Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA.
Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Surg Endosc. 2024 Oct;38(10):5643-5650. doi: 10.1007/s00464-024-11078-1. Epub 2024 Aug 8.
Despite a growing body of literature supporting the safety of robotic hepatopancreatobiliary (HPB) procedures, the adoption of minimally invasive techniques in HPB surgery has been slow compared to other specialties. We aimed to identify barriers to implementing robotic assisted surgery (RAS) in HPB and present a framework that highlights opportunities to improve adoption.
A modified nominal group technique guided by a 13-question framework was utilized. The meeting session was guided by senior authors, and field notes were also collected. Results were reviewed and free text responses were analyzed for major themes. A follow-up priority setting survey was distributed to all participants based on meeting results.
Twenty three surgeons with varying robotic HPB experience from different practice settings participated in the discussion. The majority of surgeons identified operating room efficiency, having a dedicated operating room team, and the overall hospital culture and openness to innovation as important facilitators of implementing a RAS program. In contrast, cost, capacity building, disparities/risk of regionalization, lack of evidence, and time/effort were identified as the most significant barriers. When asked to prioritize the most important issues to be addressed, participants noted access and availability of the robot as the most important issue, followed by institutional support, cost, quality of supporting evidence, and need for robotic training.
This study reports surgeons' perceptions of major barriers to equitable access and increased implementation of robotic HPB surgery. To overcome such barriers, defining key resources, adopting innovative solutions, and developing better methods of collecting long term data should be the top priorities.
尽管越来越多的文献支持机器人肝胆胰（HPB）手术的安全性，但与其他专业相比，微创技术在 HPB 手术中的应用进展缓慢。我们旨在确定在 HPB 中实施机器人辅助手术（RAS）的障碍，并提出一个突出改善采用机会的框架。
采用由 13 个问题框架指导的改良名义小组技术。会议由资深作者指导，并收集现场记录。审查结果并分析主要主题的自由文本回复。根据会议结果向所有参与者分发了后续的优先事项设定调查。
来自不同实践环境的 23 名具有不同机器人 HPB 经验的外科医生参加了讨论。大多数外科医生认为手术室效率、有专门的手术室团队以及整体医院文化和对创新的开放性是实施 RAS 计划的重要促进因素。相比之下，成本、能力建设、差异/区域化风险、缺乏证据以及时间/精力被认为是最大的障碍。当被要求优先考虑需要解决的最重要问题时，参与者指出机器人的可及性和可用性是最重要的问题，其次是机构支持、成本、支持证据的质量以及对机器人培训的需求。
本研究报告了外科医生对公平获得和增加机器人 HPB 手术实施的主要障碍的看法。为了克服这些障碍，确定关键资源、采用创新解决方案以及开发更好的长期数据收集方法应是重中之重。
