Laparoscopic Cholecystectomy

Fisher, Kerry; Reddick, Eddie Joe; Olsen, Douglas O.

doi:10.1097/00129689-199106000-00003

Cited by 26 publications

(8 citation statements)

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“…This is in no small part because of the numerous studies that have substantiated the bene ts of laparoscopy, particularly its clinical advantages (7,13,14,22,30,(38)(39)(40)(41)(42)47).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

Bösch¹,

Wehrman

Saeger

et al. 2002

Eur J Surg

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“…This is in no small part because of the numerous studies that have substantiated the bene ts of laparoscopy, particularly its clinical advantages (7,13,14,22,30,(38)(39)(40)(41)(42)47).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

Bösch¹,

Wehrman

Saeger

et al. 2002

Eur J Surg

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“…However, reports on the cost of laparoscopic cholecystectomy are confusing. A generally accepted method of cost evaluation yet has not been established, and therefore hospital costs [3,5], hospital charges [4,10,15,28], or cost-effectiveness analyses [1] have been reported. Published cost estimations were very varying: DuToit reported $1,298 per operation [3], while Jordan [10] and Llorente [14] calculated more than $7,500.…”

Section: Discussionmentioning

confidence: 99%

“…Economic aspects of laparoscopic compared to conventional cholecystectomy have been investigated [4,5,13,15], but the specific components of the total costs remain unclear. Since health-care costs are increasing at an alarming rate and surgeons are responsible for costs related to operations [28], the aim of the present study was to determine potential savings by a detailed cost analysis.…”

mentioning

confidence: 99%

Costs of laparoscopic cholecystectomy

1995

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Despite the growing acceptance of laparoscopic cholecystectomy the costs remain unclear. Therefore, a detailed cost analysis was performed to determine potential savings. As part of a continuing audit, data of 508 consecutive laparoscopic cholecystectomies have been prospectively collected. Pre-, intra-, and postoperative variables were assessed by standardized questionnaires. These data were used to estimate the average use of diagnostics, drug consumption, operation time, and hospital stay. In addition, costs for loss in income, "hotel services", diagnostic procedures, and for the operation itself were calculated in detail. The total costs for a standard laparoscopic cholecystectomy were 3,395 deutsche marks (DM). The costs for the operation itself represented 19%, "hotel services" and medical treatment except the operation such as nursing, visits, or diagnostic procedures represented 47%, and the loss of income another 33% of the total costs. Thus, most effective savings may be achieved by shortening the hospital stay and the time of inability to work. However, each additional 30 min of operating time costed 146 DM (4.88 DM/min) and an "ideal" operation performed within 40 mins and with a 3-day hospital stay would save 20% of the total and 31% of the hospital costs. An increase in the number of operations per year would not have a relevant impact on the cost. Disposable instruments would have increased the costs by 1,118 DM (33%). The costs for cleaning, packing, and disposal were only marginal. Reusable instruments were not related to any disadvantage either to the patients or to the staff.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Early literature suggested higher costs due to longer operative times, the learning curve, and the cost of disposable instruments, 31 yet later literature established its higher value. 32–35 Introduction of video-assisted thoracic surgery followed a similar path. 36–39 We anticipate that implementation of robotic technology in cardiac surgery will progress in the same fashion, with a transition to newer and technologically more advanced procedures.…”

Section: Commentmentioning

confidence: 98%

Value of Robotically Assisted Surgery for Mitral Valve Disease

et al. 2014

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Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotic surgery mitigate high technology costs. Design Clinical cohort study comparing costs of robotic vs. three contemporaneous conventional surgical approaches for degenerative mitral disease. Surgery was performed from 2006–2011, and comparisons were based on intent-to-treat, with propensity-matching used to reduce selection bias. Setting Large multi-specialty academic medical center. Participants 1,290 patients aged 57±11 years, 27% women, underwent mitral repair for regurgitation from posterior leaflet prolapse. Robotic surgery was used in 473, complete sternotomy in 227, partial sternotomy in 349, and anterolateral thoracotomy in 241. Three propensity-matched groups were formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiology, and echocardiographic measurements: robotic vs. sternotomy (n=198 pairs) vs. partial sternotomy (n=293 pairs) vs. thoracotomy (n=224 pairs). Interventions Mitral valve repair. Main Outcome Measures Cost of care, expressed as robotic capital investment, maintenance, and direct technical hospital cost, and benefit of care, based on differences in recovery time. Results Median cost of care for robotically assisted surgery exceeded the cost of alternative approaches by 27% (−5%, 68%), 32% (−6%, 70%), and 21% (−2%, 54%) (median [15th, 85th percentiles]) for complete sternotomy, partial sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: median 35 days for robotic surgery, 49 for complete sternotomy, 56 for partial sternotomy, and 42 for anterolateral thoracotomy. Resulting net differences in cost of robotic surgery vs. the three alternatives were 16% (−15%, 55%), 16% (−19%, 51%), and 15% (−7%, 49%), respectively. Beyond a volume threshold of 55–100 robotic cases per year, confidence limits for the cost of robotic surgery broadly overlapped those of conventional approaches. Conclusions In exchange for higher procedural costs, robotically assisted mitral valve surgery offers the clinical benefit of least invasive surgery, lowest postoperative cost, and fastest return to work. The value of robotically assisted surgery comparable to conventional approaches can only be realized in high-volume centers.

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Laparoscopic Cholecystectomy

Cited by 26 publications

References 0 publications

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

Laparoscopic or open conventional cholecystectomy: clinical and economic considerations

Costs of laparoscopic cholecystectomy

Value of Robotically Assisted Surgery for Mitral Valve Disease

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