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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2018

01-03-2018

Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013

Authors: Yen-Yi Juo, Aditya Mantha, Ahmad Abiri, Anne Lin, Erik Dutson

Published in: Surgical Endoscopy | Issue 3/2018

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Abstract

Introduction

Robotic-assisted procedures were frequently found to have similar outcomes and indications to their laparoscopic counterparts, yet significant variation existed in the acceptance of robotic-assisted technology between surgical specialties and procedures. We performed a retrospective cohort study investigating factors associated with the adoption of robotic assistance across the United States from 2008 to 2013.

Methods

Using the Nationwide Inpatient Sample database, patient- and hospital-level variables were examined for differential distribution between robotic-assisted and conventional laparoscopic procedures. Multilevel logistic regression models were constructed to identify independent factors associated with robotic adoption. Furthermore, cases were stratified by procedure and specialty before being ranked according to proportion of robotic-assistance adoption. Correlation was examined between robotic-assistance adoption and relative outcome in comparison with conventional laparoscopic procedures.

Results

The national robotic case volume doubled over the five-year period while a gradual decline in laparoscopic case volume was observed, resulting in an increase in the proportion of procedures performed with robotic assistance from 6.8 to 17%. Patients receiving robotic procedures were more likely to be younger, males, white, privately insured, more affluent, and with less comorbidities. These differences have been decreasing over the study period. The three specialties with the highest proportion of robotic-assisted laparoscopic procedures were urology (34.1%), gynecology (11.0%), and endocrine surgery (9.4%). However, no significant association existed between the frequency of robotic-assistance usage and relative outcome statistics such as mortality, charge, or length of stay.

Conclusion

The variation in robotic-assistance adoption between specialties and procedures could not be attributable to clinical outcomes alone. Cultural readiness toward adopting new technology within specialty and target anatomic areas appear to be major determining factors influencing its adoption.
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Literature
1.
Rogers EM (2003) Diffusion of innovations, 5th edn. Free Press, New York
2.
Barkun JS, Aronson JK, Feldman LS, Maddern GJ, Strasberg SM, Altman DG, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Flum DR, Glasziou P, Marshall JC, McCulloch P, Nicholl J, Reeves BC, Seiler CM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J (2009) Evaluation and stages of surgical innovations. Lancet 374:1089–1096CrossRefPubMed
3.
Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87:408–410CrossRefPubMed
4.
Abbou CC, Hoznek A, Salomon L, Lobontiu A, Saint F, Cicco A, Antiphon P, Chopin D (2000) Remote laparoscopic radical prostatectomy carried out with a robot. Report of a case. Prog Urol 10:520–523PubMed
5.
Elhage O, Challacombe B, Shortland A, Dasgupta P (2015) An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int 115:274–281CrossRefPubMed
6.
Hollingsworth JM, Krein SL, Dunn RL, Wolf JS Jr, Hollenbeck BK (2008) Understanding variation in the adoption of a new technology in surgery. Med Care 46:366–371CrossRefPubMed
7.
Parsons JK, Messer K, Palazzi K, Stroup SP, Chang D (2014) Diffusion of surgical innovations, patient safety, and minimally invasive radical prostatectomy. JAMA Surg 149:845–851CrossRefPubMedPubMedCentral
8.
Mirheydar HS, Parsons JK (2012) Diffusion of robotics into clinical practice in the United States: process, patient safety, learning curves, and the public health. World J Urol 31:455–461CrossRefPubMed
9.
Casula R, Athanasiou T, Foale R (2004) Recent advances in minimal-access cardiac surgery using robotic-enhanced surgical systems. Expert Rev Cardiovasc Ther 2:589–600CrossRefPubMed
10.
Ismail M, Swierzy M, Ulrich M, Ruckert JC (2013) Application of the da Vinci robotic system in thoracic surgery. Chirurg 84:643–650CrossRefPubMed
11.
12.
Jung M, Morel P, Buehler L, Buchs NC, Hagen ME (2015) Robotic general surgery: current practice, evidence, and perspective. Langenbecks Arch Surg 400:283–292CrossRefPubMed
13.
Mirnezami AH, Mirnezami R, Venkatasubramaniam AK, Chandrakumaran K, Cecil TD, Moran BJ (2010) Robotic colorectal surgery: hype or new hope?: A systematic review of robotics in colorectal surgery. Colorectal Dis 12:1084–1093CrossRefPubMed
14.
Choi JE, You JH, Kim DK, Rha KH, Lee SH (2010) Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 67:891–901CrossRef
15.
Robertson C, Close A, Fraser C, Gurung T, Jia X, Sharma P, Vale L, Ramsay C, Pickard R (2013) Relative effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta-analysis. BJU Int 112:798–812CrossRefPubMed
16.
Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A (2010) Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol 116:1422–1431CrossRefPubMed
17.
Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching. JAMA Surg 149:177–184CrossRefPubMedPubMedCentral
18.
Nagendran J, Catrip J, Losenno KL, Adams C, Kiaii B, Chu MW (2017) Minimally invasive mitral repair surgery: why does controversy still persist? Expert Rev Cardiovasc Ther 15:15–24CrossRefPubMed
19.
Patel R, Szymaniak J, Radadia K, Faiena I, Lasser M (2015) Controversies in robotics: open versus robotic radical cystectomy. Clin Genitourin Cancer 13:421–427CrossRefPubMed
20.
Albright BB, Witte T, Tofte AN, Chou J, Black JD, Desai VB, Erekson EA (2016) Robotic versus laparoscopic hysterectomy for benign disease: a systematic review and meta-analysis of randomized trials. J Minim Invasive Gynecol 23:18–27CrossRefPubMed
21.
Cathelineau X, Sanchez-Salas R, Sivaraman A (2014) What is next in robotic urology? Curr Urol Rep 15:460CrossRefPubMed
22.
Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, Aschkenazi S, Olivera C, South M, Lowenstein L, Schaffer J, Balk EM, Sung V (2014) Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 21:353–361CrossRefPubMed
23.
Meshkinpour H, Hsu D, Farivar S (1988) Effect of gastric bubble as a weight reduction device: a controlled, crossover study. Gastroenterology 95:589–592CrossRefPubMed
24.
Ruffin JM, Grizzle JE, Hightower NC, McHardy G, Shull H, Kirsner JB (1969) A co-operative double-blind evaluation of gastric “freezing” in the treatment of duodenal ulcer. N Engl J Med 281:16–19CrossRefPubMed
25.
EC-IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200CrossRef
26.
Kramer FM, Stunkard AJ, Spiegel TA, Deren JJ, Velchik MG, Wadden TA, Marshall KA (1989) Limited weight losses with a gastric balloon. Arch Intern Med 149:411–413CrossRefPubMed
27.
Warlow C (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243CrossRef
28.
29.
Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27CrossRefPubMed
30.
Romano PS, Roos LL, Jollis JG (1993) Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol 46: 1075–1079; discussion 1081–1090
31.
32.
StataCorp (2005) Stata data management reference manual, Release 9. Stata Press, College Station
33.
Karthikesalingam A, Holt PJ, Vidal-Diez A, Bahia SS, Patterson BO, Hinchliffe RJ, Thompson MM (2016) The impact of endovascular aneurysm repair on mortality for elective abdominal aortic aneurysm repair in England and the United States. J Vasc Surg 64:321.e322–327.e322
34.
Chmielecki DK, Hagopian EJ, Kuo YH, Kuo YL, Davis JM (2012) Laparoscopic cholecystectomy is the preferred approach in cirrhosis: a nationwide, population-based study. HPB (Oxford) 14:848–853CrossRef
35.
Jaschinski T, Mosch C, Eikermann M, Neugebauer EA (2015) Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. BMC Gastroenterol 15:48CrossRefPubMedPubMedCentral
36.
Varda BK, Johnson EK, Clark C, Chung BI, Nelson CP, Chang SL (2014) National trends of perioperative outcomes and costs for open, laparoscopic and robotic pediatric pyeloplasty. J Urol 191:1090–1095CrossRefPubMed
37.
Moghadamyeghaneh Z, Phelan M, Smith BR, Stamos MJ (2015) Outcomes of open, laparoscopic, and robotic abdominoperineal resections in patients with rectal cancer. Dis Colon Rectum 58:1123–1129CrossRefPubMed
38.
Liu JJ, Leppert JT, Maxwell BG, Panousis P, Chung BI (2014) Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol 32:473–479CrossRefPubMed
39.
Yamasato K, Casey D, Kaneshiro B, Hiraoka M (2014) Effect of robotic surgery on hysterectomy trends: implications for resident education. J Minim Invasive Gynecol 21:399–405CrossRefPubMed
40.
Lee MG, Chiu CC, Wang CC, Chang CN, Lee SH, Lee M, Hsu TC, Lee CC (2017) Trends and outcomes of surgical treatment for colorectal cancer between 2004 and 2012—an analysis using national inpatient database. Sci Rep 7:2006CrossRefPubMedPubMedCentral
41.
Moran PS, O’Neill M, Teljeur C, Flattery M, Murphy LA, Smyth G, Ryan M (2013) Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis. Int J Urol 20:312–321CrossRefPubMed
42.
Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252:254–262CrossRefPubMed
43.
44.
Yu J, Wang Y, Li Y, Li X, Li C, Shen J (2014) The safety and effectiveness of Da Vinci surgical system compared with open surgery and laparoscopic surgery: a rapid assessment. J Evid Based Med 7:121–134CrossRefPubMed
45.
Wright JD, Ananth CV, Lewin SN, Burke WM, Lu YS, Neugut AI, Herzog TJ, Hershman DL (2013) Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease. JAMA 309:689–698CrossRefPubMed
46.
Blake EA, Sheeder J, Behbakht K, Guntupalli SR, Guy MS (2016) Factors impacting use of robotic surgery for treatment of endometrial cancer in the United States. Ann Surg Oncol 23:3744–3748CrossRefPubMed
47.
Gabriel E, Thirunavukarasu P, Al-Sukhni E, Attwood K, Nurkin SJ (2016) National disparities in minimally invasive surgery for rectal cancer. Surg Endosc 30:1060–1067CrossRefPubMed
48.
Kim SP, Boorjian SA, Shah ND, Weight CJ, Tilburt JC, Han LC, Thompson RH, Trinh QD, Sun M, Moriarty JP, Karnes RJ (2013) Disparities in access to hospitals with robotic surgery for patients with prostate cancer undergoing radical prostatectomy. J Urol 189:514–520CrossRefPubMed
49.
Monn MF, Bahler CD, Schneider EB, Sundaram CP (2013) Emerging trends in robotic pyeloplasty for the management of ureteropelvic junction obstruction in adults. J Urol 189:1352–1357CrossRefPubMed
50.
Falkenback D, Lehane CW, Lord RV (2015) Robot-assisted oesophageal and gastric surgery for benign disease: antireflux operations and Heller’s myotomy. ANZ J Surg 85:113–120CrossRefPubMed
51.
Tolboom RC, Broeders IA, Draaisma WA (2015) Robot-assisted laparoscopic hiatal hernia and antireflux surgery. J Surg Oncol 112:266–270CrossRefPubMed
52.
Benmessaoud C, Kharrazi H, MacDorman KF (2011) Facilitators and barriers to adopting robotic-assisted surgery: contextualizing the unified theory of acceptance and use of technology. PLoS ONE 6:e16395CrossRefPubMedPubMedCentral
53.
Stafinski T, Topfer LA, Zakariasen K, Menon D (2010) The role of surgeons in identifying emerging technologies for health technology assessment. Can J Surg 53:86–92PubMedPubMedCentral
54.
Guru KA, Hussain A, Chandrasekhar R, Piacente P, Bienko M, Glasgow M, Underwood W, Wilding G, Mohler JL, Menon M, Peabody JO (2009) Current status of robot-assisted surgery in urology: a multi-national survey of 297 urologic surgeons. Can J Urol 16: 4736–4741; discussion 4741
55.
Tseng TY, Cancel QV, Fesperman SF, Kuebler HR, Sun L, Robertson CN, Polascik TJ, Moul JW, Vieweg J, Albala DM, Dahm P (2007) The role of early adopter bias for new technologies in robot assisted laparoscopic prostatectomy. J Urol 177:1318–1323CrossRefPubMed
56.
57.
Cundy TP, Marcus HJ, Hughes-Hallett A, Najmaldin AS, Yang GZ, Darzi A (2017) International attitudes of early adopters to current and future robotic technologies in pediatric surgery. J Pediatr Surg 49:1522–1526CrossRef
58.
Wexner SD, Bergamaschi R, Lacy A, Udo J, Brolmann H, Kennedy RH, John H (2009) The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference. Surg Endosc 23:438–443CrossRefPubMed
Metadata
Title
Diffusion of robotic-assisted laparoscopic technology across specialties: a national study from 2008 to 2013
Authors
Yen-Yi Juo
Aditya Mantha
Ahmad Abiri
Anne Lin
Erik Dutson
Publication date
01-03-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5822-4

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