Prospective Study of a Structured Robotic Surgery Training Program at a Public Cancer Center

INTRODUCTION: The integration of new technologies into surgical practice poses a significant challenge, requiring specialized training and continuous education for surgeons. This study details the experience and outcomes of a structured training program for 10 years practicing non robotic surgeons at the Cancer Institute of São Paulo (ICESP) during the implementation of a robotic surgery program in a public, highvolume cancer center. OBJECTIVE: To evaluate the clinical performance of surgeons trained in a proctored robotic surgery program, analyzing key perioperative metrics including surgical time, estimated blood loss, number of dissected lymph nodes, and intraoperative events. METHODS: A prospective, randomized trial was conducted with 564 patients, divided into a robotic surgery group (n=326) and a gold standard open or minimal invasive surgery control group (n=238) procedures. Sixteen surgeons from five surgical specialties participated in a comprehensive training program. The training consisted of a preoperative phase with four stages (10 hours of virtual training, 4 hours of dry lab, 4 hours of realistic incursion, and 8 hours in an animal/corpse model) and a perioperative phase, both with a proctor. RESULTS: All 16 surgeons successfully completed the preoperative training, and eight proceeded to the full training program, that means they fully operated all considered patients. Robotic procedures demonstrated a longer mean duration compared to the control group (p<0.001), but were associated with a significant reduction in estimated blood loss (p<0.001). CONCLUSION: The structured training program effectively prepared surgeons for robotic surgery, leading to positive clinical outcomes. This study provides a valuable model for the viable implementation of a robotic surgery program with a robust training protocol in a public-sector setting.