This cross-sectional study was conducted twice from January 18, 2021, to February 1, 2021, and from November 1, 2021, to November 14, 2021. We emailed questionnaires to all JSGOE members who were reachable via the Internet, and the responses were submitted anonymously using Google Forms. The questionnaire was designed by members of the JSGOE Technical Certification System for Gynecological Robotic Surgery task force. The primary endpoint was to determine how the members felt about the development of a certified training facility and a technical certification system for robotic surgery, and the secondary endpoint was to determine what type of system design would be considered important. This questionnaire study did not require ethical approval.
Definition of an Accredited Training Facility and Technical Certification System
Certified training facilities
An accredited training facility for robotic surgery refers to a facility certified by the JSGOE as one in which the quality and safety of robotic surgery are assured. Although specific details have not yet been formulated, the goal is to ensure that safe surgery is performed through appropriate institutional management. The objectives of the JSGOE-accredited training facility in laparoscopy are as follows: to evaluate the skills and knowledge of endoscopic surgeons in the field of obstetrics and gynecology, to certify facilities where endoscopic surgery can be safely and smoothly performed, to promote the development and spread of endoscopic surgery in the field of obstetrics and gynecology in Japan, and to contribute to the maintenance of the health of the people.
Technical certification system
The robotic surgery technical certification system evaluates the skills of individuals. Although a specific evaluation system has not yet been established, the academic society properly evaluates surgical videos and certifies those whom they judge to have excellent skills. In Japan, a system of certified laparoscopic surgeons has been established in the field of gynecology, and there are currently 1,090 certified laparoscopic surgeons in Japan. The objectives of the laparoscopic certification program are presented below:
Endoscopic surgery is a procedure performed in a closed space using delicate peripheral equipment that requires sufficient knowledge of the equipment and advanced techniques. The JSGOE technical certification system is designed to evaluate the skills and knowledge of endoscopic surgeons in the field of obstetrics and gynecology, certify those who have the skills to perform endoscopic surgery safely and smoothly and have the qualifications to serve as leaders in endoscopic surgery, promote the development and spread of endoscopic surgery in the field of obstetrics and gynecology in Japan, and contribute to the maintenance of the health of the people.
Questionnaires
The questionnaire collected information on age, sex, prefecture, primary place of employment (university hospital, university-affiliated hospital, national hospital, city hospital, clinic, etc.), membership in the Japanese Society for Gynecologic Robotic Surgery (JSGRS), endoscopic technical certification by the JSGOE, gynecologic oncologist certification by the Japan Society of Gynecologic Oncology, total number of laparoscopic hysterectomy (TLH) procedures (0, < 10, 10–50, 50–100, and > 100), whether the facility has obtained the certification offered by da Vinci, the type of equipment installed in the da Vinci surgical system™ at the facility (Si, X, and Xi), number of robotic surgeries performed annually at their institution (0, < 10, 10–30, 30–50, and > 50), number of robotic surgeries they have performed (0, < 10, 10–30, 30–50, and > 50), how they are involved in robotic surgery (proctor, primary surgeon, assistant surgeon, and not involved), whether there is a need for a system of certified facilities for physician training, whether there is a need for a system for technically certifying physicians, and whether they would like to obtain a certification if such a system is established. If a technical certification system was to be established, the respondents were asked to choose from the following four options as to what type of system should be designed:
a) Certification system for robotic surgery alone (with or without certification in laparoscopy, but experience in laparoscopic surgery is a requirement).
b) Certification system for robotic surgery alone (those who have obtained certification in laparoscopic surgery can easily obtain this certification, and those who have not obtained certification in laparoscopic surgery are not required to have experience in laparoscopic surgery).
c) Incorporation of robot-assisted surgery into the current certification system, considering it as a device used in endoscopic surgery.
d) Other (the respondents could provide their own suggestions).
Statistical Analysis
We used the Chi-square test and Fisher’s exact test to investigate the significance of differences. Significance was set at P < 0.05. All statistical analyses were performed using GraphPad Prism 8.3 software (GraphPad Software, Inc., La Jolla, CA, USA).