Evaluation of robotic exposure among gynecological surgeons: results of survey from the Young European Advocates of Robotic Surgery (YEARS)

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A cross-sectional survey consisting of a 28-item online questionnaire was developed and disseminated through the social media channels of the Young European Advocates of Robotic Surgery (YEARS) and the Society of European Robotic Gynaecological Surgery (SERGS). Eligible participants included gynecologists with exposure to robotic surgery who were either (1) still in specialty training or (2) within three years of completing their postgraduate training or fellowship. The questionnaire collected sociodemographic information, details on surgical experience, access to robotic platforms, and self-perceived confidence in different surgical approaches. Main results A total of 81 respondents completed the survey. Among the 63 surgeons with access to robotic surgery at their institutions, 29 reported high self-perceived confidence and 36 reported lower confidence. Factors associated with higher confidence included age >35 years (51.8% vs. 33.3%; p<0.001) and having received structured robotic training through a fellowship or industry-sponsored course (40.7% vs. 19.4%; p=0.017). Departments performing ≥55 robotic procedures per year showed a greater likelihood of hosting surgeons with high confidence. Finally, age >35 years and access to at least one dedicated robotic operating day per week was independently associated with higher confidence. Conclusion Self-perceived confidence in robotic surgery among early-career gynecologic surgeons appears to be associated with age, and regular access to robotic operating time. Robotic surgery gynecology young surgeons surgical confidence Figures Figure 1 Figure 2 INTRODUCTION Gynecologic surgery has undergone a substantial technological evolution in recent decades, largely driven by the increasing global adoption of robotic platforms. More than two decades have passed since the first reported robotic-assisted hysterectomy in 2002 ( 1 ). Since then, the use of robotic surgery has expanded steadily across both high-income ( 2 ) and low- and middle-income countries ( 3 ). This trend contrasts with a documented decline in overall gynecologic surgical volume. For example, the incidence of hysterectomy in Denmark decreased from 362.9 per 100,000 person-years in 2000 to 307.1 in 2015 ( 4 ) while hysterectomy prevalence in the United States has remained stable or slightly decreased over recent years ( 5 ). This discrepancy of growing implementation of high-technology surgical platforms and reduced operative volumen, has raised concerns regarding the adequacy of surgical training for young gynecologists. Recent studies have reported reduced exposure to core gynecologic procedures during training. A national Irish survey of gynecology trainees showed a significant decline in confidence to perform abdominal and vaginal hysterectomies when comparing cohorts from 2014 and 2021 ( 6 ). Likewise, data from the Australian Institute of Health and Welfare showed a reduction in major gynecologic procedures performed between 2013 and 2018, including laparotomies, vaginal hysterectomies, and continence surgeries ( 7 ). Trainees performed fewer than 12 major gynecologic procedures per year on average raising concerns about potential implications for surgical safety and outcomes ( 8 ). Despite the rapid expansion of robotic technology, there is limited published data describing the level of exposure to robotic surgery and the availability of structured training opportunities for early-career gynecologic surgeons in Europe. Understanding these patterns and their influence in self-perceived confidence may indicate how prepared surgeons feel and may help reveal gaps in training. Identifying which factors are associated with higher confidence can therefore provide insight into potential inequalities in access, surgical volume, and training pathways that influence a surgeon’s readiness to perform robotic procedures independently. In this context, the Young European Advocates of Robotic Surgery (YEARS) conducted a survey among early-career gynecologic surgeons across Europe to evaluate exposure to robotic surgery. The primary objective of this study was to identify factors associated with higher self-perceived confidence in performing robotic surgery. A secondary aim was to assess satisfaction with current surgical activity among young consultants. METHODS Study design and participants The YEARS Council developed a 28-item questionnaire following three rounds of expert consensus (Document S1). The target population consisted of early-career gynecologic surgeons with exposure to robotic surgery. Three inclusion criteria were defined for survey participation: ( 1 ) trainee/resident enrolled in a national obstetrics and gynecology training program; ( 2 ) gynecology clinical fellow; and ( 3 ) recent consultant (within the past 3 years) of a fellowship or sub-specialty training program. Survey structure The questionnaire collected sociodemographic data, information on surgical experience, access to robotic platforms, and exposure to different surgical approaches including questions about gynecologic surgical training and the surgical activity of both the respondent’s department and the individual surgeon. It also assessed satisfaction with current surgical activity and self-perceived confidence in performing robotic procedures. Most items used predefined response categories, although free-text fields were included where appropriate. This approach ensured respondent autonomy and improved data completeness. Once the survey was completed and submitted, responses were automatically stored in the repository. Respondents were not able to review or change their answers after submission. To avoid duplicate entries, responses were cross-checked for internal consistency and stored in a confidential repository accessible only to the study investigators. Recruitment and data collection The survey was hosted on SurveyMonkey and distributed through the social media accounts of YEARS and the Society of European Robotic Gynaecological Surgery (SERGS) inviting members to complete the 5-minute survey. When the survey was launched, the YEARS group had 65 registered members. Responses were accepted from December 2022 to September 2023, and all data were handled confidentially. This study was exempt from Institutional Review Board (IRB) approval as it involved an anonymous survey without collection of identifiable personal or clinical data. Preliminary results were shared in the annual SERGS conference in June 2023. Definition of confidence groups Among respondents working in departments with robotic activity, two confidence groups were defined: The High-Confidence Group: included surgeons who identified robotic surgery as their preferred approach and reported operating independently or with only minimal supervision. The Low-Confidence Group: included surgeons who preferred another surgical approach or who required consultant assistance or supervision when performing robotic procedures. Statistical analysis Descriptive and comparative statistics were applied to summarize the survey results. Student’s t -test and Chi-square ( χ² ) test were used to assess differences between continuous and categorical variables, respectively. The number of cases and percentages were presented for categorical variables while continuous variables are reported as median with range or mean with standard deviation (SD), depending on data distribution. Univariate and multivariate logistic regression models were performed to identify factors associated with higher surgical confidence. Odds ratios (OR) with 95% confidence intervals were reported. Statistical significance was set at p < 0.05. Additionally, a Receiver Operating Characteristic (ROC) curve was used to determine the optimal threshold for annual departmental robotic case volume associated with higher surgeon confidence. All analyses were conducted using SPSS version 25.0 (IBM Corp., Armonk, NY, 2018). RESULTS Participant Characteristics A total of 81 respondents completed the survey. Most participants (65.4%, n=53/81) were between 30 and 39 years of age, and the majority (70.4%, n=57/81) reported a primary interest in gynecologic oncology (Table 1). Of all respondents, 53.1% (n=43/81) were already practicing as consultants, while the remainder were still enrolled in a structured or unstructured training program. Among consultants, 9.3% (4/43) reported working in a different sub-specialty than the one they were trained in. Regarding robotic surgery training, 17.3% (n=14/81) had not received any formal education in robotic surgery, and 22.2% (n=18/81) perceived access to robotic training as difficult. Notably, robotic courses and webinars were the two preferred modalities for learning in 42% (n=34/81) and 49.4% (n=40/81) respectively. Finally, 80.3% (n=65/81) of respondents expressed strong interest in undertaking a robotic surgery observership. Table 1. Characteristics of respondents All (N=81) Respondent demographics and professional background Age, years (%) <30 8 (9.9%) 30-34 27 (33.3%) 35-39 26 (33.1%) ≥40 20 (24.6%) Gender (%) Female 44 (54.3%) Male 37 (45.7%) Level of experience (%) Currently, doing training program in gyn/obs 16 (19.8%) Currently, 1/2 half of fellowship 12 (14.8%) Currently, 2/2 half of fellowship 5 (6.2%) Working as a consultant < 4 years 43 (53.1%) Currently working in other competencies 4/43 (9.3% Others 5 (6.2%) Area of interest (%) Gynecology Oncology 57 (70.4%) Benign gynecology 18 (22.2%) Urogynecology 6 (7.4%) Subspecialty training program (%) Structured fellowship 33 (40.7%) Non-structured fellowship 25 (30.9%) Not enrolled in any subspecialty training program 21 (25.9%) NA 2 (2.5%) Learning resources for robotic surgery Robotic training (%) Fellowship 19 (23.5%) Local hospital course 11 (13.6%) Industry course 23 (28.4%) National or international society course 14 (17.3%) None 14 (17.3%) What learning tool do you usually access regarding robotics, (multiple choice question, %) Dedicated robotic on-site courses 34 (42%) Webinars 40 (49.4%) Society websites 27 (33.3%) Social media 12 (14.8%) Would you like to do a short observerships dedicated to robotic surgery? Extremely interested 37 (45.7%) Very interested 28 (34.6%) Low interested 15 (18.5%) NA 1 (1.2%) How is access to robotic learning tools in your opinion? Easy access 20 (24.7%) Moderate access, limited information 42 (51.9%) Difficult access 18 (22.2%) NA 1 (1.2%) Respondents’ Experience with Robotic Surgery Among the 81 respondents, 63 reported having robotic surgery available at their department and were included in the confidence analysis. Of these, 36.5% (23/63) had access to at least one dedicated robotic operating day per week. In contrast, 83.9% (52/62) indicated that their department performed robotic surgery at least weekly (Table 2). Only 17.7% (n=11/62) of surgeons reported being satisfied with their current frequency of exposure to robotic surgery. Overall, 46% (n=29/63) of respondents selected robotic surgery as their preferred surgical approach. Table 2. Surgical activity among young consultants or fellows with access to robotic platform All (63) Frequency of robotic surgery per department (%) 1 day per week 31 (49.3%) NA 1 (1.5%) Robotic research per department (%) Yes, prospective 33 (54%) Yes, retrospective 6 (9.5%) No 23 (36.5%) Robotic platform (%) Da Vinci Si 9 (14.3%) Da Vinci X 11 (17.4%) Da Vinci Xi 49 (77.8%) Hugo 4 (6.3%) Frequency of robotic surgery per young surgeon (%) 1 day per week 8 (12.8%) NA 1 (1.5%) Level of confidence as a main surgeon by any approach (%) High confidence: no need of supervision 26 (41.3%) Medium confidence: Assisted by fellows with some supervision 12 (19%) Low confidence: Assisted by a consultant 20 (31.7%) Low confidence: not ready as a main surgeon 5 (7.9%) Surgical approach of preference (multiple choice question, %) Open 21 (33.3%) Laparoscopy 23 (36.5%) Robotics 29 (46%) Not specified 10 (15.9%) Satisfaction regarding frequency as a main surgeon by robotics No, I am happy with my frequency 11 (17.5%) I would like to operate more often as a main surgeon 35 (55.6%) I would like to initiate surgeries as a main surgeon 16 (25.4%) NA 1 (1.5%) Surgeons who selected robotic surgery as their preferred approach and require “no” or “minimal supervision” when operating were classified into the High-Confidence Group (n=29), while those who preferred another approach or required consultant assistance were classified into the Low-Confidence Group (n=36) (Figure 1). Significant factors associated with high surgical confidence are shown in Table 3 and included being older than 35 years: 51.8% in the High-Confidence group vs. 33.3% in the Low-Confidence group (p<0.001), and having received robotic training during a fellowship or industry-sponsored course in 40.7% vs. 19.4% respectively, (p=0.017). Table 3. Comparison between high-confidence group vs low-confidence group operating by robotics. Univariate analysis. High confidence (27) Low confidence (36) p value Age (years, %) <0.001 < 35 years 4 (14.8%) 23 (63.9%) 35-39 years 14 (51.8%) 12 (33.3%) ≥ 40 9 (33.4%) 1 (2.8) Place of work 0.748 Tertiary University Hospital 21 (77.8) 26 (72.2) Tertiary No-University Center 3 (11.1) 6 (16.7) Private Hospital 3 (11.1) 4 (11.1) Area of interest (%) 0.955 Gyn-Oncoly 20 (74.1) 27 (75) Benign gynecology (endometriosis, fibroids…) 5 (18.5) 7 (19.4) Uro-Gynecology 2 (7.4) 2 (5.6) Subspecialty training program 0.680 Structured fellowship 12 (44.4) 13 (38.2) Non-structured fellowship 9 (33.3) 10 (29.4) Not enrolled in any training program 6 (22.2) 11 (32.4) Robotic training 0.017 During my fellowship 11 (40.7) 7 (19.4) Industry course 11 (40.7) 7 (19.4) National/International society course 2 (7.4) 5 (13.9) Local hospital course 2 (7.4) 8 (22.2) Robotic research per department? 0.462 Yes, prospective 17 (63) 17 (47.2) Yes, retrospective 2 (7.4) 4 (11.1) No 8 (29.6) 15 (41.7) Frequency of robotic surgery per department (%) 0.214 > 1 day per week 16 (59.3) 15 (41.7) 1 day per week 9 (33.3) 12 (34.3) < 1 day per week 2 (7.4) 8 (22.9) Robotic surgeries per year per department (median) 100 (10-450) 50 (10-300) 0.05 Frequency as main surgeon by robotics 1 day per week 6 (22.2) 2 (5.6) 1 day per week 13 (48.1) 2 (5.6) < 1 day per week 8 (29.6) 31 (88.6) Departments hosting high-confidence surgeons also demonstrated higher median annual robotic surgical volumes, 100 vs. 50 cases, (p=0.05). A ROC curve analysis identified 55 robotic procedures per year as the optimal threshold associated with higher levels of self-perceived confidence (AUC 0.655 [0.521–0.790], p=0.036; Figure 2). Notably, only 29.6% of surgeons in the high-confidence group operated robotically less than once per week, compared with 88.6% in the low-confidence group (p<0.001). The AUC for number of robotic surgeries per year is 0.655 (0.521-0.79) p 0.036 55 robotic surgeries per year has 77% of sensitivity 77% and 47% of specificity In the multivariate logistic regression model (Table 4), age >35 years and having access to at least one dedicated robotic operating day per week were independently associated with high surgical confidence. Table 4. Independent factors for high confidence to operate by robotics. Multivariate analysis OR 95% Confidence Interval p value Age (years, %) < 35 years Ref. 35-39 years 5.35 1.064 – 26.961 0.042 ≥ 40 52.58 3.882 – 712.216 0.003 Frequency as a main surgeon by robotics < 1 day per week Ref. 1 day per week 25.18 3.792 - 167.243 1 day per week 11.416 1.471 - 88.586 0.02 Robotic training Fellowship Ref. Industry course 0.142 0.009-2.208 0.163 National/International society course 0.306 0.043-2.167 0.236 Local hospital course 0.166 0.005-5.644 0.319 DISCUSSION To our knowledge, no previous studies have specifically evaluated the factors associated with self-perceived confidence in robotic surgery among early-career gynecologic surgeons. In this survey, higher confidence was associated with being older than 35 years and with regular exposure to robotic procedures, particularly access to at least one dedicated robotic operating day per week. These findings suggest that both cumulative surgical experience and consistent operative practice may contribute to increased confidence during the early stages of a surgeon’s career. Importantly, these associations should be interpreted as correlations rather than evidence of causality. Our results are consistent with previous studies evaluating preparedness in minimally invasive gynecologic surgery (MIGS). Trainees exposed to fellowship-trained MIGS surgeons report greater readiness for independent practice compared with those without such exposure ( 9 ). Other studies have shown that fellowship-trained MIGS surgeons achieve improved surgical outcomes compared with gynecologic oncologists or general gynecologists performing minimally invasive hysterectomies ( 10 )( 11 ). Conversely, a retrospective analysis of the impact of urogynecology fellowships on obstetrics and gynecology (OB/GYN) residency programs found that graduates from fellowship-affiliated institutions logged fewer cases overall compared with programs without such fellowships ( 12 ). Taken together, these findings highlight the complex relationship between training structure, surgical volume, and procedural autonomy ( 7 ). In our cohort, departments performing at least 55 robotic procedures per year were more likely to host surgeons reporting higher confidence. Although this threshold should be interpreted cautiously, it may reflect the minimum case volume required to provide trainees with a regular opportunity to participate in robotic surgery. This concept aligns with longstanding evidence linking surgical the quality of training and surgical volume. In fact, centralization of cases has been selected as a required criteria to offer a fellowship in gynecology oncology with the aim to guarantee an adequate surgical volume ( 13 ) which has been associated with improved outcomes ( 14 ). In addition, in an interesting survey by European Network of Young Gynaecologic Oncologists (ENYGO), fellows trained in an ESGO accredited centre had a higher chance to perform sentinel lymph node biopsy in cervical cancer ( 15 ). A broader perspective on the volume–outcome relationship is provided by a recent systematic review examining intra-abdominal robotic-assisted surgery. The review reported a positive association between institutional surgical volume and clinical outcomes across gynecologic, urologic, and general surgical procedures, although no consistent annual thresholds were identified in the literature ( 16 ). In a recent Swedish population-based registry study, it was observed that in low-volume hospitals (< 50 procedures/year) and medium-volume hospitals (50–100 procedures/year), laparoscopic hysterectomy was associated with a higher rate of intraoperative complications compared to robotic hysterectomy. Moreover, the study reported conversion rates of 2.2% in low-volume hospitals, 0.9% in medium-volume hospitals, and 0% in high-volume hospitals ( 17 ). These findings are consistent with the notion that surgical volume may impact the quality of outcomes and that this effect is likely more pronounced in the laparoscopic approach given the longer learning curve compared to robotic surgery ( 18 ). Such advantages together with improved ergonomics and enhanced visualization may help explain why robotic surgery was the preferred approach for 46% of respondents in our study. Structured robotic training, whether fellowship-based or industry-sponsored, was associated with higher confidence in the univariate analysis. It is reasonable to assume that the combination of both training modalities address both clinical and technical aspects, as previously demonstrated in the literature ( 19 ). In this context, surgical simulation has become an essential tool to complement operating room experience, leading to increased confidence and improved performance after structured practice ( 20 ) and it has been endorsed by several institutions not only by its proven educational benefits but also by the observed reduction in surgical volumes in training programs ( 21 )( 22 ). In this regard, significant efforts are underway by SERGS with the aim to develop a European consensus on core components of a curriculum for training and assessment in robot assisted gynecological surgery ( 23 )( 24 ) highlighting the importance of a structured training ( 19 ). Furthermore, there have been collaborative initiatives between the United States and Europe to develop Proficiency-based Progression Train-the-Trainer Courses for Robotic Surgery Training ( 25 ) which have proven to be an effective educational framework for gynecologic surgical trainees and robotic teams ( 26 ) ( 27 ). Despite 83.9% of departments performing robotic surgery at least once per week, only 37.1% of junior surgeons reported participating in robotic procedures with the same frequency. Limited access likely contributes to the low satisfaction rates observed in this study, with only 17.7% of participants expressing satisfaction with their current exposure. These findings mirror a recent national survey of ACGME-accredited OB/GYN residents in the United States, where 60% of trainees reported minimal hands-on robotic experience by the end of residency ( 28 ). An additional observation in our study was that 9.3% of consultants were practicing in a subspecialty different from their original training. While this might reflect a voluntary shift in professional interests, it may also indicate a disconnect between specialized training pathways and actual job availability, particularly in niche or low-volume fields such as urogynecology or gynecologic oncology. This potential mismatch may contribute to frustration among early-career specialists and merits further investigation. The relatively small sample size represents a key limitation, contributing to wide confidence intervals, particularly in multivariate analyses. This likely reflects the current limited exposure to robotic surgery among junior European gynecologic surgeons, with senior consultants still performing the majority of procedures. However, this dynamic is expected to shift in the near future, supported by the commitment to training among senior surgeons and the increasing availability of robotic platforms worldwide. We also observed a predominance of respondents with a specific interest in gynecologic oncology, which may reflect greater exposure to robotic surgery within this subspecialty. These findings are consistent with the longstanding tradition of robotic surgery in this field, as further demonstrated in a recent bibliometric study ( 29 ). Among 838 publications examined, 41.1% focused on gynecologic oncology, making it the most prevalent topic. These results call for caution when extrapolating our findings to other areas of interest. Despite these limitations, this study provides preliminary insights into current patterns of exposure and confidence in robotic surgery among young gynecologic surgeons in Europe. CONCLUSIONS Gynecologic robotic surgery is increasingly incorporated into surgical practice across Europe, yet access and exposure remain variable among early-career surgeons. In this survey, higher self-perceived confidence in performing robotic surgery was associated with being older than 35 years and with having regular access to robotic operating time, specifically at least one dedicated day per week. These findings highlight the potential importance of both cumulative experience and consistent operative exposure in developing confidence with robotic procedures. Given the nature of this study, these results should be interpreted cautiously. Nevertheless, they provide preliminary insights that may help guide future training strategies. Declarations Declaration of generative AI and AI-assisted technologies in the writing process During the preparation of this work the author(s) used ChatGPTÒ in order to translate certain paragraphs. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication. Author Contribution All authors contributed to the study conception and material preparation. Design, data collection and analysis were performed by Sergi Fernandez. The first draft of the manuscript was written by Sergi Fernandez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Diaz-Arrastia C, Jurnalov C, Gomez G, Townsend C (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc Other Interv Tech 16(9):1271–1273 Glent JCF, Thorgersen EB (2024) Current status and outlook of robotic surgery in the Nordic countries. Scand J Surg 113(1):28–30 Sinha R, Jain V, SP S, Saha SC, Sunkavalli C, Kiran L et al (2023) Multi-Institutional Trends in Gynecological Robotic Surgery in India: A Real-World Scenario. 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Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 11 Feb, 2026 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 29 Dec, 2025 Reviews received at journal 28 Dec, 2025 Reviewers agreed at journal 28 Dec, 2025 Reviewers agreed at journal 27 Dec, 2025 Reviewers agreed at journal 25 Dec, 2025 Reviewers agreed at journal 25 Dec, 2025 Reviewers agreed at journal 25 Dec, 2025 Reviewers invited by journal 16 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Submission checks completed at journal 08 Dec, 2025 First submitted to journal 07 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Fernandez-Gonzalez","email":"data:image/png;base64,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","orcid":"","institution":"Bellvitge University Hospital (IDIBELL), Hospitalet de Llobregat","correspondingAuthor":true,"prefix":"","firstName":"Sergi","middleName":"","lastName":"Fernandez-Gonzalez","suffix":""},{"id":562045791,"identity":"feefb75f-770e-4bb2-8702-174e341e3e54","order_by":1,"name":"Dina El-Hamamsy","email":"","orcid":"","institution":"Royal London 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London","correspondingAuthor":false,"prefix":"","firstName":"Manou","middleName":"Manpreet","lastName":"Kaur","suffix":""},{"id":562045814,"identity":"926f73ac-4f12-4a49-80b6-229bd99e7392","order_by":8,"name":"Christina Uwins","email":"","orcid":"","institution":"University Hospital Southampton NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Christina","middleName":"","lastName":"Uwins","suffix":""}],"badges":[],"createdAt":"2025-12-07 23:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8302218/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8302218/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-026-03153-7","type":"published","date":"2026-02-11T15:57:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":98759740,"identity":"142844db-add9-4179-a7d1-7804b96b79d2","added_by":"auto","created_at":"2025-12-22 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1","display":"","copyAsset":false,"role":"figure","size":33321,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8302218/v1/46c5334e1d1625acdeb0ca39.jpg"},{"id":98780569,"identity":"8533f7dd-4140-496d-b1de-36ea5758c1f3","added_by":"auto","created_at":"2025-12-22 12:31:28","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32486,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for number of robotic surgeries per department per year\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8302218/v1/38c30e588d9bf2e0e6dfbc4a.jpg"},{"id":102785280,"identity":"8215f3cf-111f-4ce2-9d66-ca559299b522","added_by":"auto","created_at":"2026-02-16 16:04:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":871788,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8302218/v1/f5faf463-d289-4e3d-ad46-5351dc17fbfc.pdf"},{"id":98759738,"identity":"4b18f09a-6e59-4ed4-bf1a-bbd93eeceb88","added_by":"auto","created_at":"2025-12-22 09:51:03","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23036,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8302218/v1/b0b1ddb88eb30227ad4b5c85.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of robotic exposure among gynecological surgeons: results of survey from the Young European Advocates of Robotic Surgery (YEARS)","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eGynecologic surgery has undergone a substantial technological evolution in recent decades, largely driven by the increasing global adoption of robotic platforms. More than two decades have passed since the first reported robotic-assisted hysterectomy in 2002 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Since then, the use of robotic surgery has expanded steadily across both high-income (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and low- and middle-income countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). This trend contrasts with a documented decline in overall gynecologic surgical volume. For example, the incidence of hysterectomy in Denmark decreased from 362.9 per 100,000 person-years in 2000 to 307.1 in 2015 (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) while hysterectomy prevalence in the United States has remained stable or slightly decreased over recent years (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis discrepancy of growing implementation of high-technology surgical platforms and reduced operative volumen, has raised concerns regarding the adequacy of surgical training for young gynecologists. Recent studies have reported reduced exposure to core gynecologic procedures during training. A national Irish survey of gynecology trainees showed a significant decline in confidence to perform abdominal and vaginal hysterectomies when comparing cohorts from 2014 and 2021 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Likewise, data from the Australian Institute of Health and Welfare showed a reduction in major gynecologic procedures performed between 2013 and 2018, including laparotomies, vaginal hysterectomies, and continence surgeries (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Trainees performed fewer than 12 major gynecologic procedures per year on average raising concerns about potential implications for surgical safety and outcomes (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the rapid expansion of robotic technology, there is limited published data describing the level of exposure to robotic surgery and the availability of structured training opportunities for early-career gynecologic surgeons in Europe. Understanding these patterns and their influence in self-perceived confidence may indicate how prepared surgeons feel and may help reveal gaps in training. Identifying which factors are associated with higher confidence can therefore provide insight into potential inequalities in access, surgical volume, and training pathways that influence a surgeon\u0026rsquo;s readiness to perform robotic procedures independently. In this context, the Young European Advocates of Robotic Surgery (YEARS) conducted a survey among early-career gynecologic surgeons across Europe to evaluate exposure to robotic surgery. The primary objective of this study was to identify factors associated with higher self-perceived confidence in performing robotic surgery. A secondary aim was to assess satisfaction with current surgical activity among young consultants.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eThe YEARS Council developed a 28-item questionnaire following three rounds of expert consensus (Document S1). The target population consisted of early-career gynecologic surgeons with exposure to robotic surgery. Three inclusion criteria were defined for survey participation: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) trainee/resident enrolled in a national obstetrics and gynecology training program; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) gynecology clinical fellow; and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) recent consultant (within the past 3 years) of a fellowship or sub-specialty training program.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey structure\u003c/h3\u003e\n\u003cp\u003eThe questionnaire collected sociodemographic data, information on surgical experience, access to robotic platforms, and exposure to different surgical approaches including questions about gynecologic surgical training and the surgical activity of both the respondent\u0026rsquo;s department and the individual surgeon. It also assessed satisfaction with current surgical activity and self-perceived confidence in performing robotic procedures. Most items used predefined response categories, although free-text fields were included where appropriate. This approach ensured respondent autonomy and improved data completeness. Once the survey was completed and submitted, responses were automatically stored in the repository. Respondents were not able to review or change their answers after submission. To avoid duplicate entries, responses were cross-checked for internal consistency and stored in a confidential repository accessible only to the study investigators.\u003c/p\u003e\n\u003ch3\u003eRecruitment and data collection\u003c/h3\u003e\n\u003cp\u003eThe survey was hosted on SurveyMonkey and distributed through the social media accounts of YEARS and the Society of European Robotic Gynaecological Surgery (SERGS) inviting members to complete the 5-minute survey. When the survey was launched, the YEARS group had 65 registered members. Responses were accepted from December 2022 to September 2023, and all data were handled confidentially. This study was exempt from Institutional Review Board (IRB) approval as it involved an anonymous survey without collection of identifiable personal or clinical data. Preliminary results were shared in the annual SERGS conference in June 2023.\u003c/p\u003e\n\u003ch3\u003eDefinition of confidence groups\u003c/h3\u003e\n\u003cp\u003eAmong respondents working in departments with robotic activity, two confidence groups were defined:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe High-Confidence Group: included surgeons who identified robotic surgery as their preferred approach and reported operating independently or with only minimal supervision.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe Low-Confidence Group: included surgeons who preferred another surgical approach or who required consultant assistance or supervision when performing robotic procedures.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive and comparative statistics were applied to summarize the survey results. Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-test and Chi-square (\u003cem\u003eχ\u0026sup2;\u003c/em\u003e) test were used to assess differences between continuous and categorical variables, respectively. The number of cases and percentages were presented for categorical variables while continuous variables are reported as median with range or mean with standard deviation (SD), depending on data distribution. Univariate and multivariate logistic regression models were performed to identify factors associated with higher surgical confidence. Odds ratios (OR) with 95% confidence intervals were reported. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Additionally, a Receiver Operating Characteristic (ROC) curve was used to determine the optimal threshold for annual departmental robotic case volume associated with higher surgeon confidence. All analyses were conducted using SPSS version 25.0 (IBM Corp., Armonk, NY, 2018).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eParticipant Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 81 respondents completed the survey. Most participants (65.4%, n=53/81) were between 30 and 39 years of age, and the majority (70.4%, n=57/81) reported a primary interest in gynecologic oncology (Table 1). Of all respondents, 53.1% (n=43/81) were already practicing as consultants, while the remainder were still enrolled in a structured or unstructured training program. Among consultants, 9.3% (4/43) reported working in a different sub-specialty than the one they were trained in. Regarding robotic surgery training, 17.3% (n=14/81) had not received any formal education in robotic surgery, and 22.2% (n=18/81) perceived access to robotic training as difficult. Notably, robotic courses and webinars were the two preferred modalities for learning in 42% (n=34/81) and 49.4% (n=40/81) respectively. Finally, 80.3% (n=65/81) of respondents expressed strong interest in undertaking a robotic surgery observership.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 642px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Characteristics of respondents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eAll (N=81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u003cem\u003eRespondent demographics and professional background\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eAge, years (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e8 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e27 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e26 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026ge;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e20 (24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eGender (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e44 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e37 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLevel of experience (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eCurrently, doing training program in gyn/obs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e16 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eCurrently, 1/2 half of fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e12 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eCurrently, 2/2 half of fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e5 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eWorking as a consultant \u0026lt; 4 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e43 (53.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eCurrently working in other competencies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e4/43 (9.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e5 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eArea of interest (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eGynecology Oncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e57 (70.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eBenign gynecology\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e18 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eUrogynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e6 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eSubspecialty training program (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eStructured fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e33 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNon-structured fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e25 (30.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNot enrolled in any subspecialty training program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e21 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e2 (2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u003cem\u003eLearning resources for robotic surgery\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eRobotic training (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eFellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e19 (23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLocal hospital course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e11 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eIndustry course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e23 (28.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNational or international society course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e14 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e14 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eWhat learning tool do you usually access regarding robotics, (multiple choice question, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eDedicated robotic on-site courses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e34 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eWebinars\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e40 (49.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eSociety websites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e27 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e12 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eWould you like to do a short observerships dedicated to robotic surgery?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eExtremely interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e37 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eVery interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e28 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLow interested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e15 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eHow is access to robotic learning tools in your opinion?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eEasy access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e20 (24.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eModerate access, limited information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e42 (51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eDifficult access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e18 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e1 (1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eRespondents\u0026rsquo; Experience with Robotic Surgery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 81 respondents, 63\u0026nbsp;reported having robotic surgery available at their department and were included in the confidence analysis.\u0026nbsp;Of these, 36.5% (23/63) had access to at least one dedicated robotic operating day per week. In contrast, 83.9% (52/62) indicated that their department performed robotic surgery at least weekly (Table 2). Only 17.7% (n=11/62) of surgeons reported being satisfied with their current frequency of exposure to robotic surgery. Overall, 46% (n=29/63)\u0026nbsp;of respondents selected robotic surgery as their preferred surgical approach.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 642px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Surgical activity among young consultants or fellows with access to robotic platform\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eAll (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eFrequency of robotic surgery per department (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026lt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e10 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e21 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026gt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e31 (49.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eRobotic research per department (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eYes, prospective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e33 (54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eYes, retrospective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e6 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e23 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eRobotic platform (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eDa Vinci Si\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e9 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eDa Vinci X\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e11 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eDa Vinci Xi\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e49 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eHugo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e4 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eFrequency of robotic surgery per young surgeon (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026lt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e39 (61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e15 (23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003e\u0026gt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e8 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLevel of confidence as a main surgeon by any approach (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eHigh confidence: no need of supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e26 (41.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eMedium confidence: Assisted by fellows with some supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e12 (19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLow confidence: Assisted by a consultant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e20 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLow confidence: not ready as a main surgeon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e5 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eSurgical approach of preference (multiple choice question, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e21 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eLaparoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e23 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eRobotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e29 (46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNot specified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e10 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eSatisfaction regarding frequency as a main surgeon by robotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNo, I am happy with my frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e11 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eI would like to operate more often as a main surgeon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e35 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eI would like to initiate surgeries as a main surgeon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e16 (25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 404px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003e1 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSurgeons who selected robotic surgery as their preferred approach and require \u0026ldquo;no\u0026rdquo; or \u0026ldquo;minimal supervision\u0026rdquo; when operating were classified into the High-Confidence Group (n=29), while those who preferred another approach or required consultant assistance were classified into the Low-Confidence Group (n=36) (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSignificant factors associated with high surgical confidence are shown in Table 3 and included being older than 35 years: 51.8% in the High-Confidence group vs. 33.3% in the Low-Confidence group (p\u0026lt;0.001), and having received robotic training during a fellowship or industry-sponsored course in 40.7% vs. 19.4% respectively, (p=0.017).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 642px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Comparison between high-confidence group vs low-confidence group operating by robotics. Univariate analysis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eHigh confidence\u0026nbsp;\u003cbr\u003e\u0026nbsp;(27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLow confidence\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eAge (years, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026lt; 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e4 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e23 (63.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e14 (51.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e12 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026ge; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e9 (33.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003ePlace of work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.748\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eTertiary University Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e21 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e26 (72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eTertiary No-University Center\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e3 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e6 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003ePrivate Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e3 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eArea of interest (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.955\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eGyn-Oncoly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e20 (74.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e27 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eBenign gynecology\u0026nbsp;\u003cbr\u003e\u0026nbsp;(endometriosis, fibroids\u0026hellip;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e5 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eUro-Gynecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eSubspecialty training program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.680\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eStructured fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e12 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e13 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eNon-structured fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e9 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e10 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eNot enrolled in any training program\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e6 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eRobotic training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.017\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eDuring my fellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e11 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eIndustry course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e11 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eNational/International society course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eLocal hospital course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eRobotic research per department?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.462\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eYes, prospective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e17 (63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e17 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eYes, retrospective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e8 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e15 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eFrequency of robotic surgery per department (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.214\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026gt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e16 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e15 (41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e9 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e12 (34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026lt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e8 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eRobotic surgeries per year per department (median)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e100 (10-450)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e50 (10-300)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.05\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003eFrequency as main surgeon by robotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026gt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e6 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e13 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 273px;\"\u003e\n \u003cp\u003e\u0026lt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e8 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e31 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eDepartments hosting high-confidence surgeons also demonstrated higher median annual robotic surgical volumes, 100 vs. 50 cases, (p=0.05).\u0026nbsp;A ROC curve analysis identified\u003cstrong\u003e\u0026nbsp;\u003cstrong\u003e55 robotic procedures per year\u003c/strong\u003e\u0026nbsp;\u003c/strong\u003eas the optimal threshold associated with higher levels of self-perceived confidence (AUC 0.655 [0.521\u0026ndash;0.790], p=0.036; Figure 2). Notably, only 29.6% of surgeons in the high-confidence group operated robotically less than once per week, compared with 88.6% in the low-confidence group (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe AUC for number of robotic surgeries per year is 0.655 (0.521-0.79) p 0.036\u0026nbsp; 55 robotic surgeries per year has 77% of sensitivity 77% and 47% of specificity\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the multivariate logistic regression model (Table 4), age \u0026gt;35 years and having access to at least one dedicated robotic operating day per week were independently associated with high surgical confidence.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"645\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 645px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Independent factors for high confidence to operate by robotics. Multivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e95% Confidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003ep value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eAge (years, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026lt; 35 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; Ref.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e35-39 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; 5.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e1.064 \u0026ndash; 26.961\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.042\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026ge; 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; 52.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e3.882 \u0026ndash; 712.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eFrequency as a main surgeon by robotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026lt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; Ref.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 25.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e3.792 - 167.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026lt;0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026gt; 1 day per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;11.416\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e1.471 - 88.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.02\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eRobotic training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eFellowship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Ref.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eIndustry course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e0.009-2.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.163\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eNational/International society course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e0.043-2.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.236\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eLocal hospital course\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;0.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003e0.005-5.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003e0.319\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTo our knowledge, no previous studies have specifically evaluated the factors associated with self-perceived confidence in robotic surgery among early-career gynecologic surgeons. In this survey, higher confidence was associated with being older than 35 years and with regular exposure to robotic procedures, particularly access to at least one dedicated robotic operating day per week. These findings suggest that both cumulative surgical experience and consistent operative practice may contribute to increased confidence during the early stages of a surgeon\u0026rsquo;s career. Importantly, these associations should be interpreted as correlations rather than evidence of causality.\u003c/p\u003e \u003cp\u003eOur results are consistent with previous studies evaluating preparedness in minimally invasive gynecologic surgery (MIGS). Trainees exposed to fellowship-trained MIGS surgeons report greater readiness for independent practice compared with those without such exposure (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Other studies have shown that fellowship-trained MIGS surgeons achieve improved surgical outcomes compared with gynecologic oncologists or general gynecologists performing minimally invasive hysterectomies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Conversely, a retrospective analysis of the impact of urogynecology fellowships on obstetrics and gynecology (OB/GYN) residency programs found that graduates from fellowship-affiliated institutions logged fewer cases overall compared with programs without such fellowships (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Taken together, these findings highlight the complex relationship between training structure, surgical volume, and procedural autonomy (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our cohort, departments performing at least 55 robotic procedures per year were more likely to host surgeons reporting higher confidence. Although this threshold should be interpreted cautiously, it may reflect the minimum case volume required to provide trainees with a regular opportunity to participate in robotic surgery. This concept aligns with longstanding evidence linking surgical the quality of training and surgical volume. In fact, centralization of cases has been selected as a required criteria to offer a fellowship in gynecology oncology with the aim to guarantee an adequate surgical volume (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) which has been associated with improved outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In addition, in an interesting survey by European Network of Young Gynaecologic Oncologists (ENYGO), fellows trained in an ESGO accredited centre had a higher chance to perform sentinel lymph node biopsy in cervical cancer (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). A broader perspective on the volume\u0026ndash;outcome relationship is provided by a recent systematic review examining intra-abdominal robotic-assisted surgery. The review reported a positive association between institutional surgical volume and clinical outcomes across gynecologic, urologic, and general surgical procedures, although no consistent annual thresholds were identified in the literature (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In a recent Swedish population-based registry study, it was observed that in low-volume hospitals (\u0026lt;\u0026thinsp;50 procedures/year) and medium-volume hospitals (50\u0026ndash;100 procedures/year), laparoscopic hysterectomy was associated with a higher rate of intraoperative complications compared to robotic hysterectomy. Moreover, the study reported conversion rates of 2.2% in low-volume hospitals, 0.9% in medium-volume hospitals, and 0% in high-volume hospitals (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). These findings are consistent with the notion that surgical volume may impact the quality of outcomes and that this effect is likely more pronounced in the laparoscopic approach given the longer learning curve compared to robotic surgery (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Such advantages together with improved ergonomics and enhanced visualization may help explain why robotic surgery was the preferred approach for 46% of respondents in our study.\u003c/p\u003e \u003cp\u003eStructured robotic training, whether fellowship-based or industry-sponsored, was associated with higher confidence in the univariate analysis. It is reasonable to assume that the combination of both training modalities address both clinical and technical aspects, as previously demonstrated in the literature (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In this context, surgical simulation has become an essential tool to complement operating room experience, leading to increased confidence and improved performance after structured practice (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and it has been endorsed by several institutions not only by its proven educational benefits but also by the observed reduction in surgical volumes in training programs (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In this regard, significant efforts are underway by SERGS with the aim to develop a European consensus on core components of a curriculum for training and assessment in robot assisted gynecological surgery (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) highlighting the importance of a structured training (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Furthermore, there have been collaborative initiatives between the United States and Europe to develop Proficiency-based Progression Train-the-Trainer Courses for Robotic Surgery Training (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) which have proven to be an effective educational framework for gynecologic surgical trainees and robotic teams (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite 83.9% of departments performing robotic surgery at least once per week, only 37.1% of junior surgeons reported participating in robotic procedures with the same frequency. Limited access likely contributes to the low satisfaction rates observed in this study, with only 17.7% of participants expressing satisfaction with their current exposure. These findings mirror a recent national survey of ACGME-accredited OB/GYN residents in the United States, where 60% of trainees reported minimal hands-on robotic experience by the end of residency (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). An additional observation in our study was that 9.3% of consultants were practicing in a subspecialty different from their original training. While this might reflect a voluntary shift in professional interests, it may also indicate a disconnect between specialized training pathways and actual job availability, particularly in niche or low-volume fields such as urogynecology or gynecologic oncology. This potential mismatch may contribute to frustration among early-career specialists and merits further investigation.\u003c/p\u003e \u003cp\u003eThe relatively small sample size represents a key limitation, contributing to wide confidence intervals, particularly in multivariate analyses. This likely reflects the current limited exposure to robotic surgery among junior European gynecologic surgeons, with senior consultants still performing the majority of procedures. However, this dynamic is expected to shift in the near future, supported by the commitment to training among senior surgeons and the increasing availability of robotic platforms worldwide. We also observed a predominance of respondents with a specific interest in gynecologic oncology, which may reflect greater exposure to robotic surgery within this subspecialty. These findings are consistent with the longstanding tradition of robotic surgery in this field, as further demonstrated in a recent bibliometric study (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Among 838 publications examined, 41.1% focused on gynecologic oncology, making it the most prevalent topic. These results call for caution when extrapolating our findings to other areas of interest. Despite these limitations, this study provides preliminary insights into current patterns of exposure and confidence in robotic surgery among young gynecologic surgeons in Europe.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eGynecologic robotic surgery is increasingly incorporated into surgical practice across Europe, yet access and exposure remain variable among early-career surgeons. In this survey, higher self-perceived confidence in performing robotic surgery was associated with being older than 35 years and with having regular access to robotic operating time, specifically at least one dedicated day per week. These findings highlight the potential importance of both cumulative experience and consistent operative exposure in developing confidence with robotic procedures. Given the nature of this study, these results should be interpreted cautiously. Nevertheless, they provide preliminary insights that may help guide future training strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the preparation of this work the author(s) used ChatGPT\u0026Ograve; in order to translate certain paragraphs. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and material preparation. Design, data collection and analysis were performed by Sergi Fernandez. The first draft of the manuscript was written by Sergi Fernandez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDiaz-Arrastia C, Jurnalov C, Gomez G, Townsend C (2002) Laparoscopic hysterectomy using a computer-enhanced surgical robot. Surg Endosc Other Interv Tech 16(9):1271\u0026ndash;1273\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlent JCF, Thorgersen EB (2024) Current status and outlook of robotic surgery in the Nordic countries. Scand J Surg 113(1):28\u0026ndash;30\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinha R, Jain V, SP S, Saha SC, Sunkavalli C, Kiran L et al (2023) Multi-Institutional Trends in Gynecological Robotic Surgery in India: A Real-World Scenario. Cureus. ;15(3)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLycke KD, Kahlert J, Damgaard R, Mogensen O, Hammer A (2021) Trends in hysterectomy incidence rates during 2000\u0026ndash;2015 in Denmark: Shifting from abdominal to minimally invasive surgical procedures. Clin Epidemiol 13:407\u0026ndash;416\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarvey SV, Pfeiffer RM, Landy R, Wentzensen N, Clarke MA (2022) Trends and predictors of hysterectomy prevalence among women in the United States. Am J Obstet Gynecol. ;227(4):611.e1-611.e12\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalvin D, Reilly BO, Greene R, Donoghue KO, Sullivan OO (2023) A national survey of surgical training in gynaecology: 2014\u0026ndash;2021. Eur J Obstet Gynecol Reprod Biol [Internet] 288(February):135\u0026ndash;141\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCormack L, Nesbitt-Hawes E, Deans R, Alonso A, Lim C, Li F et al (2022) A review of gynaecological surgical practices for trainees and certified specialists in Australia by volume using MBS and AIHW databases. Aust New Zeal J Obstet Gynaecol 62(4):574\u0026ndash;580\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuiz MP, Chen L, Hou JY, Tergas AI, Clair CMS, Ananth CV et al (2018) Outcomes of hysterectomy performed by very low-volume surgeons. Obstet Gynecol 131(6):981\u0026ndash;990\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlebanoff JS, Marfori CQ, Vargas MV, Amdur RL, Wu CZ, Moawad GN (2020) Ob/Gyn resident self-perceived preparedness for minimally invasive surgery. BMC Med Educ 20(1):1\u0026ndash;8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeyer R, Schneyer RJ, Hamilton KM, Levin G, Truong MD, Siedhoff MT et al (2025) The Impact of Minimally Invasive Gynecologic Surgery Subspecialty Training on Outcomes of Benign Laparoscopic Hysterectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 32(2):143\u0026ndash;150\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePfeuti CK, Makai G (2024) Gynecologic Surgical Subspecialty Training Decreases Surgical Complications in Benign Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 31(3):250\u0026ndash;257\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouglass KM, Crawford KD, Yazdany T (2024) The Impact of Fellowship Affiliation on Urogynecology Training in Obstetrics and Gynecology Residency. J Minim Invasive Gynecol 31(12):1004\u0026ndash;1010\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eESGO accreditation \u0026amp; re-accreditation of European training centres in gynaecological oncology. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.esgo.org/media/2021/03/1-SOPs-Training-centres-accreditation-reaccreditation- 2021.pdf\u003c/span\u003e\u003cspan address=\"https://www.esgo.org/media/2021/03/1-SOPs-Training-centres-accreditation-reaccreditation- 2021.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuyckx M, Jouret M, Sawadogo K, Waterkeyn M, Grandjean F, Van Gossum JP et al (2023) Centralizing surgery for ovarian cancer in a non-centralizing country (Belgium): the UNGO (UCLouvain Network of Gynaecological Oncology) experience. 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Acta Obstet Gynecol Scand 100(9):1730\u0026ndash;1739\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeijte E, de Blaauw I, Van Workum F, Rosman C, Botden S (2020) Robot assisted versus laparoscopic suturing learning curve in a simulated setting. Surg Endosc 34(8):3679\u0026ndash;3689\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFalconer H (2021) Evaluating robotic surgical courses: Structured training matters. J Gynecol Oncol 32(2):1\u0026ndash;2\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoitano TKL, Smith HJ, Cohen JG, Rossi EC, Kim KH (2021) Implementation and evaluation of a novel subspecialty society fellows robotic surgical course: The sgo minimally invasive academy surgical curriculum. J Gynecol Oncol 32(2):1\u0026ndash;7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffman MS, Xiong Y, Apte S, Roberts W, Wenham RM (2019) Twenty-year surgical trends in a gynecologic oncology fellowship training program: Implications for practice. Gynecol Oncol 155(2):359\u0026ndash;364\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStickrath E, Alston M (2017) A Novel Abdominal Hysterectomy Simulator and Its Impact on Obstetrics and Gynecology Residents\u0026rsquo; Surgical Confidence. MedEdPORTAL J Teach Learn Resour 13:10636\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRusch P, Ind T, Kimmig R, Maggioni A, Ponce J, Zanagnolo V et al (2019) Recommendations for a standardised educational program in robot assisted gynaecological surgery: Consensus from the Society of European Robotic Gynaecological Surgery (SERGS). Facts views Vis ObGyn 11(1):29\u0026ndash;41\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRusch P, Kimmig R, Lecuru F, Persson J, Ponce J, Degueldre M et al (2018) The Society of European Robotic Gynaecological Surgery (SERGS) Pilot Curriculum for robot assisted gynecological surgery. Arch Gynecol Obstet 297(2):415\u0026ndash;420\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollins JW, Levy J, Stefanidis D, Gallagher A, Coleman M, Cecil T et al (2019) Utilising the Delphi Process to Develop a Proficiency-based Progression Train-the-trainer Course for Robotic Surgery Training. Eur Urol 75(5):775\u0026ndash;785\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzadi S, Green IC, Arnold A, Truong M, Potts J, Martino MA (2021) Robotic Surgery: The Impact of Simulation and Other Innovative Platforms on Performance and Training. J Minim Invasive Gynecol 28(3):490\u0026ndash;495\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRivero-Moreno Y, Echevarria S, Vidal-Valderrama C, Stefano-Pianetti L, Cordova-Guilarte J, Navarro-Gonzalez J et al (2023) Robotic Surgery: A Comprehensive Review of the Literature and Current Trends. Cureus. ;15(7)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdkoli A, Eng S, Stephenson R (2024) Need for formalized robotic training and curriculum in obstetrics and gynecology residency: an examination of current resident outlooks and perspectives. J Robot Surg 18(1):1\u0026ndash;7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevin G, Siedhoff M, Wright KN, Truong MD, Hamilton K, Brezinov Y et al (2023) Robotic surgery in obstetrics and gynecology: a bibliometric study. J Robot Surg 17(5):2387\u0026ndash;2397\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Robotic surgery, gynecology, young surgeons, surgical confidence","lastPublishedDoi":"10.21203/rs.3.rs-8302218/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8302218/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Objective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo identify factors associated with higher self-perceived confidence in performing robotic surgery among early-career gynecologic surgeons, and to assess satisfaction with current surgical activity among young consultants.\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey consisting of a 28-item online questionnaire was developed and \u0026nbsp;disseminated through the social media channels of the Young European Advocates of Robotic Surgery (YEARS) and the Society of European Robotic Gynaecological Surgery (SERGS). Eligible participants included gynecologists with exposure to robotic surgery who were either (1) still in specialty training or (2) within three years of completing their postgraduate training or fellowship. The questionnaire collected sociodemographic information, details on surgical experience, access to robotic platforms, and self-perceived confidence in different surgical approaches.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMain results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 81 respondents completed the survey. Among the 63 surgeons with access to robotic surgery at their institutions, 29 reported high self-perceived confidence and 36 reported lower confidence. Factors associated with higher confidence included age \u0026gt;35 years (51.8% vs. 33.3%; p\u0026lt;0.001) and having received structured robotic training through a fellowship or industry-sponsored course (40.7% vs. 19.4%; p=0.017). Departments performing ≥55 robotic procedures per year showed a greater likelihood of hosting surgeons with high confidence. Finally, age \u0026gt;35 years and access to at least one dedicated robotic operating day per week was independently associated with higher confidence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSelf-perceived confidence in robotic surgery among early-career gynecologic surgeons appears to be associated with age, and regular access to robotic operating time.\u003c/p\u003e","manuscriptTitle":"Evaluation of robotic exposure among gynecological surgeons: results of survey from the Young European Advocates of Robotic Surgery (YEARS)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 09:50:58","doi":"10.21203/rs.3.rs-8302218/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-29T14:02:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-28T20:35:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122638534050521544274774745787789892555","date":"2025-12-28T18:12:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209998744259616152272279553384175637445","date":"2025-12-27T17:51:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167172042645001985576785781922737421859","date":"2025-12-26T04:45:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256519636286682794289072004339518911220","date":"2025-12-25T21:55:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"250475937913681246858648851459308243104","date":"2025-12-25T16:25:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-16T14:04:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T13:05:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-08T12:25:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2025-12-07T23:09:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"0c4edbc1-674d-4000-8f32-c6635f6495a7","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:01:18+00:00","versionOfRecord":{"articleIdentity":"rs-8302218","link":"https://doi.org/10.1007/s11701-026-03153-7","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2026-02-11 15:57:50","publishedOnDateReadable":"February 11th, 2026"},"versionCreatedAt":"2025-12-22 09:50:58","video":"","vorDoi":"10.1007/s11701-026-03153-7","vorDoiUrl":"https://doi.org/10.1007/s11701-026-03153-7","workflowStages":[]},"version":"v1","identity":"rs-8302218","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8302218","identity":"rs-8302218","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}