Governance of Robotic Assisted Surgery (RAS) in Urology  

Robotic technologies are also becoming more and more pervasive in the field of surgery, allowing doctors to perform operations by operating a robot remotely. Since these technologies have high costs for the Regional Health System and must be used with appropriateness and precautions to make them as sustainable as possible, through the CReHTA and the establishment of a special HTA Technical Table, the Agency intended to deal with the governance of Robotic Assisted Surgery (RAS), starting from the sector in which there is more evidence of clinical effectiveness, urology. 

With its action, the agency intends to monitor the performance of existing robotic technologies in the territory and to govern expenditure on robotic systems for endoscopic surgery, also promoting the creation of accident and adverse event reports linked to the use of the technologies in order to build a safety profile of the same.  

It then intends to build pathways for the medium and long-term verification of relevant clinical primary outcomes, such as survival and recurrence rates, and secondary outcomes, such as preservation of sexual potency and continence.   

Another objective is the standardisation of staff training courses, providing for the maintenance of skills acquired through frequent use of the technology. Finally, AReSS ensures that access to these technologies is guaranteed for all people.  

 The governance of robotic surgery must necessarily start from the definition of the state of the art in terms of robot-assisted urological activity in Apulia, evaluating the performance of existing robotic technologies in sel SSR facilities. The CReHTA delves into the organisational models underlying the use of robotic technologies, aims at the correct identification of the services performed through tracer coding, and at identifying the most important clinical information to be collected for monitoring the relevant clinical outcomes of robotic urology.  

The training of medical teams in this field is also crucial, so the CReHTA aims at identifying adequate training standards to ensure efficiency and effectiveness, also with a view to sustainability for the system. 

The project (establishment of the HTA Technical Table by DG Resolution no. 57/2022) started in March 2022 and is still ongoing. 

Project coordinator is Elisabetta Anna Graps.