Da Vinci Decisions: Factors to Consider before Moving Forward with Robotic Surgery

January 1, 2013 | Evaluations & Guidance


In the surgical community, the past decade has seen a rise in the implementation of robotic surgery systems to replace open surgery and minimally invasive surgery (MIS) techniques for certain types of procedures. The da Vinci Surgical System from Intuitive Surgical, being the only multipurpose robotic surgery system on the market, is the system that is used in all robotic surgery programs (RSPs). This system is unique because it is directly controlled by the surgeon to perform laparoscopic surgery.

The popularity of the da Vinci system continues to grow. In the current highly competitive market, a number of hospitals have purchased the system, or are considering doing so, to keep up with the trend of facilities starting RSPs. User facilities with whom we spoke reported many factors that motivated them to acquire the da Vinci system, obtain subsequent upgrades, and perform more robotic-assisted procedures. According to those facilities, the purchase of the system was driven in part by hopes of achieving the following, which are among the major themes presented in the vendor’s marketing materials:1

At the same time, there are two major issues facing users of the da Vinci system: limited evidence of comparative efficacy and uncertain return on investment (ROI). Proponents say the system improves patient outcomes, and that it could provide hospitals with a positive ROI. However, others believe that the widespread diffusion of the system has not been justified, pointing to the inconsistent results of clinical outcome studies comparing use of the system to traditional surgical techniques (i.e., open surgery or conventional MIS). They also say that the financial benefits of using the system have not been proven through high-quality cost analyses.

Given these conflicting viewpoints, healthcare facilities thinking about an RSP must consider a number of complex issues in order to make the best decision. They must also understand that there are a number of uncertainties associated with the adoption of a robotic surgery system and that the outcome or influence of certain factors may be difficult to predict.

If a facility does decide to pursue a RALS program, it will need to give serious attention to training and credentialing for robotic surgery staff. These individuals must be sufficiently trained to perform safe and effective RALS procedures and to be capable of handling any mishaps or complications that can occur. It is also recommended that the hospital perform annual...

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