Mp53-08 a Qualitative Assessment of Drivers, Barriers, and Value in Robotic-Assisted Lower Urinary Tract Reconstruction

Lembrikova, Katerina; Aninwene, George; Tebon, Peyton; Becker, Mark; Siapno, Allen; Yamashiro, Justine; Wood, Erika L.; Sturm, Renea

doi:10.1097/ju.0000000000002083.08

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“…They were also asked to rate the following based on procedure: ureteroenteric and urethrovesical anastomoses for CN versus appendix isolation and catheterizable channel implantation for AC. For drivers and barriers, respondents were asked to identify major barriers from a list of choices that were developed through a rigorous interview process of stakeholders in the urologic robotic industry via the National Science Foundation I-Corps program (5,16). Respondents were excluded due to incompleteness if surveys lacked responses regarding urologic specialty, technology, or surgical device adoption.…”

Section: Methodsmentioning

confidence: 99%

“…While surgeon perspectives regarding preferred approach are based on multiple factors, several key themes can be observed in discussions with surgeons and the available data that may inform robotics use in LUTR (5). These include risk of perioperative complications, long-term outcomes (e.g., oncological, continence), surgical training and volume, patient-surgeon decision-making, device limitations, and market factors.…”

Section: Introductionmentioning

confidence: 99%

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Approach to Lower Urinary Tract Reconstruction: A Survey of Adult and Pediatric Urologist Perspectives and Experiences

Lembrikova¹,

Aninwene²,

Christensen³

et al. 2022

Front. Urol.

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IntroductionRobotic adoption has rapidly increased within urology. Initial uptake in adult urology has outpaced that seen in pediatric procedures. The aim of this study was to determine adult and pediatric urologist satisfaction with specific procedural steps in lower urinary tract reconstruction (LUTR) using an open versus robotic approach and define drivers and barriers to robotics adoption to inform device development relevant to current needs.MethodsA survey was distributed to practicing urologists. Questions assessed surgeon demographics, technology adoption, satisfaction with anastomotic steps in continent neobladder (CN) and augmentation cystoplasty (AC), and drivers/barriers influencing robotic use.ResultsOf 110 respondents, 49% practiced in academic institutions; 51% reported non-academic, private, or other. Specializations were pediatrics (36%), oncology/robotics (25%), or other (39%). Sixty-eight percent completed training in the past decade. In the past year, 55% completed only open CN or AC, 36% only robotic, and 9% both. Of those that performed robotic procedures, 5% used only an intra-corporeal approach, 85% used only extra-corporeal, and 10% used both. Surgeons who performed robotic LUTR alone expressed high satisfaction with all CN and AC procedural steps evaluated. Overall, of the anastomoses evaluated, urologists found urethrovesical anastomoses more satisfactory using a robotic versus open approach. Pediatric versus adult urologists were overall less satisfied with the robotic approach. In terms of robotic adoption, major drivers for CN were adoption by neighboring institutions, improved perioperative outcomes, and equivalent oncological outcomes; barriers were cost of robotic purchase and maintenance, surgeon support for robotics, and difficult learning curve. Major drivers for AC were adoption by neighboring institutions, decreased operative time, and equivalent oncological outcomes; barriers were increased operative time, cost, and minimal perceived benefit of extracorporeal procedures.ConclusionUrologic oncologists and surgeons performing robotic LUTR alone were highly satisfied with the robotic approach. Pediatric urologists reported lower overall satisfaction with robotic steps in LUTR, potentially corresponding with limitations of current robotic platforms for pediatric application and relative training exposure. Major drivers overall were competition and outcomes; major barriers were cost, operative time, and learning curve. Based on this select surgeon cohort recruited through targeted social media platforms, maximizing surgeon experience through training and innovations to reduce complication rates is anticipated to facilitate broader adoption of robotics in LUTR. Future studies that include a broad international distribution across the specialty may further pinpoint specified needs for adult versus pediatric specialists and drive targeted robotics platform development.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%