We performed a prospective, descriptive study. We have adhered to relevant EQUATOR guidelines and reported by the STROBE reporting guidelines [12] (Supplementary File S1).

In April 2022, Copenhagen University Hospital—Rigshospitalet, Denmark, started using the Medtronic Hugo™ RAS for robot-assisted radical prostatectomies (RARP). One experienced RARP surgeon (> 1000 RARPs) transferred from the Davinci® Surgical System to the Hugo™. The robotic nurse team was assigned ad hoc from eight experienced robotic nurses and consisted of a circulating nurse, a scrub nurse, and sometimes a supervised circulating nurse in training for each operation. The tasks of the nurses were the same on the Hugo™ as for the previous RARP on the DaVinci®.

The robotic nurse team received a training program for the Hugo™ at Orsi Academy, Belgium, and Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen before the first surgery. The robotic team had dry-run team training learning the modalities of the robotic system including set-up, optimal patient positioning, docking, and undocking of the system. They received training to manage technical errors and emergency procedures, including safe and quick undocking of the system.

An engineer and two start-up specialists with OR nursing backgrounds from Medtronic (Minneapolis, Minnesota, USA) were present in the OR for all surgeries to help guide and navigate the robotic system in case of technical issues.

Data from all surgeries with the new system were prospectively registered by a dedicated on-site observer from an observation team of three different observers who all received the same training. All data were observational data with no interventions or extra tasks assigned to the nurses during this study. Data were collected from when the first member of the robotic nurse team entered the OR until the patient had finished surgery and left the OR. The observer noted when the patient and the robotic nurse team were present at the OR and when the robotic nurse team members left the room or were released for a break. Further, data consisted of preoperative, perioperative, and postoperative tasks with the specifications of the tasks explained in Table 1. All data were registered with a start time and end time with a total time calculated from these. The nurses occasionally attended a weekly scheduled educational session during the preoperative phase.

The Hugo™ system was moved from one OR to another after 15 surgeries as the robotic system was first placed at a temporary location while the permanent OR was under renovation. Both ORs were in different buildings away from the regular OR facility of the robotic nurse teams.

For comparison, the same observational data was collected from the experienced robotic team on 30 RARP performed on the DaVinci® Surgical System. The experienced robotic nurse team on the DaVinci® consisted of the same nurses as on the robotic nurse team for the Hugo™.

All participants gave oral consent after receiving information about the study. The study was reviewed and approved by The Danish Data Protection Agency (P-2022-341). No further approval was needed from the ethical committee as this was a qualitative assurance study.

We used descriptive statistics to summarize the basic demographics of the surgeries and the experience of the robotic nurse team. Categorical variables are described by frequencies and proportions while continuous variables are described by median and interquartile range. Total preoperative, perioperative, and postoperative surgical times were calculated and illustrated in a graph for learning curve analysis. The total preoperative surgical times were calculated by extracting the weekly educational session. Timelines were created for a timeline overview of the work patterns for each surgery.

SPSS (Version 28.0.; IBM SPSS Statistics for Windows, Armonk, NY) and Microsoft® Excel® (Version 2202; Microsoft Corporation, Redmond, Washington) were used for the statistical analysis.