Da Vinci Surgery: Is it a No-Brainer? Robot-Assisted Prostate Surgery in the Mirror of Social Health Insurance

Abstract

Using a qualitative methodology, this case study explored the sense of need to purchase and implement an innovative surgical device called the da Vinci robot for the removal of prostate cancer (Robot-assisted Radical Prostatectomy; RARP). It is a promising innovation despite its high costs and its as yet unproven superiority over existing treatment alternatives. The sense of need for RARP is constructed in the interconnection between the stakeholders involved, namely, the manufacturer, care-providers (including scientific communities), receivers (patients) and insurers (payers). At the heart of this need lies the subjective perception of the benefits of the new therapy which can be described as follows: the premise of progress, performing better than the competition (gaining prestige and perhaps profits), a transition platform towards minimally invasive surgery, considerable research opportunities (contributing to the clinical/technical science surrounding the da Vinci robot), technical precision and perceived improved ergonomics of operating with the da Vinci system. Constant reproduction of these benefits within the network of stakeholders perpetuates the sense of need and drives the stakeholders to demand the RARP as ‘the way to go’. Within the context of care delivery, the da Vinci system offers stakeholders the capacity to increase not only therapeutic productivity (state of the art surgery), but also scientific (clinical research), technical (device development) and economic (profit/status) productivity. Once stakeholders conceptualise the benefits of RARP in this way, they become inclined to demand and use the da Vinci system with an ever-growing frequency.