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

Chapter 3. Selection of clinical applications
La chirurgia robotica: il robot da Vinci
The methodological process for the identification and selection of the most promising
clinical applications of the da Vinci robot in the Regional Health Service is described.
Based on the analysis of the literature review, a mapping of the current stage of research
and knowledge has been developed and research results have been classified according
to an increasing degree of uncertainty into the following four categories: consolidated,
plausible, uncertain and unknown. This charting exercise - by defining the relevant
primary and secondary clinical outcomes that need to be assessed for each surgical
intervention - represents a useful starting point for the set up of future clinical trials
as well as for the surveillance and update of the scientific literature.
This mapping was also used to draw up a first list of surgical interventions for which
a plausibility of the da Vinci’s superior clinical effectiveness can be hypothesized. This
initial list was further cut-down using as selection criteria our Region’s availability of high-
level professional expertise in non-invasive surgery and regional patients’ volumes.
Through this process, a plausible positive outcome in health care was presumed for the
following types of surgery: radical prostatectomy, colo-rectal surgery, bariatric surgery
and surgery for gastroesophageal diseases.
Chapter 4. Economic analysis
The costs of the technology (set up, use and maintenance) are outlined. Using the Break
Even Analysis approach some hypothetical ratios between suitable fees and necessary
volumes are put forward to investigate the economic sustainability of this very costly
health technology. The analysis, carried out using data referring to the intervention for
radical prostatectomy, shows the need for a revision of the robotic surgery’s current fees
in order to ensure a point of break-even between the service’s costs and the expected
volumes.
Chapter 5. Impact on the Health Regional System
A brief discussion is offered on the methodological and theoretical terms of reference
used to study the introduction and implementation of complex interventions in the health
organizations. Using the Normalization Process Model approach as a theoretical
framework for the identification of necessary requirements and foreseeable bearings on
the health service, the following issues have been highlighted and discussed:
• appropriate introduction of the new service in target patients’ current clinical
pathway;
• expected impact of the technology on the relationship between professionals and
their network and content and format of necessary dedicated professional training
programmes;
• necessary system for the recognition of skills, allocation of tasks and evaluation
of performance;
• required plans for the allocation of resources and responsibilities needed for the
control and implementation of the technology.
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