Cost and benefit of the trained laparoscopic team. A comparative study of a designated nursing team vs a nontrained team.
BACKGROUND
In spite of the emergence of laparoscopic cholecystectomy as the gold standard for treatment of symptomatic gallstones, questions still remain regarding its overall cost effectiveness, especially at low-volume centers where operating room (OR) time and operative complications are higher. We hypothesize that the presence of a well-organized, dedicated laparoscopic OR team will improve surgical outcomes for this procedure. This study compares the operative results of an advanced and a basic laparoscopic surgeon using either a designated laparoscopic operating team or a nondesignated team.


METHODS
The hospital records for 71 elective laparoscopic cholecystectomies with cholangiograms were retrospectively reviewed and anesthesia times and conversion rates were analyzed. Procedures were performed either at a hospital with a dedicated laparoscopy team or a hospital with nondedicated OR personnel. All procedures were done by an advanced laparoscopic surgeon or a basic laparoscopic surgeon.


RESULTS
Case characteristics were evenly matched between sites and surgeons. The mean total anesthesia time at the dedicated site was 120.8 min, compared to 152.3 min at the nondedicated site with a mean difference of 31.5 min (p = 0.001). A 12% conversion rate was documented at the nondedicated site. There were no conversions at the site with a dedicated laparoscopy team. No major complications were encountered in this series.


CONCLUSIONS
This study demonstrates that having a designated laparoscopic trained team provides a time savings to both advanced and basic laparoscopic surgeons. Although no major complications were encountered, there was a significant conversion rate for the less experienced surgeon operating without the support of a trained team. The end result from having a dedicated team in endoscopic surgery is decreased operative time, an improvement in patient care, and decreased costs to the patient and institution.
Kenyon
T A
TA
Minimally Invasive Surgery Program, Legacy Portland Hospitals, OR 97227, USA.
Lenker
M P
MP
Bax
T W
TW
Swanstrom
L L
LL
D017081:Cholecystectomy, Laparoscopic; D003362:Cost-Benefit Analysis; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000451:nursing*; D009746:Nursing, Team; D010348:Patient Care Team; D012189:Retrospective Studies; D013041:Specialties, Nursing