Access, training, and perceived barriers to robotic surgery in gynecologic practice: findings from a cross-sectional survey of Latin American surgeons.

Objective

This study aimed to evaluate access to robotic platforms, training pathways, cumulative robotic surgical experience, perceived barriers, and factors associated with self-reported technical confidence among gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin America.

Methods

This was an observational, cross-sectional survey conducted over 4 weeks using an electronic questionnaire. Gynecologists, gynecologic oncologists, and oncologic surgeons treating gynecologic tumors in Latin American countries were recruited through professional networks and organizations, with subsequent snowball sampling.

Results

A total of 210 responses were analyzed, with the majority from Brazil (81.4%) and from practitioners working in private or mixed health care settings (95.7%). Access to robotic platforms was reported by 88.6% of respondents, mainly involving da Vinci Xi (68.6%) and da Vinci X (57.1%) systems. Training pathways were heterogeneous, including postgraduate programs (27.6%) and industry-sponsored courses (27.1%). In multivariable analysis, cumulative robotic surgical experience and perceived training adequacy were independently associated with technical confidence. For the animal model training variable, both participants with formal training without animal model exposure and those with animal model training reported higher technical confidence compared with participants with no formal training. Specific training modalities, such as simulation hours or fellowships, were not independently associated with technical confidence after adjustment. Economic barriers were nearly universal, with 91.4% identifying costs and insurance denial as the primary obstacle to implementation. Furthermore, 76.7% of respondents perceived access as highly concentrated in major urban centers.

Conclusions

Among the surveyed gynecologic professionals, access to robotic surgery platforms was commonly reported, although perceived access remained limited by financial and geographic disparities. Support for structured training is widespread, but cumulative operative experience appears to be the key factor associated with technical confidence.