A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably.

BACKGROUND: Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children's Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget METHODS: Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ. RESULTS: The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin). CONCLUSIONS: Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital.

[Exposure to hand-arm vibrations in orthopaedic plaster room: risk management]. / Esposizione a vibrazioni mano-braccio nel personale di sala gessi: risk management.

BACKGROUND: In hospitals, the use of vibrating tools, such as oscillating saws to cut plaster, can expose the staff to hand-arm vibrations. OBJECTIVES: The aim of the study was to assess the exposure of workers to vibrations in the plaster room and then  identify the most appropriate  intervention for  prevention and protection to be implemented in order to minimize  exposure and  protect  workers' health, considering different individual hyper-susceptibility conditions. METHODS: Four different models of plaster saws were examined for the evaluation.  Various measurements were made in normal working conditions of the operators. RESULTS AND CONCLUSIONS: The values of acceleration and noise detected on the instruments  were  in line with those reported in the literature. The preventive measure adopted (replacing plaster saws currently used in the hospital with similar ones with lower vibration emission) was an adequate means of protection. Health surveillance activities  recorded a higher level of wellbeing, both environmentally and individually and, specifically, an increased protection level for the hyper-susceptibility conditions observed during health checks of exposed personnel  which will be monitored regularly by the Occupational Health Service.