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Cost analysis of laparoscopic hysterectomy and abdominal hysterectomy
Selected Scientific Abstracts
Laparoscopic Bowel and Vascular Complications: Should the Veress Needle and Cannula Be Replaced?
once one is beyond the learning curve and if steps are taken to reduce the cost of supplies. Our study is in progress and will consist of approximately 160 laparoscopic hysterectomies when completed. From the preliminary results, we can expect further decreases in operating time that would make the costs of laparoscopic hysterectomy and TAH virtually identical.
A Lam, DMB Rosen. Sydney Women's Endosurgery Centre, Sydney, Australia.
We undertook a retrospective survey of bowel and vascular complications in gynecologic laparoscopic surgery reported to the three major medical defense organizations in this state between January 1988 and September 1993. Twenty-six bowel injuries and eight vascular complications were reported. The majority of these patients had undergone either diagnostic laparoscopy or laparoscopic tubal ligation. The majority of injuries were attributed to the Veress needle in creating primary pneumoperitoneum or inserting the primary cannula. Three of the 26 bowel injuries and 3 of 8 vascular injuries resulted in death. Laparoscopic bowel and vascular injuries can thus be related to the Veress needle or the primary cannula. The serious sequelae suggest a need to assess the current methods of establishing pneumoperitoneum for laparoscopy.
Cervical Coring versus Noncoring Technique in Supracervical Laparoscopic Hysterectomy CN Lee, JH Cho, JW Kin, MC Shin. CHA General Hospital, Seoul, Korea.
Cost Analysis of Laparoscopic Hysterectomy and Abdominal Hysterectomy R Laveran, NV Simon, DH Gerlach, JR Jackson. York Hospital, York, PA.
We reviewed the first 75 laparoscopic hysterectomies performed between December 1992 and June 1995, and compared them with 59 total abdominal hysterectomies (TAHs) done by the same surgeons during the same period. Length of hospital stay, use of supplies, operating time, and actual total costs (fixed, variable) were compared for both procedures. The mean length of stay for laparoscopic hysterectomy was significantly shorter than for TAH (1.2 SD 1.2 days vs 3.4 SD 0.8 days, respectively; t = 12.74, p <0.05). Laparoscopic hysterectomy had higher mean operating room cost than TAH ($823 vs $593), reflecting longer mean operating time (186 SD 5l min vs 105 SD 30 min; t = 11.46, p <0.05) and greater use of supplies. The mean total cost of laparoscopic hysterectomy was $2928 (SD $643) and that of TAH was $2721 (SD $395). The cost difference between procedures, although statistically significant (t = 2.31, p <0.05), amounted to only $207. The length of stay, operating time, and use of supplies for laparoscopic hysterectomy decreased over the time of the study. Laparoscopic hysterectomy can be a cost-effective alternative to TAH
We questioned whether cervical coring is necessary in laparoscopic supracervical hysterectomy. More than 250 laparoscopic supracervical hysterectomies have been done with transvaginal resection of the endocervical canal at our hospital since October 1992, and 35 cases without transvaginal resection of endocervical canal in 1995 and 1996. Women with suspicious cervical lesions and abnormal Papanicolaou smears were excluded from the noncoring technique. The purpose of coring the cervix is to prevent cancer in the remaining cervix, but the occurrence rate is the same as with an intact cervix. After comparing operating times, length of hospital stay, blood loss, and technique in both groups, we concluded that noncoring technique has many advantages over coring.
$24
Advantages of Total Laparoscopic Hysterectomy PI Lee, YT Lee, SH Lee, YK Chang. Jeil Women's Hospital, Seoul, Korea.
We compared 112 total laparoscopic hysterectomies (TLH) with 72 laparoscopic hysterectomies (LH) performed from January 1, 1995, to September 30, 1995. Patient characteristics (age, weight, parity) and indications for surgery were similar between the groups. All surgeries were performed with electrosurgery or suture ligature, or both. Average uterine weight was slightly lower with TLH (193.1 + 96.2 g) versus LH (237.4 + 84.5 g). Thirty-three women (29.46%) undergoing TLH had had previous pelvic surgery, versus 12 having LH (16.67%). Operating time was significantly shorter for TLH (117.6 + 38.2 min) than LH (134.9 + 37.4 min). Less bleeding, as indicated by decreased postoperative hemoglobin, was noted with TLH (1.3 + 0.7 g/ml) versus LH (1.7 + 1.1 g/ml). Fewer cases of serious complications, such as
Laparoscopic Bowel and Vascular Complications: Should the Veress Needle and Cannula Be Replaced?
once one is beyond the learning curve and if steps are taken to reduce the cost of supplies. Our study is in progress and will consist of approximately 160 laparoscopic hysterectomies when completed. From the preliminary results, we can expect further decreases in operating time that would make the costs of laparoscopic hysterectomy and TAH virtually identical.
A Lam, DMB Rosen. Sydney Women's Endosurgery Centre, Sydney, Australia.
We undertook a retrospective survey of bowel and vascular complications in gynecologic laparoscopic surgery reported to the three major medical defense organizations in this state between January 1988 and September 1993. Twenty-six bowel injuries and eight vascular complications were reported. The majority of these patients had undergone either diagnostic laparoscopy or laparoscopic tubal ligation. The majority of injuries were attributed to the Veress needle in creating primary pneumoperitoneum or inserting the primary cannula. Three of the 26 bowel injuries and 3 of 8 vascular injuries resulted in death. Laparoscopic bowel and vascular injuries can thus be related to the Veress needle or the primary cannula. The serious sequelae suggest a need to assess the current methods of establishing pneumoperitoneum for laparoscopy.
Cervical Coring versus Noncoring Technique in Supracervical Laparoscopic Hysterectomy CN Lee, JH Cho, JW Kin, MC Shin. CHA General Hospital, Seoul, Korea.
Cost Analysis of Laparoscopic Hysterectomy and Abdominal Hysterectomy R Laveran, NV Simon, DH Gerlach, JR Jackson. York Hospital, York, PA.
We reviewed the first 75 laparoscopic hysterectomies performed between December 1992 and June 1995, and compared them with 59 total abdominal hysterectomies (TAHs) done by the same surgeons during the same period. Length of hospital stay, use of supplies, operating time, and actual total costs (fixed, variable) were compared for both procedures. The mean length of stay for laparoscopic hysterectomy was significantly shorter than for TAH (1.2 SD 1.2 days vs 3.4 SD 0.8 days, respectively; t = 12.74, p <0.05). Laparoscopic hysterectomy had higher mean operating room cost than TAH ($823 vs $593), reflecting longer mean operating time (186 SD 5l min vs 105 SD 30 min; t = 11.46, p <0.05) and greater use of supplies. The mean total cost of laparoscopic hysterectomy was $2928 (SD $643) and that of TAH was $2721 (SD $395). The cost difference between procedures, although statistically significant (t = 2.31, p <0.05), amounted to only $207. The length of stay, operating time, and use of supplies for laparoscopic hysterectomy decreased over the time of the study. Laparoscopic hysterectomy can be a cost-effective alternative to TAH
We questioned whether cervical coring is necessary in laparoscopic supracervical hysterectomy. More than 250 laparoscopic supracervical hysterectomies have been done with transvaginal resection of the endocervical canal at our hospital since October 1992, and 35 cases without transvaginal resection of endocervical canal in 1995 and 1996. Women with suspicious cervical lesions and abnormal Papanicolaou smears were excluded from the noncoring technique. The purpose of coring the cervix is to prevent cancer in the remaining cervix, but the occurrence rate is the same as with an intact cervix. After comparing operating times, length of hospital stay, blood loss, and technique in both groups, we concluded that noncoring technique has many advantages over coring.
$24
Advantages of Total Laparoscopic Hysterectomy PI Lee, YT Lee, SH Lee, YK Chang. Jeil Women's Hospital, Seoul, Korea.
We compared 112 total laparoscopic hysterectomies (TLH) with 72 laparoscopic hysterectomies (LH) performed from January 1, 1995, to September 30, 1995. Patient characteristics (age, weight, parity) and indications for surgery were similar between the groups. All surgeries were performed with electrosurgery or suture ligature, or both. Average uterine weight was slightly lower with TLH (193.1 + 96.2 g) versus LH (237.4 + 84.5 g). Thirty-three women (29.46%) undergoing TLH had had previous pelvic surgery, versus 12 having LH (16.67%). Operating time was significantly shorter for TLH (117.6 + 38.2 min) than LH (134.9 + 37.4 min). Less bleeding, as indicated by decreased postoperative hemoglobin, was noted with TLH (1.3 + 0.7 g/ml) versus LH (1.7 + 1.1 g/ml). Fewer cases of serious complications, such as