Making the Most of Robotic-Assisted Surgery

Will Robotic-Assisted Surgery Fade Away?

Medscape: What are the key factors that determine whether robotic-assisted surgery will diffuse into clinical practice?

Dr. Parsons: We've written about this topic by drawing on some of the principles of the science of diffusion.^[11,12] If a technology doesn't reach what the author Malcolm Gladwell termed the "tipping point,"^[13] then it generally won't diffuse and it will just trickle out and fade away.

Many variables affect the process by which individual surgeons adopt new technologies, but 2 important variables are the time and energy involved in learning and performing the procedure. For example, a pure laparoscopic prostatectomy is very challenging for a surgeon to master. It can take quite a long time to do, and the surgeon can be in an ergonomically uncomfortable position for hours at a time. When pure laparoscopic prostatectomy was first introduced, it didn't hit the tipping point; it didn't widely diffuse because the upfront investment in time and effort didn't seem worth it to many surgeons.

But the robot made both the learning process and the performance of the procedure easier relative to a pure laparoscopic prostatectomy. Because of those characteristics and other factors, including aggressive marketing directed to patients and surgeons, robotic-assisted laparoscopic prostatectomy was able to hit that tipping point. Surgeons were interested in learning how to use it and felt that it was worth the investment of their time and energy.

Whether cost-effectiveness plays a role in diffusion is more difficult to determine, and that is something that experts in cost-modeling would need to address. Although individual surgeons are not always directly invested in the cost-effectiveness of any given procedure because cost-effectiveness tends to be something that is approached on an institutional or hospital level, you could argue that a technology might diffuse more quickly if it allows a surgeon to perform a procedure more quickly and efficiently.