Robotic surgery across surgical specialties: an Italian survey on implementation, training, and satisfaction levels among trainees and young attendings: on behalf of the Italian Multispecialty Society of Young Surgeons (SPIGC).

European surgical institutions have been recently criticized for the insufficient endorsement of standardized robotic training curricula. In the present study, we report the results of a nationwide survey on the status of robotic surgery training and satisfaction across trainees from multiple surgical specialties in Italy. A modified-Delphi consensus was implemented with n = 41 multiple-choice or open-ended question surveys later distributed to Residents, Fellows, PhD students, Young Attendings or Assistant Professors, in n = 10 different surgical specialties. Demographics, program characteristics, exposure to robotic surgery, and satisfaction with robotic training were explored. Composite variables were created, and multivariable regression modeling adopted to explore variables associated with higher surgical training satisfaction. Similarly, predictors of minimum requirements necessary for designation as a 'reference center' for robotic surgical training institutions were further explored. A total of n = 735 trainees participated and were included for final analysis. The vast majority were male (63.5%), residents (52.1%), from University Hospitals (53.7%), and from the Central Regions of Italy (47.9%). General Surgery was the most represented specialty (44.4%) followed by Urology (26%). Availability of a dual robotic console, simulation software, and scheduled lectures were reported in 45.6%, 58.2%, and 23.4% respectively. Most respondents (61.6%) reported that the robotic console was exclusively operated by senior/experienced attendings, and the majority (88.3%) believed that the lack of standardized robotic exposure negatively impacted their training. On univariable analysis, Urology achieved the highest satisfaction with robotic training (median score 6 [IQR: 5-8], p < 0.001). However, on multivariable modeling, the surgical specialty did not impact overall satisfaction, which was instead influenced by simulation software availability (adjusted Odds Ratio [aOR]: 1.72, 95% CI 1.22-2.44), dedicated lectures (aOR: 1.72, 95% CI 1.16-2.56), higher volume of robotic-assisted procedures per center (aOR: 9.69, 95% CI 5.62-16.70), and trainee with more active role during robotic cases (aOR: 2.43, 95% CI 1.29-4.57). Finally, centers with urology specialty (p < 0.001), > 400 procedures/year (aOR: 1.92, 95% CI 1.01-4.51), > 1 robotic platform (aOR: 1.29, 95% CI 1.07-1.55), and providing robotics fellowship/masters programs (aOR: 1.43, 95% CI 0.99-2.36) were more likely to reach the minimum requirements as per robotic training 'reference center' definition. We highlighted a nationwide lack of standardized training pathways, limited mentoring opportunities, and widespread dissatisfaction among robotic surgery trainees. These findings may guide robotic programs in recognizing unmet educational needs and implementing strategies to develop equitable, structured, and standardized curricula for robotic surgical training across the multiple robotic-assisted surgical specialties.