Diffusion of Innovation: A 10 Year Review of the Adoption of Robotics in Fellowship Training

Abstract

Abstract Background: Robotic assisted surgery has existed for 20 + years but uptake has been slow among general surgery specialties. This study aimed to exam utilization trends in robotic general surgery in the decade prior to the COVID-19 pandemic.Methods: We reviewed 10 years of Fellowship Council case logs from the 2010 academic year to the 2019 academic year. The mean volumes of robotic cases per fellow were compared using ANOVA. We also stratified cases into six index categories (i.e. bariatric, foregut, colorectal, major HPB, inguinal hernia, and ventral hernia) for additional analysis. We also analyzed the stage of adoption of robotic surgery according to the popular diffusion of innovation theory.Results: We analyzed 648,858 cases performed by 2,099 fellows (mean 309 cases/fellow/year). The mean robotic volume grew from 3.6 robotic cases per fellow in 2010 to 49.5 robotic cases per fellow in 2019 (p < 1x10− 33). As a share of all cases performed, robotic surgery within FC fellowships grew from 1.3% of all operations in 2010 to 15.1% of all operations in 2019. Early in the decade, robotic utilization and growth was restricted to innovators and early adopters; however, significant growth in utilization by the early majority started in 2014 and was sustained for the remainder of the decade. Utilization among the late majority began increasing late in the decade but remains low overall.Conclusions: Utilization of robotics in general surgery is growing rapidly across multiple case types and projects to overtake laparoscopy as the dominant approach in Fellowship Council programs by 2024.