Robotic-assisted laparoscopic surgery (RAS) has become increasingly integrated into gynecologic and urogynecologic practice; however, global access, utilization, and training exposure remain uneven. We aimed to evaluate worldwide access to RAS, procedural use, surgeon perceptions, and training pathways among clinicians involved in gynecologic and urogynecologic surgery.

We conducted a cross-sectional, web-based international survey distributed through the International Urogynecological Association (IUGA) and the European Urogynaecological Association (EUGA) between April and June 2025. Surgeons, fellows, and residents performing pelvic and reconstructive procedures were eligible. The survey assessed access to robotic platforms, procedural utilization, training exposure, perceived barriers, and attitudes toward implementation. Descriptive and comparative statistical analyses were performed.

A total of 1,500 clinicians were invited, and 216 participants from 49 countries completed the survey. Overall, 68.5% (148/216) reported access to at least one robotic platform. Robotic surgery was incorporated into 61.1% of gynecology departments, most commonly in urogynecology (51.9%) and gynecologic oncology (49.1%).

Among those with access, the most frequently performed procedures were hysterectomy (50.0%), sacrocolpopexy or sacrohysteropexy (44.6%), and mesh removal (19.6%). Most centers reported fewer than five robotic surgeons and relatively low annual case volumes.

Initial exposure to robotics was most commonly industry-based (14.4%). Fellowship training (20.4%), simulation (16.7%), and structured mentorship (13.4%) were considered the most effective training pathways. Among surgeons with access, 58.8% considered prior laparoscopic experience essential or highly desirable.

The main barriers to adoption were high cost (19.0%), institutional limitations (10.6%), and insufficient training opportunities (9.3%). Surgeons with robotic access were more likely to consider robotics necessary for gynecology units (40.5% vs 8.8%; p<0.001) and to recommend its use (58.1% vs 36.8%; p=0.004). Higher procedural volume was associated with stronger support for robotics (49.2% vs 22.9%; p<0.001).

RAS is widely incorporated into gynecologic and urogynecologic practice; however, access, case volume, and training exposure remain highly variable. Surgeons with access and higher procedural volume demonstrate more favorable perceptions, suggesting that experience influences attitudes toward adoption. Persistent reliance on industry-led training highlights ongoing gaps in structured, competency-based educational frameworks.

Although robotic-assisted surgery is increasingly utilized worldwide, disparities in access and training remain significant. Efforts should focus on developing standardized, competency-based training pathways and improving equitable access to ensure safe and effective integration of robotics into gynecologic and urogynecologic practice.

Continence 19S (2026) 102572
DOI: 10.1016/j.cont.2026.102572