Public’s Perception and Knowledge of Using Robotics in General Surgery in Eastern Region, Saudi Arabia

Abstract

Background:

Robotics in general surgery is a field that involves the use of robotic systems to assist surgeons in performing various types of surgical procedures.

Objective:

The objective of this study was to evaluate the perception and knowledge of robotic surgery among the Eastern Region’s population.

Methods:

This cross-sectional study used an electronic questionnaire that was developed using Google Docs. It included males and females aged above 18 years who lived in the Eastern Province. Participants who were below 18 or above 65 years of age, or non-Saudi, or people who lived in other than the Eastern Region of Saudi Arabia were excluded from the study.

Results:

A total of 500 responses were received via the Google Form, and 81 subjects of them were excluded from the study. Approximately half of the participants were aware of the existence of general robotic surgery, while the other half had no prior knowledge about it. When assessing the participants’ understanding of how robotic surgery works, a significant proportion provided incorrect responses. In terms of the advantages of general robotic surgery, the most commonly recognized benefit was that it makes the doctor’s life easier, followed by more accurate surgical results. However, the participants’ understanding of the disadvantages of robotic surgery was not as accurate. A substantial portion of participants were unsure about the disadvantages.

Conclusion:

The general public of the Eastern Region in Saudi Arabia showed a derated level of knowledge about the use of robotics in general surgery. Furthermore, a major portion of people were unaware of the availability of robotic surgery in Saudi Arabia. Educational programs are warranted to facilitate the implantation of robotic surgery in Saudi Arabia.

INTRODUCTION

Robotics in general surgery is a field that involves the use of robotic systems to assist surgeons in performing various types of surgical procedures.[1] A robotic surgical system is being used to perform several laparoscopic surgical operations. The surgeon precisely and accurately directs the movement of the surgical tools from the robotic console. Both patients and physicians can benefit greatly from robotic-assisted surgery (RAS). The employment of this equipment, however, brings about new difficulties, such as the requirement to redesign the structure of the operating theater and the positioning of the surgical team in relation to the patient. The evolution of robotic technology during the last decade has facilitated the realization of a great variety of operations in various surgical fields.[2] A new team dynamic emerges as a result of these adjustments in the operating room. For instance, due to the physical barrier imposed by the robotic system, team member communication is altered, focusing primarily on verbalization. For surgery to go smoothly, nontechnical skills (NTS) must be developed because patient safety and successful outcomes cannot be ensured by technical abilities alone. Lack of communication and other NTS during surgery has been associated with an increased risk of complications.[3,4,5] The operator’s personal resources, social skills, and cognitive abilities make up nontechnical competencies.[3] Decision-making and context awareness are cognitive skills. Leadership, collaboration, and communication are all social skills. Personal resources include things such as stress and exhaustion.[6] According to a recent study by Boys et al. that polled 747 individuals, the majority of whom were Americans, 72% of the participants believed that robotic surgery was safer, quicker, and delivered superior results.[7]

A qualitative study by McDermott et al. in the United Kingdom, which used semi-structured interviews with 25 participants, also found that young laypeople generally lack knowledge of robotic surgery.[8] Studies on public perception and potential misunderstandings about robotic surgery are still lacking. In addition, despite the widespread usage of RAS in populations like those in the USA, it is still difficult to get the public to embrace this technology. It has been discovered that public acceptance is directly correlated with the public’s educational level and experience with social media.[9] Our study aims to explore perceptions and knowledge regarding robotic surgery among the population of the Eastern Region.

METHODS

Study design

This cross-sectional study used a survey questionnaire that was electronically developed using Google Docs. It was conducted in the Eastern Region of Saudi Arabia during the year 2023. The questionnaire was obtained from a prior published investigation, in which it has been validated.

Study population

The sample will be in the Eastern Province, and the sample size is 385 determined using the Richard Geiger equation, with a margin error determined as 5%, a confidence level of 95%, the population as 5,028,753, and 50% for response distribution. The study included males and females aged above 18 years who lived in the Eastern Province. Participants who were below 18 or above 65 years of age, or people who lived in other than the Eastern Region of Saudi Arabia were excluded from the study.

Data collection

The data were collected through a structured questionnaire. It was formulated in Arabic and was completed using Google Docs and distributed online via social media applications. Consent was taken from the participants, and the privacy of their information was ensured. The questionnaire comprised three main parts: sociodemographic, knowledge (8 questions), and attitude sections (1 question).

Statistical analyses

The SPSS for Windows version 26.0 (IBM Corp., Armonk, NY, USA) was used to analyze all the data in this project. Demographic data were categorized to calculate numbers and percentages. The chi-square test was utilized to analyze the results of categorical variables and examine the relationships between them.

Study procedure

The questionnaire comprised three main parts. The first part was sociodemographic, the second part was knowledge (8 questions), and the third part was attitude sections (1 question). The consent for voluntary participation was obtained from all participants after declaring the study objectives in the first part of the questionnaire. Respondent anonymity and confidentiality were guaranteed by design. This study is ethically approved by the Ethical Committee of the Deanship of Scientific Research at King Faisal University, Reference Number KFU-REC-2023-JAN-ETHICS522. Furthermore, this article is reported in line with STROBE guidelines.

RESULTS

A total of 500 responses were received via the Google form. Eighty-one subjects of them were excluded from the study (28 for being younger than 18 years old, 21 for being older than 60 years old, 26 for not living in Al Ahsa of Saudi Arabia, 5 for refusing to participate in the study, and 1 for submitting a response with a missing data). The final number of included participants was 419 subjects, which represents an acceptance rate of 83.8% of the total responses.

Sociodemographic data

With regard to the participants characteristics shown in Table 1, more than half of the recruited sample were of the age group between 18 and 30 years (58.7%), followed by 31–45 and 46–60 groups of age with 21.5% and 19.8%, respectively. Majority of this sample were females (73.5%) and males accounting for only 26.5% of all sample. About social status, the sample was approximately distributed between single (53%) and married (43.4%) individuals. The minor remaining percentages were of divorced (1.9%) and widows (1.7%). Regarding the educational level, more than half of the participants had a Bachelor’s degree (58.7%), followed by those with secondary education (18.4%), a diploma (15.5%), Master’s (5.0%), Ph.D. (1.7%), uneducated (0.5%), and primary education (0.2%). When it comes to family income, 43.4% had 10,000–20,000 riyals per month, whereas the remaining had 5000–10,000 riyals (25.1%), more than 20,000 riyals (20.5%), and <5000 riyals (11%), respectively. The vast majority of the sample were Saudi nationals, comprising (97.6%) of the participants, while non-Saudis represented only a small fraction at (2.4%). With respect to occupation, more than half of the sample were working off the healthy track (53.7%), followed by unemployed (18.6%), doctor (15%), and health track (nursing, medical science, etc.) (12.6%). The participants’ usage of electronic devices was mainly between 5–9 hours per week. This was followed by (36.3%) for 15 or more hours per week, (34.8%) for 10–14 hours per week, and the smallest group was those using devices for less than 4 hours per week, at (8.8%).

Table 1.

Characteristic data of the study participants

Sociodemographic items	Frequency (%)
Age
18–30	246 (58.7)
31–45	90 (21.5)
46–60	83 (19.8)
Gender
Male	111 (26.5)
Female	308 (73.5)
Social status
Single	222 (53.0)
Married	182 (43.4)
Divorced	8 (1.9)
Widows	7 (1.7)
Education level
Primary	1 (0.2)
Bachelor's	246 (58.7)
Masters	21 (5.0)
Secondary	77 (18.4)
Diploma	65 (15.5)
Ph.D.	7 (1.7)
Uneducated	2 (0.5)
Family income (Riyals)
>20,000	86 (20.5)
10,000–20,000	182 (43.4)
5000–10,000	105 (25.1)
<5000	46 (11.0)
Naturality
Saudi	409 (97.6)
Non-Saudi	10 (2.4)
Occupation
Work off the healthy track	225 (53.7)
Doctor	63 (15.0)
Unemployed	78 (18.6)
Health track (nursing, medical science, etc.)	53 (12.6)
How many hours per week do you spend using electronic devices
15 or more hours per week	146 (34.8)
<4 h a week	37 (8.8)
10–14 h per week	84 (20.0)
5–9 h per week	152 (36.3)

Participants’ level of knowledge and attitude about robotic surgery

As shown in Table 2, 53.9% of the participants were not aware about existence of general robotic surgery, whereas 46.1% have heard about it. Of those who have heard about general robotic surgery, only 7.25% have had themselves or any of their close family members undergone general robotic surgery. Almost half of the sample do not know if general surgery using robotics is available in Saudi Arabia (49.4%), while 36.4% believe that it is available, and 14.1% believe that it is not available. The vast majority did not believe that they had sufficient knowledge about general robotic surgery (89.5%), whereas only 10.5% thought that they have enough knowledge. Among respondents who believe they are well-informed about general robotic surgery, (40.91%) attribute their knowledge to the Internet. This is followed by (27.27%) who gained their information through university or work, (22.73%) through doctors, (4.55%) through family, (2.27%) through brochures, and (2.27%) were unsure about what robotic surgery entails.

Table 2.

Knowledge and attitude about robotic surgery

Item	Frequency (%)
Have you ever heard of general robotic surgery?
No	226 (53.9)
Yes	193 (46.1)
Have you or any of your close family members undergone general robotic surgery? (n=193)
No	179 (92.75)
Yes	14 (7.25)
Do you think general surgery using robotics is available in Saudi Arabia?
No	59 (14.1)
Yes	153 (36.5)
I don't know	207 (49.4)
Do you think you have enough information about general robotic surgery?
No	375 (89.5)
Yes	44 (10.5)
If yes, what is your source of information about general robotic surgery? (n=44)
Internet	18 (40.91)
Through doctors	10 (22.73)
Through brochures	1 (2.27)
Through the family	2 (4.55)
Through university or work	12 (27.27)
I don't know what robotic surgery is	1 (2.27)
What do you think about how the robot works in general surgery?
I don't know	170 (40.6)
The doctor uses robot arms	45 (10.7)
The robot performs the surgery and the doctor makes sure the patient is safe	64 (15.3)
The doctor programs the robot and the robot performs the surgery	72 (17.2)
The doctor guides the robot step by step (C)	68 (16.2)
What are the advantages of general robotic surgery from your point of view?
Make the doctor's life easier (C)	77 (18.4)
I don't know	105 (25.1)
Less complications for the operation	30 (7.2)
More accurate results of the operation	162 (38.7)
Faster processing time	45 (10.7)
What are the disadvantages of general robotic surgery from your point of view?
Its cost is higher than traditional surgery (C)	202 (48.2)
Difficulties in performing the operation	35 (8.4)
I don't know	145 (34.6)
There is no significant difference between it and traditional surgery	19 (4.5)
Longer running time	18 (4.3)
If you were offered the option of general robotic surgery, would you prefer it over traditional surgery?
I'm not sure	205 (48.9)
Never	90 (21.5)
Yes, all operations	16 (3.8)
Yes, just some operations	87 (20.8)
Yes, most operations	21 (5.0)

C: Correct answer

When participants were questioned on their understanding of how robots function in general surgery, only a small percentage, (16.2%), correctly identified that the surgeon directs the robot at each step. The rest of the responses were varied, with (40.6%) admitting they did not know, (17.2%) believing that the surgeon programs the robot which then performs the surgery on its own, (15.3%) assuming the robot carries out the surgery while the doctor ensures patient safety, and (10.7%) thinking that the surgeon operates using robotic arms. When investigated about the advantage of general robotic surgery, only 25.1% of the participants correctly responded with making the doctor’s life easier, followed by more accurate results of the operation (38.7%), I don’t know (18.4%), faster processing time (10.7%), and less complications for the operation (7.2%). Regarding the disadvantages of general robotic surgery, nearly half of the participants correctly identified that its cost is higher than traditional surgery, with a response rate of (48.2%). A significant number were unsure, with (34.6%) stating ‘I don’t know’. A smaller fraction mentioned difficulties in performing the operation (8.4%), a belief that there is no significant difference between robotic and traditional surgery (4.5%), and longer operation times (4.3%).

In evaluating participants’ attitudes towards general robotic surgery, (48.9%) were uncertain about undergoing robotic surgery, (21.5%) stated they would never accept it, (20.8%) would agree to it for some operations, (5%) for most operations, and only (3.8%) were willing for all operations.

Furthermore, as demonstrated in Tables 3 and 4, only occupation showed a significant association with the knowledge of robotic surgery definition. Moreover, understanding the definition of robotic surgery was reported to be significantly associated with participants who are Saudi nationals. Females showed a higher correct answer with regard to general robotic surgery advantage, in addition to educational level. However, younger age groups showed a significant association with the knowledge of general robotic surgery disadvantage, as well as social status, educational level, and occupation.

Table 3.

Association between demographic data and awareness and knowledge of robotic surgery definition the Eastern Region public of Saudi Arabia

Sociodemographic items	Awareness of robotic surgery		P	Robotic surgery definition		P
	Incorrect	Correct		Incorrect	Correct
Age
18–30	130	116	0.874	206	40	0.841
31–45	50	40		74	16
46–60	46	37		71	12
Gender
Male	64	47	0.376	92	19	0.881
Female	162	146		259	49
Social status
Single	116	106	0.547†	180	42	0.342†
Married	101	81		157	25
Divorced	6	2		8	0
Widows	3	4		6	1
Education level
Primary	1	0	0.218†	1	0	0.441†
Bachelor's	129	117		204	42
Masters	12	9		19	2
Secondary	43	34		60	17
Diploma	38	27		59	6
Ph.D.	1	6		6	1
Uneducated	2	0		2	0
Family income (Riyals)
>20,000	43	43	0.152	72	14	0.727
10,000–20,000	95	87		153	29
5000–10,000	56	49		90	15
<5000	32	14		36	10
Naturality
Saudi	221	188	1.000	346	63	0.013*
Non-Saudi	5	5		5	5
Occupation
Work off the healthy track	140	85	0.0001*	192	33	0.316
Doctor	19	44		49	14
Unemployed	51	27		68	10
Health track (nursing, medical science, etc.)	16	37		42	11
How many hours per week do you spend using electronic devices
15 or more hours per week	72	74	0.324	119	27	0.341
<4 h a week	25	12		30	7
10–14 h per week	42	42		68	16
5–9 h per week	87	65		134	18

*Significant P value, † Fisher's exact test was used when the cell counts were less than

Table 4.

Association between demographic data and awareness and knowledge of the Eastern Region public of Saudi Arabia

Sociodemographic items	Advantage of robotic surgery		P	Disadvantage of robotic surgery		P
	Incorrect	Correct		Incorrect	Correct
Age
18–30	206	40	0.075	108	138	0.0001*
31–45	66	24		50	40
46–60	70	13		59	24
Gender
Male	106	5	0.0001*	54	57	0.506
Female	236	72		163	145
Social status
Single	187	35	0.060†	96	126	0.001†,*
Married	146	36		110	72
Divorced	4	4		6	2
Widows	5	2		5	2
Education level
Primary	0	1	0.002†,*	0	1	0.0001†,*
Bachelor's	189	57		121	125
Masters	17	4		9	12
Secondary	68	9		36	41
Diploma	61	4		51	14
Ph.D.	6	1		0	7
Uneducated	1	1		0	2
Family income (Riyals)
>20,000	67	19	0.309	40	46	0.078
10,000–20,000	156	26		96	86
5000–10,000	83	22		63	42
<5000	36	10		18	28
Naturality
Saudi	333	76	0.697†	215	194	0.055†
Non-Saudi	9	1		2	8
Occupation
Work off the healthy track	188	37	0.264	129	96	0.0001*
Doctor	49	14		19	44
Unemployed	59	19		48	30
Health track (nursing, medical science, etc.)	46	7		21	32
How many hours per week do you spend using electronic devices
15 or more hours per week	123	23	0.634	67	79	0.146
<4 h a week	28	9		24	13
10–14 h per week	67	17		42	42
5–9 h per week	124	28		84	68

^*Significant P value, ^†Fisher's exact test was used when the cell counts were <5

DISCUSSION

Our study aims to determine the perception and knowledge of the Eastern Region’s population toward robotic surgery in general surgery.

The age distribution might reflect the higher likelihood of younger individuals being more tech-savvy and open to exploring new medical technologies like robotic surgery. In terms of gender representation, the study showed a higher proportion of female participants (73.5%). Regarding educational levels, study indicates that a significant portion of the participants had attained at least secondary education, making them potentially more receptive to understanding and evaluating new medical procedures like robotic surgery. The diverse occupational distribution suggests that the study captured perspectives from individuals with different levels of exposure and experience in the medical field.

Regarding the knowledge and attitudes of participants toward robotic surgery, approximately half of the participants were aware of the existence of general robotic surgery, while the other half had no prior knowledge about it. This indicates that there is a lack of awareness about robotic surgery among a significant portion of the sample population. Buabbas et al. (2020) conducted a similar survey and reported that participants were unaware of robotic surgery.[10] This similarity in results suggests that the lack of awareness about robotic surgery is not isolated to our study but might be a widespread issue.

Regarding the experience with general robotic surgery, only a small proportion of participants reported having undergone or had a close family member who underwent such a procedure. This finding is consistent with the study, where they found that few participants had direct experience with robotic surgery.[11] It appears that despite the increasing use of robotic surgery in medical practice, it is not yet a common procedure in the population.

One concerning finding was that almost half of the participants were uncertain about the availability of general robotic surgery in Saudi Arabia. This uncertainty may be attributed to the lack of information and public awareness about robotic surgical options. A study by Chan et al. in a different country revealed similar results, with large number of participants being unsure about the availability of robotic surgery.[12]

Regarding the source of information, the Internet was the primary means through which participants reported gaining knowledge about general robotic surgery. This is consistent with other studies, such as the one conducted by Sultan et al., where the Internet was found to be the most common source of information for 35% of their participants.[13]

Despite the participants’ self-perceived knowledge, the majority believed that they lacked sufficient information about general robotic surgery. This finding suggests a need for improved educational initiatives and outreach programs to disseminate accurate information about the benefits and risks of robotic surgery.[14]

When assessing the participants’ understanding of how robotic surgery works, a significant proportion provided incorrect responses. This highlights a knowledge gap among the participants regarding the robotic surgical process. Similar results were reported by Lawrie et al., where few participants accurately described the role of the doctor in guiding the robot during surgery.[15]

In terms of the advantages of general robotic surgery, the most commonly recognized benefit was that it makes the doctor’s life easier, followed by more accurate surgical results. This is consistent with the study, where the majority of participants identified improved surgical precision and ease of operation as the primary advantages of robotic surgery.[16] This study can be used as roadmap toward introducing the robotic system in the Eastern Province.

However, the participants’ understanding of the disadvantages of robotic surgery was not as accurate. A substantial portion of participants were unsure about the disadvantages, indicating a lack of awareness about potential risks. In contrast, a study by Peter van et al. found the higher cost of robotic surgery as a disadvantage.[17]

Assessing the attitude of participants toward general robotic surgery revealed that a significant proportion were uncertain or hesitant about accepting robotic surgery for themselves. This finding is consistent with the study, where majority of participants expressed uncertainty or reluctance toward robotic surgery.[18]

Regarding the association between demographic data and the awareness and knowledge of robotic surgery, the findings indicate that occupation is the only demographic factor that showed a significant association with the knowledge of robotic surgery definition. This suggests that individuals’ professional backgrounds may influence their understanding of this advanced surgical technique.[13] Further exploration into the reasons behind this association would be beneficial for tailoring educational initiatives to improve awareness among specific occupational groups.

Interestingly, the study also reveals that Saudi subjects displayed a significant relationship with the knowledge of robotic surgery definition. This finding implies that cultural factors or specific cultural awareness campaigns might play a role in shaping individuals’ understanding of this technology.[18] Understanding how cultural perceptions impact knowledge about robotic surgery can facilitate the implementation of culturally sensitive educational interventions.

Regarding gender differences, it was observed that females demonstrated higher accuracy in answering questions related to general robotic surgery advantages. This result aligns with previous studies that have shown women to be more receptive to health-related information and proactive in seeking health-care services.[19] Capitalizing on this trend, health-care providers could focus on targeted educational programs to further improve women’s knowledge of robotic surgery benefits.

In contrast, younger age groups displayed a significant association with knowledge of general robotic surgery disadvantages. This finding may indicate that younger individuals are more aware of potential risks and limitations associated with robotic surgery, possibly due to their familiarity with technology and access to online health information.[20] It would be prudent to investigate the information sources that influence the younger population’s awareness of robotic surgery disadvantages to ensure accuracy and reliability of the information they receive.

Moreover, educational level, social status, and occupation were also significantly associated with the knowledge of general robotic surgery disadvantages. These findings suggest that individuals with higher education, higher social status, and certain occupations are more informed about the potential drawbacks of robotic surgery. Targeted educational campaigns aimed at other demographics with lower awareness levels could help bridge the knowledge gap and promote a more informed public perception of robotic surgery.

Limitations

Despite the valuable insights provided by this study, several limitations should be acknowledged. First, the research relied on a convenience sampling method, which may introduce selection bias and limit the generalizability of the findings to the broader population of the Eastern Region of Saudi Arabia. A more representative and random sampling approach could enhance the study’s external validity. Second, the data collection was conducted through a Google form, which may have resulted in self-selection bias, as individuals with greater interest or awareness of robotic surgery might have been more inclined to participate. Additionally, the study was limited to self-reported data, which could be subject to recall bias and social desirability bias, leading to potential inaccuracies in responses.

CONCLUSION

The general public of the Eastern Region in Saudi Arabia showed a derationed level of knowledge about the use of robotics in general surgery. Furthermore, a major portion of people were not aware of the availability of robotic surgery in Saudi Arabia. Educational programs are warranted to facilitate the acceptance and implantation of robotic surgery in Saudi Arabia. More generalized national studies should be conducted to perceive a better insight into the current knowledge of Saudi Arabia’s population with regard to robotic surgery.

Ethical approval

This study was ethically approved by the Ethical Committee of the Deanship of Scientific Research at King Faisal University on February 15, 2023, with the reference number of KFU-REC-2023-FEB-ETHICS580. Participation in the study was voluntary, and online consent was obtained before filling out the survey.

Author contribution

LSA and AAA conceived and designed the study. AAA and NAA analyzed and interpreted the data. FFA, LAA, and MAA wrote the initial and final draft of the study. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.