Robotic Surgery in Australasian Gynaecology: Results of a 2025 Cross-Sectional Survey

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This study is a cross‐sectional survey of Australasian specialists in obstetrics and gynaecology, conducted in 2025. The survey targeted practicing clinicians across Australia and New Zealand and was distributed electronically through the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) centralised survey distribution process. Survey invitations were disseminated on two occasions (June and July 2025) to maximise participation. All RANZCOG specialists were eligible to participate, regardless of subspecialty, years in practice, or practice setting. Participation was voluntary, no incentive, and responses were anonymised. As distribution was managed directly by RANZCOG, the investigators did not have access to the mailing list or the exact number of recipients. The survey instrument was developed by a panel of 6 experienced minimally invasive gynaecology surgery (MIGS) specialists, with extensive exposure to both robotic and laparoscopic procedures. The questionnaire was pilot‐tested and refined for clarity and relevance prior to distribution and included 18 items and 8 screens. Key domains covered: Demographics (years post‐training, gender, type of practice: obstetrics and gynaecology, gynaecology only, obstetrics only), annual MIGS surgical volume (number of major gynaecological surgeries performed. Major gynaecological surgery was defined as myomectomy, hysterectomy, stage III–IV endometriosis surgery, prolapse/incontinence surgery, or gynaecologic oncology surgery), use of minimally invasive techniques (laparoscopy and robotics), access to robotic surgical platforms (e.g., da Vinci X/Xi, Si, Hugo, Versius CMR). Focus on robotic use: proportion of surgeries performed robotically, attitudes and perceptions regarding robotic surgery (perceived advantages/disadvantages, willingness to increase use if access improved), institutional influences (hospital encouragement to use robotics), preferences for future access and usage (The full questionnaire is provided in the Supporting Information ). The survey allowed for both categorical and free‐text responses, capturing quantitative data and qualitative attitudes. Respondents had the ability to review and change their answers before final submission. All available data were included in the analysis, including information from incomplete questionnaires. The primary outcome was the evaluation of the population's perspectives and attitudes regarding the use of robotic surgery. Secondary outcomes included: 1. Perceived advantages and barriers to robotic surgery adoption, 2. Association between years of practice to access, usage, and willingness to expand robotic practice. This study was conducted in accordance with Good Clinical Practice guidelines and was approved by the St George Hospital Human Research Ethics Committee (HREC) (approval number 2024/ ETH01796 ). As this was an anonymous survey of practicing clinicians, the requirement for individual informed consent was waived by the Committee. All responses were collected and analysed anonymously. Descriptive statistics were calculated for all variables. Categorical variables are presented as frequencies and percentages. Continuous variables are summarised as means with standard deviations or medians with interquartile ranges, as appropriate.

A total of 276 responses were collected and included in the analysis. A majority of respondents practice both Obstetrics and Gynaecology 181 (65.6%) with a significant minority 87 (31.5%) performing gynaecological surgery exclusively (Figure  1 ), with 162 (61.1%) females and 99 (37.4%) males (Table  1 ). Access to robotic platforms and patterns of robotic surgery use. Flowchart showing respondents' access to robotic platforms, willingness for more access, current use, and proportion of procedures performed robotically. Demographic data of the study population. Myomectomy, hysterectomy, St 3–4 endometriosis, prolapse/incontinence surgery, or gynae‐oncology surgery. Sixty‐five (24.3%) had less than 5 years of practice, 36 (13.5%) had between 6 and 10 years, 61 (22.8%) had more than 10 years, and the largest proportion, 105 (39.3%) responders had over 20 years of clinical experience (Table  1 ). Current trends in surgical exposure show 199 (74.8%) respondents performing < 100 major gynaecological surgeries per annum and 183 (69.6%) major gynaecological cases are performed using minimally invasive techniques (Table  1 ). Only 100 (37.5%) of Australasian responders have access to a surgical robot (Figure  1 ), the majority (> 80%) having a da Vinci X/Xi and a minority of 9 (9.6%) using other platforms (Hugo and Versius CMR). Of those 34 (34%) currently perform any robotic procedures whatsoever (Figure  1 ). Among respondents with access to a robotic platform, the majority perform it for only a minority of their surgical cases. The distribution of the proportion of surgeries performed robotically was as follows: 21 (61.8%) reported that less than 25% of their major gynaecological surgeries were performed using the robot, 6 (17.6%) performed 25%–50% of their cases robotically, 4 (11.8%) reported that 50%–75% of their cases were robotic, and 3 (8.8%) performed more than 75% of their cases using the robotic approach. When asked if, given greater access, their robotic usage would increase, roughly the same percentage said no (Figure  1 ). Fewer than 1% of respondents reported that patients specifically requested robotic surgery. Finally, only half of those who responded believe there was an advantage to their gynaecological practice of robotic surgery. The main reasons for a negative response were a belief that surgical outcomes were not improved and that the cost of robotic surgery was not justified (75.4%), whilst a majority also cited increased time per case (74.6%) and the learning curve of adopting a new surgical technique (51.5%). More than half also cited limited opportunity to train on a robot as a factor in their response (53.1%), and the some suggested no difference in outcome (67.7%). Of those who believe robotic surgery is a positive addition to their practice, surgeon longevity was by far the major reason provided (94.7%) with 84% citing the enhanced instrument dexterity (i.e., wristing) as a factor. Of great interest in the antipodean context is that only 17.6% of respondents believed that patient demand was a factor influencing their decision to perform robotic surgery (Figure  2 ). Perceived advantages and limitations of robotic‐assisted surgery. Bar charts showing the proportion of respondents reporting key advantages (top panel) and limitations (bottom panel) of robotic‐assisted gynaecologic surgery. Analysis by years of experience revealed that of the respondents, 166 (62.2%) had more than 10 years of clinical experience, while 101 (37.8%) had 10 years or less. Access to a surgical robot was similar between groups, with 39.2% of senior clinicians and 34.7% of their junior counterparts reporting availability. Among those with access, approximately one‐third in each group currently performed robotic procedures (33.8% for > 10 years; 34.3% for ≤ 10 years). Regarding perceptions of robotic surgery, 38.8% of senior clinicians perceived advantages to robotic surgery, 68.3% of less experienced respondents identified benefits. Furthermore, willingness to expand robotic use if access improved was markedly higher among those with ≤ 10 years' experience (60.9% vs. 20.9%). Among respondents without access to a surgical robot, a majority of clinicians with 10 years or less experience (56.9%) expressed a desire to have access to a robotic system, whereas only one third (33.7%) of those with more than 10 years of experience reported similar interest (Figure  3 ). Access, use, and willingness to expand robotic surgery by years of clinical experience. Comparison between respondents with ≤ 10 years and > 10 years of clinical experience. Panels show differences in access to robotic platforms, current robotic surgery use, and willingness to expand use if access improved. When considering specific advantages, ergonomics and surgeon longevity were cited by all junior clinicians who perceived benefit, compared to 89.1% of senior clinicians. Patient demand was identified more frequently by senior clinicians (25.0% vs. 10.4%). Among those not perceiving advantages, cost and increased operative time were the most common concerns in both groups, with senior clinicians more likely to cite cost (77.6% vs. 68.8%) and the learning curve (53.1% vs. 46.9%). The perception of no difference in outcomes between robotic and other surgical modalities was similarly prevalent in both cohorts.

This survey provides a contemporary snapshot of attitudes and practices surrounding robotic‐assisted surgery among Australian and New Zealand gynaecologists. Our results from 276 responders show limited overall adoption, 37.5% of respondents reported access to a robotic system, and among those, 34% currently perform robotic surgery. Even with hypothetical improved access, 57.2% of respondents indicated they would not increase their robotic case volume, reflecting that barriers extend beyond simple availability. The focus of our responders was gynaecologists only or gynaecologist and obstetrician. The minimal ratio of Obstetrics‐only respondents is more likely to reflect the fact that those not performing gynaecology surgery elected to discard the survey request rather than indicating a small number of Obstetrics‐only practitioners in our college. In contrast to our findings, a 2024 national united states (U.S.) survey found that nearly all residents now train in institutions performing robotic surgery, with over 90% having access to robotic trainers and 80% aiming to become robot‐certified by graduation [ 12 ]. This stands in contrast to the current situation in Australia and New Zealand, where, despite steady annual growth, the overall numbers remain modest. Analysis of national data, largely derived from Intuitive Surgical, indicates that as of 2024, there are 100 da Vinci robotic systems installed across Australia and New Zealand, with more than 200 gynaecologists currently accredited to perform robotic procedures. In 2023, the annual volume of robotic gynaecological surgery reached approximately 3900 procedures, reflecting a broader trend of global expansion: worldwide, the number of robotic gynaecological operations has more than doubled over the past decade, with an estimated 450,000–500,000 procedures performed annually by 2023 [ 13 ]. However, the absolute scale of adoption in Australia and New Zealand is still comparatively small. For reference, the United States reports 5807 da Vinci surgical systems installed as of 2024, with 1876 in Europe and 1745 in Asia [ 14 ]. In the U.S., a much higher proportion of benign hysterectomies are performed robotically 31%–38% in 2010–2015, rising to 49% in 2020 [ 8 , 15 ] Similarly, the use of robotic assistance for endometrial cancer has increased substantially, with around 58% of cases now performed robotically [ 15 , 16 , 17 ]. Thus, despite a similar upward trajectory, the scale of robotic gynaecological surgery in Australia and New Zealand remains modest relative to international benchmarks. Interestingly, despite the availability of advanced robotic systems in some Australasian and New Zealand centres, actual utilisation by gynaecologists reported in our survey remains low. This limited adoption appears to be influenced both by institutional allocation, where robotic platforms may be prioritised for other specialties such as urology or general surgery, often based on stronger or more established evidence and clinical benefit in those fields [ 13 , 14 , 18 , 19 ] and perhaps by varying levels of enthusiasm within gynaecology itself. Our findings show a generational divide: while the majority of senior gynaecologists with extensive laparoscopic experience express little interest in adopting robotic technology, younger clinicians are more open to integrating robotics into their practice if access were to improve, consistent with previous reports [ 20 ]. This suggests that established practitioners may be more inclined to adhere to familiar techniques, while early‐career surgeons are more willing to engage with new platforms. Indeed, gynaecologists were pioneers in the development and clinical adoption of laparoscopic surgery [ 21 ], this established proficiency in laparoscopy, combined with the process required to acquire robotic skills, may contribute to scepticism among experienced surgeons [ 22 ]. Robot‐assisted surgery has emerged as an important technological development in minimally invasive gynaecology, with adoption increasing substantially in some regions over the past decade [ 23 ]. A significant proportion of respondents in our survey still perform predominantly open procedures. This finding may carry particular relevance: evidence from general surgery suggests that open surgeons face a shorter learning curve when transitioning to robotic compared to laparoscopic surgery [ 24 ], owing to the robotic platform's intuitive instrument motion and three‐dimensional visualisation that more closely mimic open operative conditions. If this pattern holds true in gynaecology, robotic surgery may represent an especially attractive pathway for open surgeons seeking to adopt minimally invasive techniques. Although the learning curve for achieving surgical proficiency in robotic benign gynaecologic procedures has been reported as approximately 30 cases, and stabilisation of operative times is typically reached after around 50 cases, this threshold is not excessively high [ 25 , 26 ]. However, it may still have practical implications for surgical efficiency, operating time, and even perceived confidence, and may temporarily impact workflow and institutional resource utilisation. Furthermore, whilst certain patient subgroups, notably those with obesity, may derive particular benefit from robotic surgery, proficiency with the platform is generally acquired through a structured progression from more straightforward procedures before undertaking increasingly complex cases [ 26 ]. It may also be particularly challenging for established surgeons to achieve and maintain true proficiency in both advanced laparoscopy and robotic surgery, especially after having already developed deep expertise in one modality. This dual mastery may require ongoing investment in training and case volume. Notably, among current respondents in our survey, most do not anticipate increasing their robotic case volume in the future, suggesting that significant changes in training paradigms, resource allocation, or the development of stronger evidence specific to gynaecology will be required to drive broader adoption. When exploring the advantages and limitations identified by the respondents, most considered robotics to be advantageous primarily for ergonomic reasons, surgeon longevity, and the opportunity to remain current with technological advances. Fewer than half believed that robotic surgery leads to improved patient outcomes. The principal concerns raised included cost, increased operative time, the lack of clear evidence for improved outcomes, and limited opportunities for hands‐on training and exposure. The cost barrier identified by our respondents as the primary limitation of robotic surgery is likely to diminish over time. The recent emergence of modular platforms designed with cost‐containment as a core objective alongside increasing market competition following patent expiration and greater surgical volumes are all anticipated to improve cost‐effectiveness and broaden institutional access [ 27 , 28 ]. It is essential that attitudes toward robotic surgery be grounded in evidence; however, the available data are mostly of low to moderate quality. While some trials comparing robot‐assisted to conventional laparoscopic surgery have shown minimal superiority in patient outcomes such as reduced intraoperative blood [ 29 ] and shorter operative time [ 30 ], they may offer additional advantages in particularly challenging cases, including patients with morbid obesity [ 31 ]. Other studies, however, have shown no clear superiority of the robotic approach, particularly in endometriosis surgery [ 32 ]. Nevertheless, surgeon satisfaction and ergonomic benefits have been consistently reported [ 33 ]. The ergonomic advantages of robotic surgery including reduced upper limb muscular activation, improved posture, and decreased physical strain compared to conventional laparoscopy have been documented in several studies and a recent systematic review [ 3 , 34 , 35 ]. These benefits are postulated to support surgeon longevity though direct long‐term evidence remains limited. Still, cost remains a major barrier to wider adoption, and access to training while variable by region, appears to be a worldwide challenge [ 1 , 12 ]. Almost 90% of patients in the United States reported satisfaction with robotic surgery [ 36 ] however, these rates have not been directly compared to laparoscopy and do not necessarily reflect patient preferences in Australia and New Zealand. In our region, patient demand appears minimal, with fewer than average of 1% of surgeons reporting that patients actively request robotic surgery. Furthermore, in Australia and New Zealand, access to medical care in remote and rural areas remains a challenge, and as a result, current healthcare priorities may be focused less on expanding robotic surgical programs and more on improving basic access to care. This study has several strengths. It is one of the largest surveys to date examining attitudes and practice patterns regarding robotic gynaecologic surgery among a broad spectrum of clinicians in Australia and New Zealand. By comparing responses across different levels of experience and stratifying the results accordingly, the study provides insights into generational and institutional influences on adoption. Additionally, the findings are strengthened by the use of national data, contemporary procedural volumes, and comparison with international benchmarks. Nevertheless, several limitations should be acknowledged. The cross‐sectional design is inherently susceptible to nonresponse and selection bias. The survey was distributed through the RANZCOG central survey process, and the investigators did not have access to the mailing list or exact number of recipients; therefore, a precise response rate could not be calculated. Based on publicly available estimates of approximately 2500 RANZCOG members in 2025, the 276 respondents represent around 11% of the College membership. While this level of participation is comparable to that reported in other recent RANZCOG surveys, the possibility of response bias cannot be excluded. The subgroup of respondents currently performing robotic surgery was relatively small, which may limit the precision and generalisability of analyses involving active robotic surgeons. Furthermore, voluntary participation may have introduced response bias, as clinicians with a particular interest in robotic surgery could have been more likely to participate. In addition, the sample size for age‐stratified analyses was relatively small, restricting the ability to draw conclusions or project future adoption trends with confidence. In conclusion, as of 2025, robotic surgery remains a minority approach within Australasian gynaecology, with scepticism regarding its added value and cost‐effectiveness. Unless future generations of surgeons introduce a paradigm shift, adoption is likely to remain cautious, guided by available evidence and pragmatic considerations unique to the Australasia and New Zealand healthcare environment. Continued research and ongoing evaluation will be essential to clarify the role of robotic surgery and to inform future practice.

Robotic‐assisted surgery has become an increasingly available option in minimally invasive gynaecology, although adoption rates and perceived clinical value remain highly variable across healthcare systems [ 1 , 2 ]. Advanced three‐dimensional visualisation, articulated instrumentation, and improved ergonomics are frequently cited as technical advantages of robotic surgery over conventional laparoscopy; however, data on reductions in postoperative complications remain inconsistent [ 1 , 3 , 4 ]. Despite widespread marketing and the theoretical benefits, high‐quality studies have not demonstrated significant improvements in patient outcomes for benign hysterectomy, while costs have markedly increased [ 2 , 5 , 6 , 7 , 8 ]. Furthermore, challenges such as inconsistent training access and difficulties maintaining procedural competency in low‐volume settings persist [ 9 , 10 ]. These unresolved issues have led to pronounced geographic variability in adoption, with regions such as Australasia reporting much lower uptake compared to the United States [ 11 ]. While the narrative surrounding robotic surgery is often influenced by industry marketing and the technological progress, decisions to advocate for or adopt this technology are increasingly shaped by patient expectations and institutional pressures. Despite the growing presence of robotic platforms, little is known about the real‐world attitudes of Australasian gynaecologists toward robotic surgery, the perceived barriers to its adoption, and the extent to which current practice patterns reflect pragmatic scepticism or deeper systemic constraints. By directly surveying practicing clinicians, this study seeks to address these critical gaps, offering a nuanced, data‐driven perspective on the evolving role of robotic surgery within Australasian gynaecological practice.

The authors declare no conflicts of interest.

Supporting Information.