This work aims to update the previous robotic surgery health technology assessment (HTA) study conducted in 2013 in Bambino Gesù Children's Hospital. The study, focused on the evaluation of the newest evidence that have emerged over the last three years, aims to identify if there are new perspectives and advantages of introducing this technology in the hospital.

Decision-oriented HTA (DoHTA) method was applied to conduct the assessment. It involved the integration of the European Network for HTA Core Model® (version 3.0) and the analytic hierarchy process providing the definition and the numerical evaluation of assessment parameters through which it is possible to evaluate the performance of the technologies compared. Three years after the first technology's evaluation, an updated literature review was conducted, using the same 2013 key words, to identify changes in the indicators’ performance score. The performance values have been updated through a quantitative and qualitative evaluation of data gathered from the literature review, expert opinion and context analysis. The global weights’ system, developed in 2013, has not been updated because the relative importance of each domain remained unchanged. The performance values of safety, efficacy, costs, and social aspects have been estimated, identifying the differences in terms of percentage values in comparison with the previous study.

Results showed a slight improvement on safety and organizational aspects in robotic surgery; however, clinical effectiveness and economic, social and legal aspects remained unvaried. More specifically, it has been registered a 3 percent reduction of the difference of the distance between robotic and laparoscopic performance values (2013: 14, 15 percent; 2017: 11, 29 percent).

Results highlighted a slight improvement in robotic surgery performances even if it confirmed the previous results for which the laparoscopic system outperformed the others and currently is keeping the best performance techniques. Finally, sensitivity analysis and a Monte Carlo simulation were carried out proving the stability and reliability of the solution.