L. D. Delaney1, R. Howard1, Q. Solano1, B. Fry1, J. Dimick1, D. A. Telem1, A. Ehlers1 1University Of Michigan, Ann Arbor, MI, USA
Introduction: The use of robotics for hernia repair has exploded over the last decade, despite the increased cost and questionable change in outcomes compared to traditional laparoscopic technique. However, there is variability in adoption of the technology, and it is unclear when and how surgeons choose to use the robotic technique. The unknown factors that drive the use of this high-resource technology are unable to be captured by traditional quantitative methods. Within this context, we sought to qualitatively explore surgeon motivations for use of robotic surgery in abdominal wall hernia repair.
Methods: Twenty-one surgeons participating in the Michigan Surgical Quality Collaborative (MSQC) were purposively sampled for participation in the study. Semi-structured interviews captured motivating factors for choice of approach for hernia repair. Surgeons were presented with clinical vignettes and open-ended questions to capture motivating factors for approach. Qualitative descriptive analysis was conducted using MaxQDA Plus 2020.
Results: Of the 21 participants, 17 (81%) were men, with a median (IQR) age of 47 (45-54). Qualitative analysis identified 3 dominant themes that characterized surgeon motivation for use of robotic approaches for hernia repair: Availability, Ease of Use and Market Factors. Surgeons reported that robotic use was heavily influenced by availability of the technology and if it was unavailable, they would default to a different approach rather than delay hernia repair. Surgeons also expressed that a robotic approach was associated with an increase in their personal physical comfort, allowing for improved approaches to difficult surgical techniques and improved ergonomics. Finally, surgeons agreed that the hospital system promotion of the robot to both patients and providers increased their desire to utilize the technology. Illustrative quotes for each theme are outlined in Table 1.
Conclusion: In this study, we found that adoption of robotic hernia repair is driven by surgeon perceptions about availability, comfort, and market competition, rather than patient or hernia characteristics. While surgeons thought that the robot was beneficial, the discretionary and variable use of this technology (i.e., willingness to use other approaches rather than delay care if the robot was unavailable) may indicate that the robotic technology is viewed as a useful but nonessential resource. Future work will quantitatively examine the patient factors that drive robotic utilization, to further assess the value and optimal utilization of robotic technology.
