EP954 - The Colon and Rectal Robotic Surgeon: Training and Current Practice Patterns

Purpose/Background: As the robotic platform is embraced by colorectal surgeons, the impact of robotic surgery training on current colorectal practice patterns remains unknown. The aim of this study is to assess the association between robotic exposure during fellowship and the use the robotic platform in practice, as well as to identify main drivers of adoption.

Methods/Interventions: This is an IRB approved quantitative study that employed a survey designed by the ASCRS Young Surgeons committee. The questionnaire queried demographic information, current practice and preferences, as well as motivators for utilization of the robotic platform. We then compared the results among surgeons based on years in practice. Descriptive statistics were performed. Chi-Square testing was used to assess the association between an individual’s reason to choose robotic surgery and the years of practice. All data was analyzed using SAS Studio (SAS Institute, Cary, N.C.).

Results/Outcomes: 248 surveys were completed by ASCRS members. Respondents were early career (24%), mid-career (37%) and greater than 15 years in practice (39%). A majority, 40%, self-reported being in an academic practice.

A minority of respondents attended the APDCRS training course or had a robotic curriculum during their fellowship (24% and 29%, respectively). Similarly, 66% reported performing a low proportion (0-5%) of abdominal operations robotically during their fellowship. Most respondents selected mastery of laparoscopy as the most important component of fellowship training (65%). Despite this, 57% of respondents currently describe >75% of their abdominal operations are performed robotically, while only 15% report use of laparoscopy for >75% of abdominal operations.

There was no significant association between the training environment and the current use of the robotic platform. Nonetheless, our results demonstrate an increased utilization of the robotic platform among recent fellowship graduates for most abdominal operations. When stratified into three groups based on years in practice, there is a significantly higher preference in the early career cohort to utilize the robotic platform for the ability to perform intracorporeal anastomosis (p=0.0009) and improved surgeon experience (p=0.0342).

Conclusion/Discussion: This is the first study to evaluate the association between robotic training and current robotic practice patterns, as well as motivators for use of the robotic platform, among colorectal surgeons. The ability to perform more technically demanding tasks (i.e. creation of the anastomosis) and overall improved surgeon experiences were significantly more likely to represent drivers of adoption in the early career cohort. Interestingly, the robotic experience during fellowship did not impact current practice preferences. This could reflect the relative ease to integrate the robotic platform into one’s practice, or this finding may reflect that robotic surgery is a relatively novel aspect of colorectal surgery, with only recent inclusion into colorectal training. As robotic surgery becomes more prevalent in colorectal training, continued investigation into practice trends will help identify educational gaps and implement more effective curricula.

Table 4. Reasons for Choosing Robotic Surgery by Years of Practice
Note: Table 4 is color-coded to provide a better visualization of differences in reason for choosing robotic surgery by years of practice. Cells highlighted more in green have a higher percent, while cells highlighted more in blue have a lower percent.
Note: A Chi-Square test (or Fisher’s Exact Test if assumptions were violated) were run to see if there was a difference in reason for choosing robotic surgery by years of practice between at least two years of practice. The cells that are highlighted in yellow have a statistically significant p-value, indicating a difference in reason for choosing robotic surgery by years of practice.