Proctoring in Robot-Assisted Urologic Surgery: Safety and Implementation Patterns from a Multicentre Registry

This study aimed to characterise perioperative safety and real-world implementation patterns of proctoring in robot-assisted laparoscopic urologic surgery performed with the da Vinci Surgical System across heterogeneous centres and surgeons. A personal registry of 150 consecutive manufacturer-registered proctoring procedures performed between July 2022 and February 2026 was analysed. The primary outcome was 30-day major complications (Clavien-Dindo ≥ III); secondary outcomes included intraoperative blood transfusion, conversion to open surgery, reoperation and endovascular embolisation. Overall, 150 proctored cases were delivered across 18 centres and 25 surgeons. The most frequent procedures were robot-assisted radical prostatectomy (RARP, n = 76), robot-assisted partial nephrectomy (RAPN, n = 44) and robot-assisted radical nephrectomy (RARN, n = 12). Thirty-day Clavien-Dindo ≥ III complications occurred in two cases (1.3%), with one patient requiring reoperation and one undergoing arterial embolisation; no 30-day mortality occurred, and no conversion to open surgery was recorded. Implementation patterns differed by baseline experience: among surgeons with low overall robotic exposure, the first proctored procedure was most commonly RARP, whereas surgeons with higher baseline experience more often initiated proctoring with non-RARP procedures. In conclusion, formal proctoring in robot-assisted laparoscopic urologic surgery across multiple centres was associated with a low rate of major complications and no conversions to open surgery. Reporting temporal trends, centre-procedure distribution and baseline surgeon experience alongside safety outcomes may provide a pragmatic framework for evaluating structured proctoring programs in routine practice.