My career began with the evolution of minimally invasive surgery, particularly in hernia repair, as a surgeon and educator, and then evolved as an entrepreneur developing real-world data (RWD) and data science methods to measure actual patient value–based outcomes. Over the last 10+ years, that work has helped device companies expand indications, grow revenue, increase valuation, and highlight benefits in multiple specialties.
Coming out of the 2025 Society of Robotic Surgery (SRS) conference and preparing for my panel discussion at the American Hernia Society (AHS) conference next week, I’m struck by a simple truth: in robotic surgery, the next big leap forward won’t be about hardware, software, or even UX —it will be about real-world evidence. With hernia surgery now one of the fastest-growing robotic applications, and the robotic vendor space getting bigger and bigger, I expected SRS to highlight clinical breakthroughs. Instead, it left me asking: When will we stop selling the idea of robotics and start evaluating its value?
The SRS exhibit hall looked more like the concept car section of an auto show—sleek designs, bold promises, flashy demos, and very little substance. Most vendors are anchored on two primary “advantages”: cost effectiveness (we’re cheaper) and operational form-factors (we take up less space). That’s not innovation – that’s commoditization in action.
Many companies come to market through “clinical non-inferiority”—proving they’re not worse than current systems. But in a value-driven healthcare market, “not worse” isn’t enough. Hospitals want clear, defensible proof of better: better outcomes, efficiency, and economics. Without that, decisions default to price—and price wars always end the same way.
The robotics companies that will thrive in the coming decade will shift from concept marketing to outcome-driven differentiation:
- Prove Clinical Value: Demonstrate measurable improvements through patient outcomes, financial outcomes, satisfaction, and clinical measures, to justify premium pricing.
- Deliver Real-World Evidence: Move beyond regulatory minimums to show how your platform performs in actual practice—across clinical, operational, and financial metrics.
- Be Transparent: Sharing credible data builds trust; hiding it raises doubts.
The CDaaS methodology relies on the fundamentals of measurement and improvement, and through an iterative process, creates valuable, never-before-seen datasets that enable true value-based decision making. One of our published abstracts from this year’s Society of Robotic Surgery (SRS) meeting is a perfect example.
In Carroll et al, we evaluated the value of different approaches for incisional hernia repair at an academic medical center partner. The data revealed that no approach has the best value for all patients and all situations. While the laparoscopic approach had the best value for many patients and types of hernias, the data showed that the robotic approach had the best value for larger hernias and more complex patients. Through this project, we assembled a novel dataset that allows our clinical partner to segment their own patient population. In 40 years of surgical experience, I have never seen a dataset of combined financial and clinical outcomes in this way. And, to top it off: the beauty of the quality improvement methodology is the system of multiple feedback loops, incorporating ideas for improvement that can lead to further improvement in financial and quality outcomes down the road. As I always say - if you can measure it (value-based outcomes) and use data science tools appropriately, you can improve what you measure.
Robotic surgery is at an inflection point. Hospitals are under increasing pressure to justify capital investments, and they will no longer settle for theoretical advantages or marketing claims. Plus, there is an obvious gorilla in the room: an entrenched competitor that is not going to willingly give up its dominant market position. Across this rapidly expanding landscape, the winners will be those who stop asking customers to imagine value—and start proving it with evidence from real patients, in real operating rooms, delivering real results.
