Emergency undocking in robotic surgery: an international Delphi consensus study
- 1Division of Surgical and Interventional Sciences, University College London, London, UK
- 2Griffin Institute, Northwick Park Hospital, Harrow, UK
Abstract
Emergency undocking in robotic surgery is an uncommon but high-stakes event. Published protocols are predominantly single-institution and specialty-specific, and no multidisciplinary cross-specialty consensus exists. This study aimed to establish expert consensus on the definitions and procedural steps of safe emergency undocking. A four-round modified Delphi study was conducted with an international panel of robotic theatre team members. Round 1 used open-text questions to generate themes; Rounds 2 to 4 presented binary statements (Yes / No / Unable to rate), with a pre-specified threshold of 80% agreement and Unable to rate responses excluded from the denominator. Items below threshold, or reaching threshold with substantive comments, were revised and re-presented. Fifty-two experts from 10 countries consented and completed Round 1. The panel comprised lead or experienced console surgeons (53.8%), first assistants (30.8%), surgical care practitioners (9.6%), anaesthetists (3.8%), and one industry representative (1.9%). Response rates were 80.8%, 80.8%, and 76.9% for Rounds 2 to 4 respectively. Thirty-seven statements reached consensus, comprising two definitions, six common pathway items, 18 controlled undocking items, and 11 uncontrolled undocking items. Of the 37 statements, 25 were classified as platform-agnostic and 12 as platform-dependent. Three role-allocation items were deferred to a planned subsequent round. This Delphi process produced 37 consensus statements defining controlled and uncontrolled emergency undocking and the steps for each. The panel was predominantly United Kingdom-based and surgical, and included no scrub or circulating practitioners. The resulting framework requires simulation and clinical validation before implementation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04102-0.
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BibTeX
@article{ryan2026emergency,
title = {{Emergency undocking in robotic surgery: an international Delphi consensus study}},
author = {George Ryan and Taner Shakir and Nader Francis},
journal = {Journal of Robotic Surgery},
year = {2026},
month = oct,
doi = {10.1007/s11701-026-04102-0},
url = {https://doi.org/10.1007/s11701-026-04102-0},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Emergency undocking in robotic surgery: an international Delphi consensus study
AU - George Ryan
AU - Taner Shakir
AU - Nader Francis
PY - 2026
DA - 2026/10/26
JO - Journal of Robotic Surgery
DO - 10.1007/s11701-026-04102-0
UR - https://doi.org/10.1007/s11701-026-04102-0
AB - Emergency undocking in robotic surgery is an uncommon but high-stakes event. Published protocols are predominantly single-institution and specialty-specific, and no multidisciplinary cross-specialty consensus exists. This study aimed to establish expert consensus on the definitions and procedural steps of safe emergency undocking. A four-round modified Delphi study was conducted with an international panel of robotic theatre team members. Round 1 used open-text questions to generate themes; Rounds 2 to 4 presented binary statements (Yes / No / Unable to rate), with a pre-specified threshold of 80% agreement and Unable to rate responses excluded from the denominator. Items below threshold, or reaching threshold with substantive comments, were revised and re-presented. Fifty-two experts from 10 countries consented and completed Round 1. The panel comprised lead or experienced console surgeons (53.8%), first assistants (30.8%), surgical care practitioners (9.6%), anaesthetists (3.8%), and one industry representative (1.9%). Response rates were 80.8%, 80.8%, and 76.9% for Rounds 2 to 4 respectively. Thirty-seven statements reached consensus, comprising two definitions, six common pathway items, 18 controlled undocking items, and 11 uncontrolled undocking items. Of the 37 statements, 25 were classified as platform-agnostic and 12 as platform-dependent. Three role-allocation items were deferred to a planned subsequent round. This Delphi process produced 37 consensus statements defining controlled and uncontrolled emergency undocking and the steps for each. The panel was predominantly United Kingdom-based and surgical, and included no scrub or circulating practitioners. The resulting framework requires simulation and clinical validation before implementation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11701-026-04102-0.
SN - 1863-2483
SN - 1863-2491
ER -