Presentation (CTI)

OBJECTIVES: Robot-assisted surgery (RAS) is expanding rapidly in China, with Shanghai becoming the first metropolitan to reimburse selected RAS procedures since 2021. However, the extent to which procedural completeness of informed consent supports patient autonomy under conditions of high technical complexity remains unclear. This study aimed to explore the technical informed consent paradox from the perspectives of healthcare providers and administrators.
METHODS: A qualitative study followed COREQ guidelines. Semi-structured interviews were used to examine clinical adoption patterns, surgeons' modality preferences, the impact of Shanghai reimbursement policy, patient financial burden, and decision-making processes. Seven participants were recruited from tertiary hospitals in Shanghai, including five surgeons across hepatobiliary, gastrointestinal, colorectal, pancreatic, and urological specialties, and two administrators from medical affairs and finance departments. This study employed a dual standard of code saturation and meaning saturation to guide the termination of data collection and the assessment of adequacy. In this study, code saturation was initially achieved after the sixth interview, following which a seventh interview was conducted specifically to examine meaning saturation.
RESULTS: Three themes were identified. First, technical complexity structurally limits patients’ ability to independently evaluate surgical recommendations, with modality choice often reflecting trust in the surgeon rather than informed technical understanding. Second, reimbursement coverage substantially influences patient decision-making, increasing preference for RAS when financially supported. Third, patients tend to emphasize perceived advantages of RAS while underappreciating potential limitations, including risks of complications.
CONCLUSIONS: Technical complexity, reimbursement policies, and patient-centered expectations collectively create tension between procedural and substantive autonomy in RAS decision-making. Although patients are expected to make independent choices regarding complex surgical options, comprehension remains limited within highly specialized clinical contexts. Addressing this issue requires not only enhanced preoperative communication but also institutional strategies, including independent decision-support resources, physician-patient shared decision making, standardized treatment comparison frameworks, and multidisciplinary preoperative assessment mechanisms.