Robotic systems are increasingly used in other surgical fields, but there is currently no agreed framework for orbital surgery, measures of success and failures to support safe and ethical introduction to the speciality.

We invite all oculoplastics and orbital surgeons to take part in a research study that aims to shape how orbital robotic surgery should be developed, evaluated and introduced into clinical practice – regardless of whether you have any experience in robotic surgery.

This study aims to develop expert consensus on:

1. Indications for orbital robotic surgery in its early and later phases
2. Outcome measures and definitions of success (clinical, technical, patient-reported)
3. Early failure modes and risks of adoption (technical, clinical, organisational)
4. Risk control strategies, aligned with international medical device risk-management standards
5. A staged research and implementation roadmap for orbital robotics

The end-product will be a set of consensus-based recommendations that can guide future preclinical work, ethics applications, early clinical studies and eventual comparative trials. All contributors will be acknowledged in the consensus framework.

If you agree to take part:

• We ask you to complete the following online questionnaire (round 1) (time to complete aprox. 3o mins)
• This includes background questions and a series of Likert-scale items with definitions provided.
• You will also have the chance to add free-text comments and suggest additional items.
• Your responses will be analysed in aggregate. Items with clear consensus will be identified; others will be revised or clarified.
• You will then be invited to one or more further rounds (usually 2-3 rounds in total) (subsequent rounds, aprox 20 mins).
• In each round, you will be shown summarised group responses from the previous round (anonymised) and may be asked whether you wish to reconsider your ratings in light of your peers views.
• We will stop when we reach a reasonable level of stability and consensus across key domains (indications, outcomes, risks, risk controls, trial design, etc.).
• You can skip any question you do not wish to answer, and you may withdraw from the study at any time without giving a reason.

This study has received ethical approval in accordance with the principles of the Declaration of Helsinki. Ethical approval was granted by King’s College London, UK Research Ethics Committee. KCL Ethics Reference: LRS/RGO-24/25-50552

Thank you for your consideration, and we look forward to your participation.

Best wishes,

Mohsan Malik

---