Current Practice in Robotic Surgery Among Pediatric Urologists: A Survey Study

Introduction: Since its introduction, robotic surgery has gained most traction among urologists. Pediatric urologists have been slower to adopt the technology than their adult counterparts. Our objectives were to understand current practice patterns for robotic surgery among pediatric urologists, to identify perceived barriers, and to identify factors associated with the use of robotic surgery. Methods: An anonymous online survey was administered using Research Electronic Data Capture (REDCap) to members of the Societies for Pediatric Urology (SPU) including questions about provider demographics and personal practice patterns. Comparisons were made using Pearson's chi-squared analysis. Results: Of 351 SPU members surveyed, 95 completed the survey (27%): 55 (58%) reported performing robotic surgery and 40 (42%) reported not performing robotic surgery. Twenty-seven (28%) reported receiving robotic training in residency, 26 (27%) in fellowship, 34 (36%) in a robotics course, and 30 (32%) with proctored surgery. Cited reasons for not performing robotic surgery were lack of training, referring to practice partners, and lack of benefit. Of those performing robotic surgery, most reported performing 0-1 or 2-4 per month. Thirty-one (56%) reported having selection criteria for use of the robot: 26 (47%) cited an age cutoff, 12 (22%) cited a weight cutoff, and 14 (26%) cited an abdominal size cutoff. Eighteen (33%) reported using hidden incisions endoscopic surgery (HIdES) approach and 40 (42%) reported using an assistant port. Factors associated with using the robot included surgeon age, years in practice, practice setting, having robotic training, and having practice partners who perform robotic surgery. Conclusions: Practice variation exists in the use and application of robotic surgery among pediatric urologists. The main self-reported barriers to performing robotic surgery are lack of training, referring to practice partners, and no perceived benefit to robotic surgery. Factors associated with performing robotic surgery were surgeon age, years in practice, practice setting, and having practice partners perform robotic surgery. There is no Clinical Trial Registration number associated with this study.