La chirurgia robotica - Agenzia sanitaria e sociale regionale ...

Abstract
La chirurgia robotica: il robot da Vinci
Robot-assisted surgery: the da Vinci robot
Robot-assisted surgery is being proposed and used as a minimally invasive surgical
technique for surgeries requiring a very high degree of precision due to the smallness
of the surgical site as well as the relevance of the reconstruction phase. Although this
technology is fairly widely diffused, research is still at an early stage and to date
published clinical studies - mainly case series aimed at assessing feasibility and safety -
do not provide conclusive information on its clinical effectiveness. Nonetheless it has
been judged necessary to carry out a Health Technology Assessment on this costly and
innovative technology.
The present report - produced by the Emilia-Romagna Regional Health and Social Agency
with the contribution of surgeons of the Regional Health Service - evaluates the da Vinci
robot and includes the following six chapters.
Chapter 1. Technical description and evaluation
The main technical characteristics of the da Vinci robot are outlined as well as the
certification status and the pattern of geographical diffusion. This trend shows a decisive
increment during the year 2007, especially in the United States of America. Italy
is holding a fairly relevant share of the European market with its 27 robots installed
(19% of the EU distribution). The most important future developments of the technology
are also briefly discussed, in particular those relating to further clinical application
(neurosurgery, urology, heart surgery etc.) and new technological evolution, such as the
haptics function, techniques for the fusion of images and systems for the networking
of information.
Chapter 2. Review of the scientific literature
The methodology and main results of a systematic review of the scientific literature are
reported. The literature search has been carried out on tertiary (health technology
assessment reports) and secondary (systematic reviews) literature published since 2004.
A search of primary studies has also been carried out for surgical interventions judged as
most promising by the panel’s members. The methodological quality of the systematic
reviews and primary studies is generally poor. Trials are mainly aimed at assessing
feasibility and safety and there are very few comparative studies. Main conclusions from
this literature review are that the da Vinci robot is to be considered an emerging
technology for which there are no sufficient data to assess its superiority versus
conventional or laparoscopic surgery for any type of surgery. Further randomised
controlled clinical trials and cost-effectiveness evaluation are recommended.
Dossier 167
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