Decision-oriented HTA for comparing Three-Dimensional (3D)/Two- Dimensional (2D) laparoscopic display systems in a variety of pediatric surgical procedures

Laparoscopic procedures have become increasingly popular. The use of 3-dimensional (3D) vision might aid in performing laparoscopic procedures. The aim of the study is to show the main results of applying the “Decision-oriented Health Technology Assessment” (doHTA) method for the assessment of 3D laparoscopic system compared to conventional two-dimensional (2D) laparoscopic system to support the decisionmaking process about the choice to adopt the new technology in the Hospital. DoHTA is a new implementation of the EUnetHTA Core Model®, which integrates the Multi-Criteria Decision Analysis (MCDA) using the Analytic Hierarchy Process (AHP). A decision tree covering all the relevant assessment aspects of 3D laparoscopic systems has been derived and weighted by means of pairwise comparisons. Subsequently, another pairwise comparison list was set up to compare both alternative technologies with respect to every lowest indicator. DoHTA results have quantitatively shown how 3D laparoscopic system appears to be as safe as 2D laparoscopic system in many surgical procedures and how it seems to offer many benefits for surgeons, such as reduced eyestrain, headaches, or other side effects than 2D vision. 3D system is also suitable in reducing the mean error rate, also thanks to the stereoscopic depth perception, that is lost in 2D vision. From the technical perspective, the analysis has indicated the reduction in median instrument path length, an enhancement of median motion smoothness, and the decrease in grasper frequency with the 3D display. However, the comparative cost-analysis has pointed out that 3D procedure cost was slightly higher that its comparator. Based on the appreciation of such results, especially taking into account the positive technical and clinical features, we conclude that 3D system may be a good alternative to 2D system. Indeed, the doHTA results have led to a confident decision to implement 3D laparoscopic system in the hospital.