Robotic-assisted surgery in Egypt: national insights into awareness, knowledge, and perceptions among surgeons and patients

Abstract

The integration of robotic-assisted surgery (RAS) in low- and middle-income countries (LMIC) is hindered by significant perception gaps among key stakeholders. This study evaluated the awareness, knowledge, and perceptions of RAS in Egypt to identify barriers to its adoption. A national, multi-center, cross-sectional study was conducted across ten Egyptian university hospitals (Nov 2024-Apr 2025). Validated questionnaires were administered to three cohorts: general surgical patients (n = 539), surgeons (n = 486), and RAS-experienced patients (n = 32). Multivariable logistic regression identified predictors of patient preference and surgeon support for RAS. A stark perception gap was observed. Surgeon awareness was high (90.7%), but knowledge was limited; only 56.8% knew RAS was available in Egypt. Despite this, 80.0% supported national implementation, which was independently predicted by awareness of local availability (aOR 6.35, 95% CI 3.25-12.42) and correct technical understanding (aOR 2.49, 1.48-4.18). Conversely, patient awareness was low (30.4%), with high prevalence of fears regarding malfunction (63.3%). Only 20.0% preferred RAS. Patient preference was associated with the absence of fears (aOR 0.08, 0.04-0.16) and belief in improved outcomes (aOR 4.08, 2.10-7.94). RAS-experienced patients, informed primarily by surgeons (90.6%), reported high satisfaction (84.4% "Very Good"/"Excellent") and were strong advocates (90.6% would recommend it). RAS adoption in Egypt appears to be influenced mainly by modifiable perceptual barriers rather than demographics. Surgeons are generally supportive but under-informed, while patient hesitancy seems driven by fear that can lessen after direct exposure and education. National strategies should prioritize targeted education and the use of positive patient experiences to help address these gaps.