Advantages And Risks Of Da Vinci Robotic Equipment For Prostatectomies Essay.

Evidence to support the technology

A few (five out of 10) of the Urology surgeons in your private facility would like to start using the Da Vinic Robot for routine prostatectomies. The new robotic equipment has been approved by the TGA and proposes to use technology that ensures smaller, more precise incisions, is purported to reduce the risk of bleeding and lead to faster rates of recover. The new procedure will incur extra costs for the hospital, not all of which can be shared by the patient as an out of pocket expense, as it is not fully covered by the major health insurers as yet.

The Da Vinci robot has been in used for some 10 years, but despite this the evidence is not conclusive of the benefits of the equipment, although some clinicians vouch for this. Not all the surgeons want to use the new device, therefore it will be additional to the hospital inventory. In addition, as is the case with new equipment, there will be flow on effects; the training staff of staff, ensuring there are enough equipment sets in theatre and in order to rotate through sterilising, more ‘advisors’ from the manufacturers in the theatre, etc.

The Da Vinci robot has been in used for some 10 years, but despite this the evidence is not conclusive of the benefits of the equipment, although some clinicians vouch for this. Not all the surgeons want to use the new device, therefore it will be additional to the hospital inventory. In addition, as is the case with new equipment, there will be flow on effects; the training staff of staff, ensuring there are enough equipment sets in theatre and in order to rotate through sterilising, more ‘advisors’ from the manufacturers in the theatre, etc.

Your assignment is to:

1. Develop a business case to use as a decision guide.
Your business case should include (this is not an exclusive list): ? Evidence to support the use of the technology ? The identification and rating of the risks and benefits for such an introduction. ? Clinical factors: Safety, Efficacy and suitability of patient group ? Financial impacts: costs, value for money, and funding.

2. Make a recommendation to your manager, based on the business case and risk assessment, on whether to introduce the equipment and procedure.

3. Outline how you would communicate such a recommendation to the stakeholders including the surgeons and the manufacturer.

4. Outline any policies and procedures necessary and training processes to commence the use of this new technology. 
 

The medical sector requires a constant demand for the change in surgical techniques. The previous minimally invasive surgical process was ineffective and associated with potential risk factors. The constant development of updated medical technology has reduced the risk factors in the healthcare setting. The installation of DA Vinci robotic equipment brought a big change in the surgery. This reduces the potential threats of bleeding and surgical flaws due to its audio-visual facility. The installation of the Da Vinci system can be beneficial for the routine prostatectomies.  This robotic technology enables the surgeon to translate small and precise movement of the surgical instrument into the patient's body. Additionally, it has a thin tube that includes a camera and light. This enables the surgeon and healthcare staffs a visual representation of the inner body surgery procedure. The use of Da Vinci robotic technology is always beneficial for healthcare organizations. As mentioned in the case study, the surgeons of the private facility are aiming to adopt Da Vinci robot techniques for the routine treatment of prostatectomies. This technique has been approved by TGA. However, no conclusive beneficial evidence has been observed for this technique. Thus, the effectiveness of the robotic techniques of Da Vinci is still unknown. Moreover, the healthcare organization presumes that the adaptation of Da Vinci may be costly. Thus, the organization may not bear the extra expense. Thus, this study has been developed to advise the manager of the organization regarding the beneficial parts of using the Da Vinci robotic technique. This technique can be applied for the betterment of the treatment procedure. Moreover, the surgeons of the private facility would be unable to ease the surgery procedure. Apart from that, this robotic medical equipment can be used prostatectomies surgery for a better experience. It is also a cost-effective technique where no additional cost is required to be bothered by the organization.  This study will provide several concrete shreds of evidence that will clarify the effective use of Da Vinci robotic equipment. However, there are several risk factors associated with the use of Da Vinci robotic equipment. This includes it is costly, hard to maintain effective and requires an efficient healthcare professional to use it in an effective manner. The attachment of clinical factors with Da Vinci equipment will be analyzed on the context of the use of the robotic equipment. The financial impacts of the installation and maintenance of the machine will be analyzed in this study supported by relevant financial health factors. Recommendations will be provided based on the identified critical issues of using Da Vinci equipment. The communication techniques with the stakeholders to provide the possible recommendations will also be provided in the study. The concluding part of the study will analyze all the discussion within a nutshell and will recommend the effective use of DA Vinci robotic equipment for the treatment of prostatectomies.

Clinical Factors of Da Vinci Robot

Evidence to support the technology

Da Vinci robotic equipment uses to provide surgery effective urological treatment. This treatment plan includes the prostatectomies treatment and radical nephrectomies. It is an invasive technique that can be referred to as an audio-visual medium to see the internal treatment procedure (Ozben et al., 2016). This robotic process helps to mitigate the surgery-related risks. The visual effect of this robotic treatment visualizes the small cuts and wounds at the inner body parts (Barman & Palese, 2016). This helps the physicians and surgeons to take effective care technique. It is evident that Da Vinci surgical equipment is useful as it

• reduces long hospital stay
• Reduces the blood loss during the surgery
• Reduces the surgical complications
• Reduce the use of narcotic pain medicines
• Enhances the possibility of faster  recovery and
• Small incisions are required that minimizes the scarring possibilities

This can be helpful for the organization to reduce the number of open surgery. The prostatectomies are an internal surgery with several complications. The visual effect of the Da Vinci machine would reduce the number of amount of complications (Judson, Aaronson & Neubauer, 2015). There would be less possibility for internal wounds. Moreover, the private facility need not care about the open surgery as the surgery can be done without opening or cutting any of the body parts (Valli & Gubler, 2017).   

The most important aspect of Da Vinci equipment is its evidence-based approach. The whole treatment process is recorded in Da Vinci equipment that can be used for the further treatment process (Guneri, Kirac & Biri, 2016).  This is an evidence-based treatment process that can mitigate the treatment associates risks and helps in reducing the number of wounds in the internal body parts during the surgery (Khalil, 2017).  Thus, the shreds of evidence suggest that  

It is undeniable that the use of Da Vinci mitigates the risks associated with the surgical treatment process. The clinical factors of the use of the techniques of Da Vinci can be segregated into five parts.

The use of Da Vinci robotic equipment is useful is reducing the potential surgical threats. It includes internal bleeding and clot fractures The healthcare organizations need to be careful while using the equipment as this includes the effective treatment procedure for prostatectomies surgery, gynecological laparoscopic surgery and transoral otolaryngology surgery (Kaldarov, Gorin, Kriger, Berelavichus & Raevskaya, 2017).  This equipment can also be used for the adjunctive mediastinotomy treatment process. This process is helpful in finding out the internal wounds during the surgical procedure (Yoshida et al., 2015). The organization must employ well-trained healthcare physician to use the equipment effectively for the best outcome. The healthcare physician must be well trained in using updated surgical instruments (Buchs, 2015). The adaptation of Da Vinci robotic equipment can be helpful to develop the overall surgical process for healthcare organizations.

Effectiveness of Using Da Vinci Technique

The conventional minimally invasive equipment lacked the potential of the audiovisual effects. However, Da Vinci is equipped with audiovisual effects that enables the surgeons to monitor the internal treatment procedure of the patient.  Thus, the health care factors that are adaptive in the conventional medical equipment need to be adaptive in the invasive use of Da Vinci. However, minimally invasive surgery would contradict the highly invasive surgery of Da Vinci equipment (Blute & Prestipino, 2014). The minimally invasive surgery is not safe for the surgery as there is the possibility of bleeding. On the contrary, the use of the Da Vinci surgery would mitigate the risks of bleeding and surgical complications as it includes the audiovisual effects (Sebastian, MD, 2017). Da Vinci robotic equipment must be used by the private facility healthcare organization.

The surgical procedure of Da Vinci is considered to be the safest treatment process. This helps to continue the surgical techniques effectively reducing the risk factors. This is considered to be the best alternative for minimally invasive techniques (Ali Moshiri, 2013). It is notable the many of the healthcare professionals from the private facility healthcare organization were not interested in adopting the techniques of Da Vinci robotic equipment as they were ignorant on the outcome of the use of this equipment (Kim, 2016). They are of the opine that they do not have conclusive evidence of the effectiveness of the treatment. It is clear that they prefer to use minimally invasive surgical techniques (Olson, 2013). Hence, they must be convinced that Da Vinci reduces the possibility of internal wounds during the surgery reduces the complications during surgery. This can be helpful for them to understand the effectiveness of the use of Da Vinci robotic equipment during surgery.   Additionally, this is considered the most fruitful surgical procedure having almost zero risk factors (Kim, 2016). The use of audio-visual techniques reduces the possibility of bleeding and clot fracture during surgery.   

The previous minimally invasive surgical process was not efficient in managing the critically surgical process. There were possibilities of internal bleeding and several fractures. On the contrary, the present Da Vinci robotic equipment is potential with the updated audio-visual techniques (Watanabe & Ishikawa, 2014). There were possibilities for internal bleeding and clot fracture. On the contrary, Da Vinci is the most effective surgical techniques that lack the potential healthcare risk factors (Watanabe & Ishikawa, 2014).

The effectiveness of using Da Vinci relies on effective training for healthcare professionals. The surgeons having efficient robotic skills are the most eligible to use Da Vinci robotic equipment (A, 2016). Moreover, the equipment specific training is also required by the surgeons to develop the efficiency in using the Da Vinci machine with potential. Thus, the organization needs to provide adequate training and knowledge regarding the robotic skill for the best uses of Da Vinci techniques to the persons who lack the efficiency in using robotic skills (A, 2016). 

Financial Impacts of Da Vinci Robot

The unavoidable part of using Da Vinci robotic technique is its costly use. The machines are costly enough. Thus, many of the healthcare organizations lack the sufficient financial resources to avail the equipment. The financial factors that can be caused a hindrance to the use of Da Vinci equipment are as follows:

• The high-cost equipment
• The robotic skill development program for the surgeons can be costly
• The training program for healthcare professionals to gather adequate knowledge regarding the effective use of the machine
• The machine is to be maintained properly to retain its effectiveness. Thus, the maintenance cost of the machine can also be identified as the critical financial hindrance for the healthcare organization to avail the machine(Carter-Brooks, Du, Bonidie & Shepherd, 2017).

The Da Vinci robot surgical technology is an innovative creation of the present time. It consists of some sophisticated equipment that enables the surgeons to perform the surgery in a systematic way (Ozben et al., 2016). Considering these positive impacts still, there is some risk associated with the robotic surgery that should be effectively analyzed, before implementation of the technology in the nursing care setting to treat prostate patients (Terry et al., 2015). The first factor is the high cost related to the proper maintenance of the technology. The new technology is very expensive and involves a high cost of maintenance (Fantola et al., 2016). If effective maintenance is not done then it may result in fatal consequences.

The Da Vinci robot is mainly operated by programming. There is a high risk of system failure in the operation setting. If the system failure occurs then it might have fatal results. The operation of the robot requires information that is geometrically difficult to express (Ficko, Koo & Hyams, 2016). Since the programming is hard there might occur a problem during surgery of the patient. The information required to run the system is very difficult to be expressed in an effective way in the nursing care settings. Besides that this high tech technology can be efficiently operated by the tech-savvy surgeons (Goonewardene & Cahill, 2016). The surgeon possessing proper knowledge about programming may operate the machine in a successful manner. There might occur problem if the technology is used by the doctors lacking proper knowledge of the technology. 

Another effective point that should be considered as the risk factor is the internal injury caused sometimes due to malfunction of the instrument. The internal injury may result in internal bleeding that has a negative effect on the patient.  The patient might suffer from pain due to this kind of injury (Carugno, Gyang, Hoover, Taylor & Lamvu, 2014).  There might occur infection due to the injury that may cause complication to the patients. In the procedure, gas is used that might result in the discomfort of the patient (Gao, 2017). There might be a problem during the anesthesia procedure that may have a negative impact on the patient.

Recommendations

Another important risk factor of using robotic surgery is that the machine may cause burns to the patient due to the electric current. This is one of the major risks of using robotic surgery. In some cases, it is seen that the patient has suffered permanent nerve damage due to robotic surgery (Tatebe, Gray, Tatebe, Garcia & Putty, 2017). This is one of the most significant risk factors that should be considered in the implementation of robotic surgical technology. In the opinion of the researcher, the surgeons are unable to receive the tactile feedback while performing an operation with the robot (Yu et al., 2014). Due to this reason, a risk factor is developed while performing surgery with the robot in hospital care settings. These are some of the risk factors those should be analyzed efficiently during the implementation of the new technology to treat the patient

Significant analysis of the risk factors for surgical technology is essential. After effective analysis of the total technology efficient recommendation are prepared. These recommendations may have a significant impact on the holistic implementation of the new technology in the hospital care setting.

• Cost management-Significant cost-effective analysis should be done in an effective manner. Since the installation and maintenance of the robotic technology involve the high amount of cost, cost-effective fund management should be done in the hospital for the implementation of the technology (Fantola et al., 2016). Maintenance of the surgical robot is a prime requirement. If maintenance is not done then it might have a fatal result. If the technology is installed in the hospital setting then an effective maintenance plan should be there. Through cost management, the technology might be implemented in the hospital care setting.
• Capacity building program- Capacity building program is one of the most essential components to implement the new technology in the hospital care setting.  Since the Da Vinci Robot is operated in programming setting techs savvy personals are required. Through efficient capacity building training, the surgeons should be made familiar with the new robotic technology(Terry et al., 2015).If there is any Lacuna among the surgeons about handling the programs of the new technology it will have fatal results. This is why by fund management and relocation of the fund should be done to implement efficient capacity building program. Introduction of the new technology should be done after building the effective capacity of the surgeon.
• Effective recruitment: The human resource recruited in the hospital care setting for the operation and maintenance of the new technology should be tech savvy. The recruitment policy should be formulated in such a way that tech-savvy personals are recruited to maintain the robotic surgical technology.  During the time of recruitment, the background of the surgeons should be analyzed. The focus should be given on the recruitment of the tech-savvy surgeon. This is one of the important components to effectively implement the surgical robot technology in the hospital care setting.

Stakeholders are the most important components of any plan. In this analysis of the implementation of the robotic surgery technology in hospital care settings, the main stakeholders are the surgeons, maintenance staffs and the patient present in the nursing care(Yu et al., 2014). The most important thing is to set the target audience before communicating any information. After analysis of the advantage and the disadvantage of the robotic surgical device, it is essential to communicate the implementation plan with the stakeholders of the hospital. There are formal and informal methods of communication with the stakeholders. The formal method of communication with the stakeholders includes the following points:

• Meetings: Meeting is one of the most effective ways to communicate effectively with the stakeholders in the hospital care setting. In this case, formal meetings can be arranged to communicate the implementation plan with the doctors and the maintenance staff. Prior information should be provided to the doctors about the time and agenda of the meeting. An open communication platform should be maintained in the meeting during communication with the doctors. There might be effective feedback from the doctors that will enhance the implementation plan of the new technology (Gao, 2017).
• Conference calls: Through conference calls the detail information about the new technology may be communicated with the stakeholders. The detailed information about the technology including its advantage and disadvantage that should be shared with the doctors and the maintenance staffs.
• Newsletters email and poster- This is another method of stakeholder communication that involves mainly one-way communication. The detailed information about the cost and different features of the technology may be printed as posters or uploaded in the newsletter of the hospitals. In this way, the patient will be able to know the detailed information about the Da Vinci surgical robot(Goonewardene & Cahill, 2016. The features focusing on the advantage and disadvantage may be mentioned in the newsletter of the hospital. This will help in increasing effective communication with the stakeholders.

Policies and procedures are the most essential components that should be followed for proper implementation of the action plan. There should be definite policies and procedures to use the new technology in an effective manner. The policies should include the following points.

The human resource should be focused on the policy. The tech-savvy surgeon should be allowed to operate the Da Vinci robot in the performance of prostate treatment of the patient. It will increase the efficiency of the surgery. Risk mitigation will be achieved through this kind of policy. There should be sufficient maintenance of the Da Vinci robot. Since it is electronic equipment prominent maintenance policy should be there. The maintenance person should have proper knowledge and information about the technology (A, 2016). Cost management policy is another essential element needed for the proper implementation of the maintenance process. Allocation of the fund should be done in an efficient manner so that proper maintenance of the technology may be done. 

Conclusion

The policies should make compliance with the rules and regulation of the national standards of Australia.  The national standard for the efficiency of the human resource should be achieved by the organization. Presence of sufficient fund should be there to maintain the technology in an effective manner. Proper compliance with the national standards will help in the better implementation of the technology.

There are some important procedures before using the new technology. Those procedures are mentioned below:

Since the technology is new and is operated through programming it is essential to perform capacity building training. The new technology possesses some advantage as well as some disadvantages. To mitigate the risk proper capacity building training of the surgeons should be done.  Besides that, the trainer should have sound knowledge about the new technology (Blute & Prestipino, 2014). However efficient and effective trainer should be hired to perform the capacity building training of the surgeons. This will help in developing the basic concept. Effective capacity building training with the maintenance staff should be done in a prominent manner.  If the effective capacity building training is performed then unparallel precision during the surgery may be achieved by the surgeons.

Conclusion

To conclude it is essential to summarize the analysis of the implementation plan of the Da Vinci surgical robot in the hospital care setting. The study is mainly focused on the analysis of the evidence that supports the implementation of the new technology. Besides that critical analysis of the key features of the technology is done. Mainly the technology comprises of sophisticated components that helps in increasing the precision of the surgery.  This is the main reason for the recommendation of technology in the surgical setting. The financial analysis of the study is done that depicts the technology is costly and efficient cost management and fund allocation should be done to effectively use the technology in the hospital care setting. If efficient fund management is done then the technology may give unparallel precession in the field of surgery. Subsequently, the study comprises of risk factor assessment. There are several risk factors that should be properly analyzed. Mitigation plan should be formulated to reduce the risk factors of the new Da Vinci Robot technology in the Hospital care setting.  After the risk and financial assessment, the study comprises of the recommendation needed to strengthen the implementation plan of the new robotic surgery technology.  

 The recommendation includes different components like strengthening the capacity of the human resources through proper capacity building program and effective cost management and maintenance of the new technology.  Subsequently, the policy and procedures that should be maintained before the implementation of the action plan are studied. There should be the formulation of specific policies to implement and maintain the Da Vinci Robotic surgery equipment. Effective capacity building program through training should be done. Trainer with sound knowledge of the technology should be hired to give training to the surgeons and the maintenance staffs.  This will help in the efficient implementation of the technology in the hospital settings. 

Reference list

A, G. (2016). Robotic Training in General Surgery Residency: How Early Can We Begin?. Journal Of Surgery And Surgical Research, 021-024. doi: 10.17352/2455-2968.000025

Ali Moshiri, A. (2013). Tissue Engineering: Alternative Option in Managing Large and Massive Tissue Deficits. Tropical Medicine & Surgery, 01(01). doi: 10.4172/2329-9088.1000e101

Barman, N., & Palese, M. (2016). Robotic surgery for treatment of chyluria. Journal Of Robotic Surgery, 10(1), 1-4. doi: 10.1007/s11701-016-0560-5

Blute, M., & Prestipino, A. (2014). Factors Associated With Adoption of Robotic Surgical Technology in US Hospitals and Relationship to Radical Prostatectomy Procedure Volume. Annals Of Surgery, 259(1), 7-9. doi: 10.1097/sla.0000000000000390

Buchs, N. (2015). Robotic technology: Optimizing the outcomes in rectal cancer?. World Journal Of Clinical Oncology, 6(3), 22. doi: 10.5306/wjco.v6.i3.22

Carter-Brooks, C., Du, A., Bonidie, M., & Shepherd, J. (2017). The Impact of a Dedicated Robotic Team on Robotic-Assisted Sacrocolpopexy Outcomes. Female Pelvic Medicine & Reconstructive Surgery, 1. doi: 10.1097/spv.0000000000000413

Carugno, J., Gyang, A., Hoover, F., Taylor, K., & Lamvu, G. (2014). Physician Risk Estimation of Operative Time: A Comparison of Risk Factors for Prolonged Operative Time in Robotic and Conventional Laparoscopic Hysterectomy. Journal Of Gynecologic Surgery, 30(1), 15-19. doi: 10.1089/gyn.2013.0037

Fantola, G., Brunaud, L., Nguyen-Thi, P., Germain, A., Ayav, A., & Bresler, L. (2016). Risk factors for postoperative complications in robotic general surgery. Updates In Surgery, 69(1), 45-54. doi: 10.1007/s13304-016-0398-4

Ficko, Z., Koo, K., & Hyams, E. (2016). High tech or high risk? An analysis of media reports about robotic surgery. Journal Of Robotic Surgery, 11(2), 211-216. doi: 10.1007/s11701-016-0647-z

Gao, S. (2017). Exploring Da Vinci robotic surgery with Prof. David Rice and Prof. Hecheng Li. Journal Of Visualized Surgery, 3, 4-4. doi: 10.21037/jovs.2016.12.01

Goonewardene, S., & Cahill, D. (2016). Salvage robotic prostatectomy and high risk disease: what else can we do?. Journal Of Robotic Surgery, 12(1), 197-198. doi: 10.1007/s11701-016-0628-2

Guneri, C., Kirac, M., & Biri, H. (2016). Surgical treatment of an acquired posterior urethral diverticulum with cystoscopy assisted robotic technique. Journal Of Robotic Surgery, 11(1), 83-86. doi: 10.1007/s11701-016-0623-7

Judson, B., Aaronson, N., & Neubauer, P. (2015). Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review. Robotic Surgery: Research And Reviews, 59. doi: 10.2147/rsrr.s64869

Kaldarov, A., Gorin, D., Kriger, A., Berelavichus, S., & Raevskaya, M. (2017). Robotic surgery as a part of ERAS technology in pancreaticoduodenectomy. Clinical Nutrition ESPEN, 19, 83-84. doi: 10.1016/j.clnesp.2017.04.037

Khalil, H. (2017). Evidence-based quality improvement. International Journal Of Evidence-Based Healthcare, 15(3), 81. doi: 10.1097/xeb.0000000000000118

Kim, M. (2016). Incidence and risk factors of postoperative delirium after peripheral vascular surgery. Surgery: Current Research, 06(05). doi: 10.4172/2161-1076.c1.024

Olson, C. (2013). The robotic colorectal surgeon. OA Robotic Surgery, 1(1). doi: 10.13172/2053-3225-1-1-676

Ozben, V., Cengiz, T., Atasoy, D., Bayraktar, O., Aghayeva, A., & Erguner, I. et al. (2016). Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 26(5), 417-423. doi: 10.1097/sle.0000000000000320

Ozben, V., Cengiz, T., Atasoy, D., Bayraktar, O., Aghayeva, A., & Erguner, I. et al. (2016). Is da Vinci Xi Better than da Vinci Si in Robotic Rectal Cancer Surgery? Comparison of the 2 Generations of da Vinci Systems. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 26(5), 417-423. doi: 10.1097/sle.0000000000000320

Sebastian, MD, R. (2017). Advanced Robotic Technology Is the Future of Surgery. Revista De La Facultad De Medicina Humana, 17(3). doi: 10.25176/rfmh.v17.n3.1067

Tatebe, L., Gray, R., Tatebe, K., Garcia, F., & Putty, B. (2017). Socioeconomic factors and parity of access to robotic surgery in a county health system. Journal Of Robotic Surgery, 12(1), 35-41. doi: 10.1007/s11701-017-0683-3

Terry, R., Gerke, T., Mason, J., Sorensen, M., Joseph, J., Dahm, P., & Su, L. (2015). Postoperative rhabdomyolysis following robotic renal and adrenal surgery: a cautionary tale of compounding risk factors. Journal Of Robotic Surgery, 9(3), 195-200. doi: 10.1007/s11701-015-0515-2

Valli, P., & Gubler, C. (2017). Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery. Clinical Obesity, 7(2), 115-122. doi: 10.1111/cob.12182

Watanabe, G., & Ishikawa, N. (2014). Alternative Method for Cardioplegia Delivery During Totally Endoscopic Robotic Intracardiac Surgery. The Annals Of Thoracic Surgery, 98(3), 1129-1131. doi: 10.1016/j.athoracsur.2014.02.070

Yoshida, S., Fukui, N., Saito, K., Fujii, Y., Kageyama, Y., & Kihara, K. (2015). Novel image monitoring system using a head-mounted display for assistants in da Vinci surgery. International Journal Of Urology, 22(5), 520-521. doi: 10.1111/iju.12735

Yu, J., Wang, Y., Li, Y., Li, X., Li, C., & Shen, J. (2014). The safety and effectiveness of Da Vinci surgical system compared with open surgery and laparoscopic surgery: a rapid assessment. Journal Of Evidence-Based Medicine, 7(2), 121-134. doi: 10.1111/jebm.12099