Trends in the diffusion of robotic surgery in prostate, uterus, and colorectal procedures: a retrospective population-based study


This study aimed to propose quantifiable metrics on the adoption lifecycle of robotic-assisted surgery (RAS) within and across prostate, hysterectomy, and colorectal procedures. This was a retrospective population-based cohort study of commonly performed RAS procedures in the US conducted from July 2001 to July 2015. The patients were identified from the Premier Hospital Database using International Classification of Diseases, 9th revision, Clinical Modification codes denoting prostate, uterus, and colorectal procedures. The Diffusion of Innovations theory was applied to percent RAS utilization to determine discrete eras of technology adoption. Overall and by-era patient baseline characteristics were compared between robotic and non-robotic groups. This study included a total of 2,098,440 RAS procedures comprising prostate (n = 155,342), uterus (n = 1,300,046), and colorectal (n = 643,052) procedures. Prostate (76.7%) and uterus (28.9%) procedures had the highest robotic utilization by the end of the study period and appear to be in the last adoption era (Laggard). However, robotic utilization in colorectal procedures (7.5%) was low and remained in the first era (Innovator) for a longer time (15 vs 60 vs 135 months). Whites, privately insured, patients with fewer comorbidities, and those admitted in large teaching hospitals were more likely to undergo RAS in the early study period. AS-associated patient and hospital profiles changed over time, suggesting that selected patient cohorts should be contextualized by overall adoption of a novel medical technology. The time-discretized analysis may also inform patient selection criteria and appropriate timing for clinical study stages proposed by the Idea, Development, Exploration, Assessment, Long-term study-Devices framework.

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The authors acknowledge Amit Koushik, MS and Ramu Periyasamy, PhD of Indegene Pvt Ltd. for assistance with the literature review and medical writing.


Study design, collection, analysis, and interpretation of data, and medical writing support were funded by Johnson & Johnson.

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All authors have contributed equally in the development of the manuscript.

Corresponding author

Correspondence to Andrew Yoo.

Ethics declarations


Gary Chung is an employee of Johnson and Johnson, Inc which sponsored this study. Piet Hinoul is an employee of Ethicon, Inc which sponsored this study. Paul Coplan is an employee of Johnson and Johnson, Inc which sponsored this study. Andrew Yoo is an employee of Johnson and Johnson, Inc which sponsored this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Informed consent

Premier Healthcare Database is aggregated, deidentified, and compliant with the Health Insurance Portability and Accountability Act and does not require institutional review board approval. Formal consent is not required.

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Chung, G., Hinoul, P., Coplan, P. et al. Trends in the diffusion of robotic surgery in prostate, uterus, and colorectal procedures: a retrospective population-based study. J Robotic Surg (2020).

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  • Robotic-assisted surgery
  • Prostate
  • Uterus
  • Colorectal
  • Diffusion of innovation
  • Premier Hospital database