Hiqa to assess robot surgery

AN ASSESSMENT of robot-assisted keyhole surgeries is to be carried out by the Health Information and Quality Authority (Hiqa). The request has come from the HSE which wants to find out if robotic surgery is a cost-effective way of carrying out procedures.

Robotic surgery, in which a doctor uses a computer console, has become more popular in hospitals around the world. It has proven to be more accurate than human hands and more precise in identifying the precise area to be operated on.

In heart surgery, a lengthy scar across the chest can be replaced by a much smaller and accurate incision, reducing the possibility of infection. Typically, the average stay in hospital is shortened from eight or 10 days to three or four days.

Robotic surgery is carried out in the Galway Clinic, in Cork University Maternity Hospital and in the Mater Private at present. The HSE would look to roll it out further if it was found to save money.

However, a barrier to its popularity is the prohibitive cost. A state-of-the-art da Vinci system costs between €1.5 million and €2 million, with maintenance costs of €250,000 a year. Surgeons also need extensive training.

On the plus side, robotic surgery is associated with better outcomes and shorter hospital stays. Procedures can be carried out with fewer personnel.

Clinical experience in the United States suggests that robotic surgery is cost neutral when all factors are taken into account.

Hiqa has convened a multidisciplinary expert advisory group chaired by the authority’s director of health technology assessment, Dr Máirín Ryan, to oversee the process.

She said: “We are pulling together all the information for the HSE as part of a cost-effectiveness analysis and how best the system could be organised so that it maximises the benefits for patients and the efficiency for the system.

“Because it is expensive, the HSE needs to pull together all of the evidence to make a well-informed decision.

“The main economic benefit would be reduced stays in hospital and reduced complications from surgery.”

The HSE is looking at the possible use of robot-assisted surgery in urology, gynaecology, cardiology and diseases of the head and neck.

The terms of reference include clinical outcomes, the relative safety of the procedure compared with open or minimally invasive surgery, the cost effectiveness, and training issues.

The assessment will also consider how it can be integrated into the health service and any additional evidence that the technology is likely to have wider implications for the health system.