Perspectives of robotic surgeons on the strengths, weaknesses, opportunities, and threats of robotic surgery in india: a cross-sectional survey.

Abstract

Robotic surgery is increasingly being adopted in India, but its wider implementation is associated with economic, training, and resource-related challenges. This study assessed the perspectives of surgeons performing robotic surgery in India regarding the perceived strengths, weaknesses, opportunities, and threats (SWOT) associated with robotic surgery. A cross-sectional questionnaire-based survey was conducted from June 2023 to January 2025 among surgeons performing robotic surgery in India. The questionnaire comprised 25 five-point Likert-scale statements addressing different aspects of robotic surgery, together with an open-ended component. Data were collected using KoboToolbox and analysed descriptively using Stata version 14.0. Seventy-five robotic surgeons participated. Participants perceived better three-dimensional visualization (72, 96.0%), improved instrument manipulation and ergonomics (73, 97.3%), greater precision (71, 94.7%), and resistance to tremor and fatigue (71, 94.7%) as important strengths. Perceived limitations included absence of tactile feedback (70, 93.3%), additional operating-room time (51, 68.0%), high procedural costs (49, 65.3%), and frequent instrument replacement (45, 60.0%). Forty-three participants (57.3%) perceived an absence of structured academic robotic training, while 46 (61.3%) felt that increasing robotic surgery could reduce residents' exposure to open and laparoscopic surgery. Perceived opportunities included expansion to additional procedures (72, 96.0%), wider penetration in India (71, 94.7%), medical tourism (66, 88.0%), microsurgical applications (54, 72.0%), and telesurgery (51, 68.0%). Open-ended responses additionally identified artificial intelligence, advanced imaging, cost reduction, and development of new robotic techniques as potential opportunities. Surgeons performing robotic surgery in India perceived substantial technical and ergonomic advantages alongside economic, training, and resource-related challenges. The findings highlight perceived opportunities for expansion into complex and microsurgical procedures and integration with emerging technologies. Structured competency-based training, systematic outcome auditing, and procedure-specific assessment of clinical benefit and resource utilization may help inform the future development of robotic surgery in India.