The adoption of robotic surgery in gynaecology has seen varied progress globally, with Japan being no exception. This study, conducted through a nationwide survey, aimed to explore the current status, disparities, and challenges associated with the implementation of gynaecological robotic surgery in Japan. The survey targeted members of the Japan Society of Obstetrics and Gynecology (JSOG) and was conducted between September and November 2023.

Survey Overview

A total of 17,444 members were approached, yielding 1,443 responses, equating to an 8.3% response rate. The respondents represented a diverse demographic, including varying years of experience, gender, and subspecialties. Notably, 46% of respondents worked in facilities without robotic systems, indicating a significant gap in robotic surgery availability.

Key Findings

1. Support for Robotic Surgery: Approximately 69.8% of participants expressed support for the promotion of robotic surgery, with younger professionals showing greater enthusiasm. However, healthcare economics were identified as the primary barrier to adoption, with 94.1% of respondents agreeing on this point.
2. Perceptions of Benefits: The perceived benefits of robotic surgery varied significantly depending on the condition being treated. For malignant conditions, 75.4% believed in the advantages of robotic surgery, while only 53.1% felt the same for benign conditions. This discrepancy highlights a gap in awareness regarding the potential benefits of robotic procedures for benign gynaecological diseases.
3. Training and Education: Only 33.2% of respondents endorsed the inclusion of robotic surgery training in residency programs. Regional differences emerged in attitudes towards educational benefits, further emphasizing the need for comprehensive training initiatives.
4. Challenges in Implementation: The study uncovered significant challenges in accessing robotic surgery, particularly in relation to limited insurance coverage and disparities in awareness among practitioners. The lack of sufficient robotic surgeries performed at facilities hindered skill acquisition, with 74.5% of respondents reporting no experience as primary surgeons in robotic procedures.

Disparities and Regional Differences

The survey highlighted regional disparities in attitudes towards robotic surgery, particularly in educational benefits and the perceived necessity for centralization of robotic surgery in specialized centres. Younger generations and those with more experience in robotic surgery exhibited more favourable attitudes toward its expansion.

Future Directions

The merging of the Japan Society of Gynecologic Robotic Surgery (JSGRS) and the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) in 2026 is anticipated to catalyse the further proliferation of robotic surgery in Japan. It is crucial for stakeholders to develop comprehensive educational programs and awareness campaigns to enhance knowledge and understanding among obstetricians and gynaecologists.

Conclusion

The results of this nationwide survey underscore the challenges faced by obstetricians and gynaecologists in accessing robotic surgery, including economic constraints and limited insurance coverage. The findings suggest a pressing need for initiatives to improve access to robotic surgery and to bolster educational efforts to enhance the understanding of its benefits among practitioners. As Japan moves forward in robotic surgery adoption, these insights will play a vital role in shaping future policies and educational strategies in the field.

READ MORE… https://link.springer.com/article/10.1007/s11701-024-02197-x

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