# The preparedness of urologists to manage cardiopulmonary arrest during robot-assisted surgery

## TL;DR

Urologists often lack formal training and institutional protocols for managing cardiopulmonary arrest during robot-assisted surgery, highlighting a need for better education and preparedness.

## Contribution

This study is the first to explore urologists' preparedness for managing cardiopulmonary arrest during robot-assisted surgery through a global survey.

## Key findings

- Most urologists had not received formal training on managing cardiopulmonary arrest during robot-assisted surgery.
- A majority of respondents were unaware of institutional protocols for such events.
- Respondents showed similar approaches to managing hypothetical cardiopulmonary arrest scenarios during surgery.

## Abstract

More patients with significant comorbidities and greater perioperative risk are being selected for robot-assisted surgery (RAS) in urology. Cardiopulmonary arrest (CPA) during RAS is an intraoperative complication that poses unique challenges. This exploratory study surveyed practicing urologists to describe preparedness to manage CPA events during RAS. An expert-developed survey was distributed via social media platforms and during international urology conferences between June 2023 and March 2025. The questionnaire assessed demographic characteristics, training background, exposure to CPA during RAS, and institutional preparedness. A total of 50 responses were included in the final analysis. Among 50 respondents, 94% were male, 74% were over 35 years old, and 56% practiced in the United States. Over half (56%) were fellowship-trained. CPA events during RAS were most commonly witnessed by respondents during residency training (76%). However, 78% had never received formal instruction on management of CPA during RAS. Of those who had, training occurred during residency (12%), fellowship (6%), or instructional courses (12%). Most (80%) were unaware of any institutional protocols for CPA during RAS. Respondents selected similar initial management steps and post-arrest strategies across hypothetical scenarios for CPA during pelvic and renal RAS. These findings identify variability in self-reported training exposure and protocol awareness, suggesting areas where structured education and institutional intervention may be considered.