MP53-08 A QUALITATIVE ASSESSMENT OF DRIVERS, BARRIERS, AND VALUE IN ROBOTIC-ASSISTED LOWER URINARY TRACT RECONSTRUCTION

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP53)1 Sep 2021MP53-08 A QUALITATIVE ASSESSMENT OF DRIVERS, BARRIERS, AND VALUE IN ROBOTIC-ASSISTED LOWER URINARY TRACT RECONSTRUCTION Katerina Lembrikova, George Aninwene, Peyton Tebon, Matthew Becker, Allen Siapno, Justine Yamashiro, Erika Wood, and Renea Sturm Katerina LembrikovaKaterina Lembrikova More articles by this author , George AninweneGeorge Aninwene More articles by this author , Peyton TebonPeyton Tebon More articles by this author , Matthew BeckerMatthew Becker More articles by this author , Allen SiapnoAllen Siapno More articles by this author , Justine YamashiroJustine Yamashiro More articles by this author , Erika WoodErika Wood More articles by this author , and Renea SturmRenea Sturm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002083.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite randomized controlled trials (RCTs) demonstrating feasibility and short-term oncologic non-inferiority of robotic radical cystectomy and urinary diversion, its superiority over the open approach has not been definitively demonstrated. The aims of this study are to identify factors influencing transition to robotic surgery and value requirements for adoption in lower urinary tract reconstruction (LUTR). METHODS: Over 300 stakeholders including physicians, administrators, and industry representatives were identified by LinkedIn, social media, references, and publications. Each was contacted with a request to participate in a structured interview including targeted questions and open-ended discussion. Interviews were conducted virtually and evaluated by a bioengineer, business professional, and urologist via a modified framework method. An initial review of interview notes identified main themes, followed by additional reviews for mapping of codes and stances across stakeholders. RESULTS: 29 urologists (17 academic, 12 non-academic), 25 device representatives, 22 administrators, 10 patients, 10 researchers, and 6 referring physicians were interviewed (n=102). Factors influencing robotic use in LUTR are illustrated (Table). Interviewees reported median procedures to achieve competence and maintain skill were 25 total (IQR 20,30) and 15 per year (10,20), respectively. Complications and readmissions were identified as the most important value requirements. When considering adoption of novel technology for LUTR, the median minimum required decrease in complications and readmissions from a patient perspective was 5% (IQR 1,5) and 1% (1,1) and for urologists was 3% (1, 15) and 8% (1,19), respectively. CONCLUSIONS: There are a range of drivers and barriers to robotics use in LUTR that may not be fully captured by RCTs. Yet, the desired end goals of decreased complications and readmissions resonated across stakeholders. Novel offerings should focus on technical aspects of the procedure that directly affect post-operative recovery beyond improvements provided by Enhanced Recovery After Surgery protocol utilization. Additionally, the perceived learning curve for robotic LUTR must be addressed to increase uptake in this space. Source of Funding: NSF Innovation Corps: #2045366 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e941-e941 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katerina Lembrikova More articles by this author George Aninwene More articles by this author Peyton Tebon More articles by this author Matthew Becker More articles by this author Allen Siapno More articles by this author Justine Yamashiro More articles by this author Erika Wood More articles by this author Renea Sturm More articles by this author Expand All Advertisement Loading ...