Logistic challenges in implementing a multispecialty robotic surgery program at university hospitals

The integration of innovative, high-cost technologies like robotic surgery presents significant managerial and logistical challenges within public university hospitals. While previous research often highlights clinical outcomes, pragmatic studies on the administrative and organizational complexities of implementation are scarce. This manuscript aims to address this gap by analyzing the multifaceted logistical issues encountered during the establishment of a multispecialty robotic surgery program.

This study's primary objective is to evaluate the managerial and logistical aspects of adopting a surgical robot in a public hospital, focusing on the administrative processes, institutional adjustments, and systemic challenges that impact patient care and institutional sustainability. The authors sought to identify key lessons learned from this experience and enumerate the institutional knowledge gained during the integration of this technology.

This study utilized a mixed-methods approach, combining an analysis of institutional data and semi-structured interviews with managers and professionals involved in the decision-making and adoption process. Data collected included demographic details, surgical times, and postoperative outcomes, which served as management indicators. The study's framework was informed by organizational and diffusion of innovation theories to reconstruct the history of the decision-making process.

The implementation of robotic surgery required substantial adjustments to hospital infrastructure, work processes, and personnel training. Key logistical difficulties documented included dependency on a single supplier, delays in importing materials, high costs without market competition, and extensive training requirements. While robotic surgery demonstrated clinical advantages, such as lower complication rates (4.2%vs. 5.2%) and reduced blood loss (266.2 mL vs. 598.2 mL), its successful adoption was contingent on detailed planning and effective management to minimize these logistical challenges and optimize benefits. The study also revealed a protracted learning curve for the surgical teams, although operative times showed a decreasing trend with increased experience.

The successful implementation of robotic surgery in a public teaching hospital requires a dedicated focus on logistical planning, stakeholder engagement, and adaptive management. Preemptive modeling of costs, diversified supplier relationships, and phased training are essential for sustainability. These findings provide valuable guidance for similar institutions aiming to integrate disruptive surgical technologies.