 I think we've heard some great experiences from our presenters and I think you'll be really interested to hear Tom Ware, a Ph.D. candidate, ASU management information systems. Clinical effects of robotic assisted surgeries. Welcome, Tom. All right. Thank you for having me. So as stated, I am a Ph.D. candidate in a business school and so in particular information systems. And so what I'll be discussing today is a quick overview of my research. The data that I used within to answer my research questions, a little bit about my, a little bit more about my experience using the VA data and some recommendations as well. Okay. So to give a quick introduction as a fourth year Ph.D. candidate, my particular research interest is at the intersection of AI and robotic engagement in human behavior. And I would like to label myself a practice driven theorist. So within the context of this research, I have particular interest in robotic in human robot augmentation within the healthcare setting, which brings me to my interest in engaging in research using centering robotic assisted surgeries. And so we use inguinal hernia repair as the surgical context for this project. And I'll explain why in the next slide. But for this research, we identified 25, over 25,000 observations over a 13 year study period from 2010 to 2022. And using this data, we were able to identify a couple of interesting findings. The first is particular to a comparative study of robotic assisted surgeries, comparing to other minimally invasive techniques, particular to this project, a manual laparoscopic technique for inguinal hernia repairs. And we use this context because this is one of the most highly performed types of surgeries in the U.S. and in rural ride as well. And so some findings that we determined using this data was first particular to the effectiveness. And we found greater effectiveness in reducing intraoperative risk in surgical performance of surgeons who engage in robotic assisted surgeries in comparison to manual laparoscopic surgeries. And secondly, and what I believe is most interesting, is we find that there is a significant spillover effect of those surgeons who engaged in robotic assisted surgeries at least once to improving their overall performance. And they actually, and those surgeons actually perform better in manual laparoscopic techniques post the collaboration with robotic assisted surgeries. And so when I read the literature on robotic assisted surgeries, there are a few things that are very obvious. The first is the immersive experience that physicians feel when engaging in robotic assisted surgeries. With the use of counsel and having to control the tools using these robotic arms from a remote counsel, you have to have a higher level of concentration and engagement with the task. And secondly, a second thing that was very obvious within the literature is the haptic feedback and how that provides a source of communication from the robot to the surgeon to manage their performance during the actual surgical operation. And the third thing that was evident was in regards to the necessity of having to have a significant level of expertise when engaging robotic assisted surgeries, meaning that the surgeons who have a higher level of competencies with inguinal hernia repairs specifically can actually perform better using robotic assisted surgeries. And so as an information systems researcher, I was curious about extrapolating these things to other instances that involve this physical augmentation of robotics in human capabilities. And so from that birth, the term congruent augmentation, which defines the interactive and immersive experience of augmentation experience when engaging in knowledge work, particularly in occupational settings. And so another contribution is to I wanted to explain a benefit of congruent augmentation and I believe this also applies in a general sense that there is a learning effect that results from this congruent augmentation. So as stated in the findings that there is a spillover effect from engaging after engaging robotics and surgeries to the manual process, there that is essentially describing a novel experience for these experienced or these expert positions. And behavioral literature within behavioral theories within experiential learning literature states that experts who engage in task using a novel experience can actually glean from that experience and they can carry over to other instances. And so the last is we look to contribute to the robotic assisted surgery literature by describing the positive effects of engaging in this type of surgery versus manual surgeries with the most comprehensive data set available. And so we chose Ingenial Hernia Repairs because as stated, it is the most commonly performed procedure in the US and in the world with potentially approximately 800,000 surgeries that occur in the US in 2000 globally. And so this type of surgery represents some of the most state-of-the-art manual techniques when it comes to task completion and surgical operations. And so any effects that we find should be particular to the augmentation benefits from robotic assisted surgeries. And the VA provided an opportune environment to study this phenomenon because Ingenial Hernia Repairs are prominent amongst men, particularly literature states that half of men will incur an Ingenial Hernia injury and some of those will require surgery. And so the VA being the largest healthcare system in the US with over 170 medical centers and over 1,008 outpatient centers, it provides the perfect opportunity to study this phenomenon. And so from the VA data, over the course of 13 years, we were able to identify initially 27,000 observations, but we removed some observations if they were duplicates. And we also wanted to ensure that each of the variables that were included in the data set were complete for each observation. And so that final number was reduced to 25,000 observations using two CPT codes for the initial hernia injury and for recurrent Ingenial Hernia injuries. And we were also able to identify each type of surgery as either being initial or recurrent, bilateral or unilateral or robotic in manual. And so, and so, latitudely, we were able to also expand the type of variables that were included in the data set. And so we were able to identify patient characteristics such as age, the race, gender and other health factors pertaining to obesity and previous smoking history as Ingenial Hernia literature has pointed to those two factors being important to patient outcomes. And so we also included variables regarding to the operational complexity, variables related to physician characteristics and as well as the facilities. And we focused on four dependent variables related to intraoperative risk pertaining to the conversion, blood loss, the post, the time it takes to recover after the surgery, and end of wound occurrences occurred during the operational procedure. And so we were able to utilize this data to answer these two research questions. So with potentially the most comprehensive data set, if I wanted to first determine if surgeons learn from robotic-assisted surgeries, I felt it was necessary to contribute to the conversation regarding the overall effectiveness of robotic-assisted surgery. So that's why we started with the initial research question. As the literature in robotic-assisted surgeries with Ingenial Hernia repairs points to there being a lack of consensus regarding the effect where some studies saying that there is no difference in effectiveness in robotic-assisted surgeries versus other minimally invasive techniques. And secondly, in answering that question pertaining to its effectiveness will allow us to determine if there is an overall benefit for surgeons, which led us to our second research question regarding the surgeon-robot congruence and its effect on its learning potential learning effect. And so to answer the first question, we engaged in linear regression using fixed effects where we used four dependent variables, those four dependent variables with robotic-assisted surgeries being the main independent variable of interest. We were able to find that there is significant reductions in blood loss and in conversion in particular for using robotic-assisted surgeries in comparison to those other minimally invasive techniques. And for the second research question, we matched surgeons who have used robotic-assisted surgeries against those who have never used robotic-assisted surgeries. And so the ones who have used robotic-assisted surgeries used it at least one time. And then so we matched using some criteria pertaining to the level of experience and some performance metrics, meaning similarities in the conversion rates, for example. And we engaged in a difference in different regression models and we were able to determine that those physicians that have used robotic-assisted surgeries at least once also perform better in manual laparoscopic surgeries versus those who have only used manual laparoscopic surgeries. And so we, and so with this research, we believe that there are practical and theoretical implications, particular to practice is we point to the superior benefits of robotic-assisted surgeries where that question is still open-ended. And theoretically, we look to introduce the congruent augmentation term, applying that to the robotic-assisted surgery context and also describing the learning effects of congruent augmentation within the robotic-assisted surgery context. And so a little bit about my experience with the VA. So the initial conversation occurred November of 2021 actually with an investigator with an appointment with the VA via the National AI Institute. His name is Christos McRittis. He also has an affiliation here at ASU. And so I'm going to go through each point step by step, but to give a brief overview, starting that following spring is when we started the documentation process of the Work Without Compensation Agreement that was initiated from Christos, based from our mutual interest in wanting to engage in research. And so from there, we had to fill out a bunch of forms and do a bunch of trainings. And I mean hours of trainings with background checks and fingerprints. And then in about, in that summer, I get access to the VA environment. And from my perspective, that's it. I have access to the data and I'm ready to go, but that was not the case. So I quickly learned that I needed to get access to the VINCY system to be able to access the data from there. And so that took another approximate, yeah, approximate five to six months. And in between that time is when I started to build my research team. So Christos McRittis is the PI at the VA who is my main contact for a lot of the administrative stuff and the CDW and things of that nature. And so during this conversation, it was brought up that I needed to also have a VA partner who is an experienced physician. And that's when Dr. Dev came into the conversation. And I think it was from an introduction from Christos and that occurred in September. And throughout the time while we're waiting to finish the documentation to get approval from the dart request, from the initial dart request for the prept to research phase is when that team expanded to Dr. Vinod and Dr. Felipe who was not here. But and so that is when the project really started to take form. And that was also introduced to the MD clone platform at that time. And the MD clone platform was instrumental for that initial look to determine how many inguinal hernia surgeries that were occurred. Identifying the percentage of robotic-assisted surgeries and able to get a high-level analysis to be able to engage in hypothesis testing. And so in the March of 2023, I was able to find there were some findings there. And then that summer is when I started the IRB process in July. And it became fully executed in November of 2023. And so between the initial conversation and now it was approximately two years. But as far as engagement in the actual analysis, it was approximately a year. And so I'm just going to quickly go over some limitations. There could be some systematic differences in those patients who select robotic-assisted surgeries versus those who don't. So some communications to determine exactly how that decision was made would be helpful to empirically control for that. And additionally, we don't have a clear understanding of the type or of the models that were particularly used in the surgeries, which could have different technological advances. But there are some other research questions that I plan to, that I'm starting to engage in in where I am targeting IS information systems and healthcare journals, particularly to the robotic-assisted surgery team and how robotic-assisted surgeries potentially reduces variances across surgeries and across surgeons. And so that would be my next set of projects. And so I appreciate you attending my talk and I'll be happy to take questions later.