Norway – Medical equipments – Voluntary ex-ante transparency notice: Surgical robot for Helse Bergen HF

Helse Bergen HF currently has 3 Da Vinci surgical robots from Intuitive Surgical Sarl in use at Haukeland University Hospital. One of them, a da Vinci Xi, was procured through a rental agreemnet from October 2022, valid until September 2026. Helse Bergen plans to enter into a new agreement with Intuitive Surgical Sarl for the hire of the existing Da Vinci Xi surgical robot for 5 years. The agreement continues use of the current installation, avoiding downtime and replacement costs. The contract is for the hire/use fee for the Da Vinci Xi system (single-console), full service and training. The existing framework agreement 402523 on equipment dependent consumables (instruments and accessories), will be expanded through an amendment agreement to meet the continued need. The total value of the procurement, including all the above, is estimated to be EUR 5,000,000 excl. VAT. The surgical robot shall, at a minimum, be able to perform the following procedures: Gastroenterology: Rectal surgery, pelvic floor surgery, colon treatments, ventral hernia, diaphragm hernia, liver treatments and pancreatic treatments, oesophagus and stomach surgery. Gynaecology: Endometrial cancer with hysterectomy, sentinel node diagnostics, glasal toilets in the pelvis and paraaortal, hysterectomies in premaligne and benign changes, treatment of ovarian cancers in early stages, including hysterectomy, omentectomy, pelvic bottom surgery, endometriosis removal and treatment of endometriosis on the diaphragm surface. Urology: Radical prostatectomy including glasion toilets, simple prostatectomy, radical nefrectomies, kidney resections, nefroureectomies with a bloc glasal tonic, retroperitoneal lympheglandeltoilette, retroperitoneal kidney detections with the use of 4 arms, renal pelvic plastic, replantations of ureter, including the use of Boari patch and reconstruction of ureter with thin arm. Thoracic surgery: Thoracosscopic surgery for lung cancer, benthic and malignant tumours in mediastinum, diaphrhea operations, and thymus interventions. Endocrinology: Adrenal surgeries. In this procurement, a professional group consisting of medical specialists has carried out the professional assessments of what is considered medically necessary to establish as requirements. They have determined that table integration and integrated staples with tissue sensor technology are necessary. The majority of the gastrosurgery operations at Haukeland University Hospital are done in several parts of the abdomen and there is a constant need for position changes. Integrated tables mean that one must not disconnect the robot during the position change, and that also means significantly shortened time spent. The shortened time allows several surgeries to be performed, in addition a reduced operating time reducing the risk to the patient. Table integration is also essential for gynaecological procedures, where it operates both in the pelvis and in the upper part of the abdominal cavity. Typically both with cancer surgery with harvesting paraaortal glands and with endometriosis surgery with the removal of foci on the diaphragm. Integrated staplers are widely used in gastro procedures, to divide the intestine, to divide the pancreas, vessels, etc. Haukeland University Hospital has the largest volume in Norway for rectal cancer. In gastrosurgery, this is one of the most frequently performed procedures with the robot. For many of the procedures, the intestine should be divided very far down by the pelvic floor, and the experience from the surgeons is that this is easier to do with an integrated stapler that can angle more than what a laparoscopic endostapler manages. The use of integrated staplers means that in some patients the intestine can be spliced together lower down and with potentially fewer leaks. The research articles "Efficacy of a robotic staples on symptomatic anastomotic leakage in robotic low anterior resection for rectal cancer" 2021 and "Advantages of using a robotic staples in rectal cancer surgery" 2019 support the subject group's assessment. The integrated stapler also has tissue sensor technology, indicating whether the tissue is too thick when trying to divide, and this can help reduce the leakage. Integrated staplers are also used for gynaecological procedures in Helse Bergen, which have the regional responsibility for endometriosis surgery and cancer surgery, and are necessary in regard to bowel surgery in connection with endometriosis surgery at segmental bowel treatment. Lung cancer surgery also depends on the robot system having an integrated stapler. The Thorax Surgery Section is responsible for the treatment of thorax surgical conditions in Helse Vest, and most of the section ́s capacity for the robot system is used for this. Sykehusinnkjøp HF has previously had procurements without competition regarding Da Vinci X and Da Vinci Xi. This was accepted in KOFA case 2024/1067 as only Intuitive had a robot with table integrations and in KOFA case 2025/0872 because only Intuitive had a robot with integrated stapler. In this procurement the project has had a market dialogue published on Doffin and TED 22.10.2025 showing it's still only Intuitive who can provide these functions. The above account shows that Helse Bergen HF has a real and factual need for a surgical robot with integrated stapler and table integration. The need is based on medical assessments and years of experience with robot-assisted surgery. The requirements do not result from adapting the procurement documents to a particular tenderer, but necessary for patient safety and in order to provide the best possible patient treatment. In addition, by continuing the already installed surgical robot, one will avoid downtime and replacement costs associated with a new installation. All the systems from Intuitive can be used interchangeably and this avoids the considerable cost of re-certifying personnel to a new system from a new supplier.