Operating Costs of Full-endoscopic Lumbar Spine Surgery in Japan

Abstract

For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical equipment necessary for full-endoscopic surgery together with surgical procedure reimbursement fees. A total of 295 cases of full-endoscopic surgery via a transforaminal approach were retrospectively analyzed. We calculated the frequency of damage and the unit purchase price of devices such as endoscopes, and surgical instruments such as grasping forceps for nucleotomy, high-speed drill bar, and bipolar forceps, and examined the operating costs in Japanese yen against the procedure fee per case. Endoscope breakage occurred seven times, and a payment of ¥760,000 was necessary for trade-in and purchase of a new endoscope. The total breakage number of grasping forceps was 58, and the purchase price per unit was ¥116,000. Therefore, a total of ¥12,020,000 was required for the 295 cases, and the calculated operating cost that accompanies equipment breakage was ¥40,000 per case. In addition, about ¥118,000 was required for disposable bipolar forceps and highspeed drill bar to be used intraoperatively for each case. Thus, for one case it is calculated that total ¥158,000 is utilized for equipment from the surgical reimbursement fee per case specified by the Japanese Ministry of Health being ¥303,900. Minimally invasive procedures provide great benefit to patients; however, the eventual contribution to hospital profits is small and may not be sufficient. To resolve this issue, the cost of surgical equipment should be lowered and/or the surgical reimbursement fee of the full-endoscopic surgery should be raised.

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

“…Uniportal FESS was originally developed for the treatment of lumbar disc herniation and has recently been used for LSCS. 19 - 21 ) Technical refinements and the development of new instruments have expanded the scope of target diseases indicative for FESS. However, there are few studies on the use of uniportal FESS for the treatment of L5/S1 LFS.…”

“… 13 - 18 ) In contrast, uniportal full-endoscopic spine surgery (FESS) was originally developed for the treatment of lumbar disc herniation and has recently been used for spinal canal stenosis. 19 - 21 ) Full-endoscopic laminectomy via the translaminar approach (FEL-TLA) has been developed for the treatment of LFS. 22 , 23 ) In the present study, we retrospectively compared the operative outcomes of two operative procedures (ME-LIF and FEL-TLA) and clarified the advantages and disadvantages of these approaches.…”

Is Spinal Endoscopy the Future of Spine Surgery?

“…16 However, research has demonstrated that the costs of expendables alone make endoscopic discectomy financially unsustainable. 17 Aside from financial costs, there are also costs to both patients and surgeons during the learning curve. The learning curve for spinal endoscopy is substantial, considered steep for even experienced surgeons, ostensibly due to the lack of flexibility in instrumentation and 2-dimensional visualization.…”

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

“…Before a surgeon embarked a journey for fellowship in endoscopic spine surgery, he should check with the local vendors and community for availability of these specialized endoscopic equipment to make decision on where he should focus on training. As it is costly to set up the equipment required for endoscopy, sufficient volume of cases is needed to make a business case for funding when presenting to hospital management 39) . In microscopic tubular spine surgery, the retractor tube is fixed to the table after confirmation of position under fluoroscopic guidance.…”