Health technology assessment of robot-assisted surgery in selected surgical procedures

Health Information and Quality Authority
Record ID 32012000797
English
Authors' objectives: a) Describe the epidemiology and clinical burden associated with specified diseases in which robot-assisted surgery may be indicated. These include diseases in urology, gynaecology, cardiology and diseases of the head and neck. b) Review the evidence of the effectiveness and safety of robot-assisted surgery compared to other surgical interventions for specified indications. c) Examine the cost-effectiveness of robot-assisted surgery compared to other surgical interventions for indications where there is evidence to show that it is more effective. d) Estimate the budget impact of implementing robot-assisted surgery for the selected indication(s). e) Examine the evidence and the research related to training and credentialing requirements to ensure safety and best outcomes. f) Examine how the health system can be organised in order to implement the technology as effectively and efficiently as possible. g) Consider any additional evidence that the technology is likely to have wider implications for the health system or for affected patients.
Authors' recommendations: Prostatectomy and hysterectomy are the two procedures for which the most evidence existed at the time of this HTA in relation to robot-assisted surgery, and represent the only procedures for which firm conclusions can be made. However, the quality of the evidence to support clinical-effectiveness was poor. This should be taken into account when interpreting the findings of this HTA. Evidence available at the time of this HTA indicated that robot-assisted prostatectomy procedures were superior to open prostatectomy procedures across a range of outcomes evaluated. There is a decreased risk of positive surgical margins for pathological stage pT2 tumours, superior functional outcomes (urinary continence and sexual function) and a reduction in peri-operative transfusion requirements. Overall duration of stay is reduced. The procedure is, however, associated with a longer operating time. The available evidence indicates that the benefits of robot-assisted prostatectomy over laparoscopic approaches are minor. There are comparable oncologic outcomes, marginal improvements in urinary continence and equivocal data on sexual function. Reductions in length of stay are obtained, although these are less pronounced than those reductions obtained by comparison with open surgery. No significant differences were observed for transfusion, operative time or in the rate of conversion to open surgery.
Details
Project Status: Completed
Year Published: 2011
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Ireland
MeSH Terms
  • Surgery, Computer-Assisted
  • Telemedicine
Contact
Organisation Name: Health Information and Quality Authority (HIQA)
Contact Address: Health Information and Quality Authority, George's Court, George's Lane,Smithfield, Dublin 7. PH : + 353 (01) 814 7464
Contact Name: info@hiqa.ie
Contact Email: info@hiqa.ie
Copyright: Health Information and Quality Authority
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.