Utilising an Accelerated Delphi Process to Develop Guidance and Protocols for Telepresence Applications in Remote Robotic Surgery Training

Justin W. Collins*, Ahmed Ghazi, Danail Stoyanov, Andrew Hung, Mark Coleman, Tom Cecil, Anders Ericsson, Mehran Anvari, Yulun Wang, Yanick Beaulieu, Nadine Haram, Ashwin Sridhar, Jacques Marescaux, Michele Diana, Hani J. Marcus, Jeffrey Levy, Prokar Dasgupta, Dimitrios Stefanidis, Martin Martino, Richard FeinsVipul Patel, Mark Slack, Richard M. Satava, John D. Kelly

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Citations (Scopus)


Context: The role of robot-assisted surgery continues to expand at a time when trainers and proctors have travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To provide guidance on setting up and running an optimised telementoring service that can be integrated into current validated curricula. We define a standardised approach to training candidates in skill acquisition via telepresence technologies. We aim to describe an approach based on the current evidence and available technologies, and define the key elements within optimised telepresence services, by seeking consensus from an expert committee comprising key opinion leaders in training. Evidence acquisition: This project was carried out in phases: a systematic review of the current literature, a teleconference meeting, and then an initial survey were conducted based on the current evidence and expert opinion, and sent to the committee. Twenty-four experts in training, including clinicians, academics, and industry, contributed to the Delphi process. An accelerated Delphi process underwent three rounds and was completed within 72 h. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as ≥80% agreement. Evidence synthesis: There was 100% consensus regarding an urgent need for international agreement on guidance for optimised telepresence. Consensus was reached in multiple areas, including (1) infrastructure and functionality; (2) definitions and terminology; (3) protocols for training, communication, and safety issues; and (4) accountability including ethical and legal issues. The resulting formulated guidance showed good internal consistency among experts, with a Cronbach alpha of 0.90. Conclusions: Using the Delphi methodology, we achieved international consensus among experts for development and content validation of optimised telepresence services for robotic surgery training. This guidance lays the foundation for launching telepresence services in robotic surgery. This guidance will require further validation. Patient summary: Owing to travel restrictions during the coronavirus disease 2019 (COVID-19) pandemic, development of remote training and support via telemedicine is becoming increasingly important. We report a key opinion leader consensus view on a standardised approach to telepresence. There is currently a lack of high-level evidence on utilising telepresence technologies to train in robot-assisted surgery. We report Delphi process consensus views, formulated by US and European training and industry experts, on safe launching of telepresence for robotic surgery.

Original languageEnglish
Pages (from-to)23-33
Number of pages11
JournalEuropean Urology Open Science
Publication statusPublished - Dec 2020


  • Communication
  • Curriculum development
  • Deliberate practice
  • Patient safety
  • Robotic-assisted surgery
  • Surgical education
  • Telementoring
  • Telepresence
  • Telesurgery
  • Training protocol


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