Cost-benefit analysis of laparoscopic versus laparotomy salpingo-oophorectomy for benign tubo-ovarian disease.
OBJECTIVE
To compare laparoscopy and laparotomy adnexectomy with respect to operating time, complications, length of hospitalization, convalescence, effectiveness, and surgical and equipment cost.


METHODS
A comparison of 30 consecutive patients undergoing laparoscopic adnexectomy from January 1990 to July 1991, and 27 consecutive patients who underwent adnexectomy by laparotomy from January 1985 to December 1990.


METHODS
Private practice of one surgeon (GAV), and Department of Obstetrics and Gynecology, Lawson Research Institute, St. Joseph's Health Care Center, London, Ontario, Canada.


METHODS
All patients had had a hysterectomy with preservation of at least one adnexa. The indications for adnexectomy were chronic pelvic pain or adnexal mass less than 6 cm diameter, with benign characteristics defined by sonography and tumor markers.


METHODS
Laparoscopic adnexectomy was performed by three-puncture technique with bipolar coagulation and endoloop ligation of the pedicle. Dissection and resection were performed with the carbon dioxide laser or scissors.


RESULTS
Differences were noted between laparoscopy and laparotomy (mean +/- SD) in operating time (90 +/- 40 vs 65 + 20 min, p < 0.01), complications (11% vs 18.5%, p < 0.05), effectiveness (72% vs 72%), length of hospitalization (1.7 +/- 1.0 vs 7.1 +/- 1.2 days, p < 0.05), convalescence (2.2 +/- 1.7 vs 9.5 +/- 5.2 wks, p < 0.05), surgical cost ($1603 vs $5158), and equipment cost ($198,048 vs $17,345).


CONCLUSIONS
Operating time, complications, safety, efficiency, and effectiveness were comparable for the two procedures. Markedly reduced hospitalization in the laparoscopy group resulted in a mean saving per patient of $3555. These women also had shorter convalescence and earlier return to normal activities and employment. The cost of laparoscopic equipment appears prohibitive, but it pays for itself after 50 surgical procedures.
Vilos
G A
GA
Department of Obstetrics and Gynecology, Division of Minimally Invasive Surgery, St. Joseph's Health Care Center, University of Western Ontario, London, Ontario, Canada.
Alshimmiri
M M
MM
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002245:Carbon Dioxide; D002908:Chronic Disease; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004210:Dissection; D004564:Electrocoagulation; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D005187:Fallopian Tubes / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D053685:Laser Therapy; D007902:Length of Stay; D008026:Ligation / Q000379:methods; D008875:Middle Aged; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010052:Ovariectomy / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D017699:Pelvic Pain / Q000000981:diagnostic imaging / Q000601:surgery; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
D014408:Biomarkers, Tumor; D002245:Carbon Dioxide