Ethical evaluation as a driver for value-based choice of innovative technology Ethical evaluation in innovative technology

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Paolo Petralia
Marco Doldi
Girolamo Mattioli


minimally invasive surgery; paediatrics; paediatric robotic surgery; innovative technology


Demonstrating the effectiveness of using an innovative technique in medicine is a multifactorial objective: there are several integrated areas in which evidence and outcomes must be measured, both in the clinical-scientific and technical-organizational areas.

Such representation, in relation to underlying costs and production tariffs, is now standard practice in the HTA methodology, rather than in the management assessment and budget choices.

What is occasionally assessed in this "value set-up" is the impact of the ethical choice as well, both with regard to the contextual data dimension - environmental and interpersonal - and the subjective perception of all the actors in the process.

The case of the introduction of robotics in paediatric surgery demonstrates - in an exemplary manner - how the ethical evaluation of the greater satisfaction for operator and patient, together with the benefit for the latter, even under the same conditions of safety and clinical outcome - can make the difference in the choice of operative technologies, even those of higher costs.

Of course, the specific expertise of the operators is a prerequisite, as it is the demonstration that paediatric robotic surgery is safe, effective and improves performance and treatment outcomes: an original synthesis in the definition and enhancement of the specificity of the paediatric patient - who is not a 'small adult' - and of the paediatric hospital, which must guarantee the provision setting tailored to his or her needs.

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