. Operative and connectivity details were reported. RARP was performed in December 2024. There were no major clinical or technical problems encountered during the procedure. The average round-trip latency (RTL) was 181.4 milliseconds (ms) using fiber optic broadband network with 5G network as back-up. On the Shanghai end two wired broadband networks were employed as back-up to ensure patient safety. There was an experienced fellowship-trained robotic surgeon (AA) in the operating room in Kuwait capable of taking over in case of clinical or connectivity issues. There were no reported complications. The patient was discharged on postoperative day (POD) 2. Final pathology described Gleason score 7(3 + 4), ISUP 2, and negative surgical margins (pT2Nx). The catheter was removed on POD 9, and the patient was continent a week later. His serum prostate specific antigen (PSA) was undetectable seven weeks post-operatively. This study described the feasibility of human RARP telesurgery between two countries using low-latency, long-distance fiber optic broadband network with 5G network as back-up with successful clinical outcomes. There is a need to establish robust legal and regulatory framework to allow wider international expansion of telesurgery.

What Patients Think About Robot-Assisted Surgery: Lessons to Learn from the Awareness and Perception Study in Mumbai

Background

We attempt to understand our patients' awareness and perception about robot-assisted surgery (RAS), to be able to educate them better and help them make informed decisions.

Methods

Patients who visited the Obstetrics & Gynaecology out-patient department were given questionnaires. Two hundred and sixty-two completed questionnaires were analysed.

Results

Comfort with technology was significantly associated with the patients' knowledge of the robot's appearance. Correct identification of the meaning of RAS, the surgeon's role, and appearance of the robot were also individually associated with preference towards RAS. Those who had undergone RAS before favoured it significantly more than those who did not have a history of RAS.

Conclusion

Counselling is important to help patients get over misinformation. Patients need to be explained that the robot does not have autonomy. The three main concepts to be focused on are-meaning of robotic surgery, surgeon's position/role during the surgery, and appearance of the robot. Limitations also need to be discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13224-023-01927-9.

Knowledge, Attitude, Awareness, and Future Expectations of Robotic Surgery in Patients Attending Surgical Specialties Clinics

Introduction The use of robotic-assisted surgeries (RAS) has been growing in surgical specialties. It allows surgeons to perform higher-quality operations with fewer complications, mortality, and morbidity. However, there are a lot of misconceptions about RAS among patients. Therefore, our study aimed to assess the knowledge, attitude, awareness, and future expectations of RAS in patients attending surgical clinics. Methods  A cross-sectional study was conducted in King Abdulaziz Medical City (KAMC) surgical clinics in Riyadh, Saudi Arabia. All participants <18 years of age were excluded. The questionnaire was distributed to 304 patients attending surgical clinics with a confidence level of 95% and a margin of error of 5%. Cluster sampling was used since the respondents were from multiple surgical specialties. Finally, multivariate analysis was performed to assess participants' preference for robotic surgery. Results Most participants (58.6%, n=178) were between 21 and 40 years old, and males were 52% of the participants. Many respondents thought a robot did not do the surgery. 70.7% of respondents had not heard of robotic surgery, with the media being the most common source of information. Internal damage was the prevalent concern (51.0%, n= 155) in malfunctions of robotic surgery. A significant relationship was found between participants from 21 to 40 years of age and a stronger preference for robotic surgery (p=.027). Respondents who preferred robotic surgery were discovered to have a significant relationship with participants who thought robotic surgery was safer and had better results (p<.001). 13.9% of participants who did not prefer robotic surgery also took cost into account significantly (χ2=28.93, p<.001, Cramer's V=.22). 67.2% (n=43) of respondents who preferred robotic surgery believed it might eventually replace present practices. Conclusion Our study concluded that the majority did not favor or were unsure whether to undergo robotic surgeries or not. However, most participants had some misconceptions and a lack of awareness about robotic surgeries. Raising awareness among patients can improve the mutual decision-making between them and their treating physician.

Robotic assisted surgery in the United Arab Emirates: healthcare experts' perceptions

The adoption of Robotic Assisted Surgery (RAS) has grown around the world. This is also the case in the Middle East and Gulf region and specifically to the United Arab Emirates (UAE). The perception of RAS has been studied in the USA, Europe, and Canada. However, there is limited research on the perception of RAS in the UAE. The study aims to examine the perception of RAS among healthcare experts in the UAE and potential challenges. This qualitative study is based on interviewing healthcare experts in the UAE. Most of the study participants were clinicians and surgeons. In the UAE, RAS is adopted in general surgery, urology, brain surgery, and obstetrics and gynecology. Our findings show that healthcare experts have positive perceptions of RAS. The cost and lack of RAS training program are considered as challenges to adopting RAS in healthcare practices. More research is encouraged to examine perception variations with surgical practices in the UAE, Gulf and the Middle East.

Reliability of YouTube videos on robotic spine surgery for patient education

BACKGROUND

Robotic surgical systems developed to improve spine surgery accuracy. Studies have found significant reductions in screw revisions and radiation exposure with robotic assistance compared with open surgery. YouTube is the largest online video platform for medical education. Therefore, there is a need for the continuous critical assessment of healthcare-related YouTube videos. Our objective is to assess the reliability of YouTube videos on robotic spine surgery for patient education.

METHODS

In April of 2022, YouTube was queried for the following keywords: "Robotic Spine Surgery". The "Relevance-Based Ranking" filter was applied, and the first 3 result pages were considered. Videos had to be uploaded by universities or hospitals and be in the English. Three independent healthcare personnel evaluated the videos' education quality using the DISCERN tool.

RESULTS

Our study found that 33 % of videos analyzed scored above a 3 on the DISCERN scoring scale (considered a ''good" video), with overall mean DISCERN score of 2.8 ± 1.3 (SD). The duration of videos was significantly different between the two groups (Good = 16 min ± 21 vs Unhelpful = 4 min ± 4, p = 0.01). In the helpful group, other characteristics were number of views (16331 ± 31308), likes (88 ± 168) and dislikes (5 ± 8). No statistically significant differences were observed compared to the unhelpful group: number of views (6515 ± 9074; P = 0.20), likes (39 ± 55; P = 0.21) and dislikes (3 ± 4; P = 0.33).

CONCLUSION

Our study shows that YouTube videos on robotic spine surgery lack accuracy and have poor educational value. There should be increased institutional oversight to combat the spread of misinformation.

Learning Curves in Pediatric Robot-Assisted Pyeloplasty: A Systematic Review

Background: Robot-assisted surgery demands a specific skillset of surgical knowledge, skills, and attitudes from the robotic surgeon to function as part of the robotic team and for maximal utility of the assistive surgical robot. Subsequently, the learning process of robot-assisted surgery entails new modes of learning. We sought to systematically summarize the published data on pediatric robot-assisted pyeloplasty (pRALP) to decipher the learning process by analyzing learning curves. Methods: This review followed the PRISMA guidelines. PubMed, EMBASE, Web of Science, and Scopus databases were systematically searched for ‘learning curve’ AND ‘pediatric pyeloplasty’. All studies presenting outcomes of learning curves (LC) in the context of pRALP in patients < 18 years of age were included. Studies comparing LC in pRALP versus open and/or laparoscopic pyeloplasty were also included; however, those solely focusing on LC in non-robotic approaches were excluded. The methodological quality was assessed using the Newcastle and Ottawa scale. Results: Competency was non-uniformly defined in all fifteen studies addressing learning curves in pRALP. pRALP was considered safe at all stages. Proficiency in pRALP was reached after 18 cases, while competency was estimated to demand 31 operated cases with operative duration as outcome variable. Conclusions: Pediatric RALP is safe during the learning process and ‘learning by doing’ improves efficiency. Competencies with broader implications than time must be defined for future studies.

Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis: A case report and review of literature

BACKGROUND

Situs inversus totalis (SIT) is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart, liver, spleen, and stomach. Herein, we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.

CASE SUMMARY

A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen, accompanied by jaundice and staining of the sclera as chief complaints. Imaging examination detected a mass at the distal end of the common bile duct, with inverted thoracic and abdominal organs. Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma. The patient successfully underwent robotic-assisted pancreaticoduodenectomy; the operation lasted 300 min, the intraoperative blood loss was 500 mL, and there were no intraoperative and postoperative complications.

CONCLUSION

SIT is not directly related to the formation of cholangiocarcinoma. Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection. Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe, feasible, minimally invasive, and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.