Economic and clinical outcomes of microlaparoscopic and standard laparoscopic sterilization. A comparison.
OBJECTIVE
To compare micro-laparoscopic surgical sterilization and standard laparoscopic sterilization with respect to cost effectiveness and patient preferences.


METHODS
A retrospective study of all laparoscopic surgical sterilizations performed under general anesthesia at Johns Hopkins Bayview Medical Center--16 micro-laparoscopies and 34 standard laparoscopies. Cases selected for review were limited to patients undergoing surgical contraception and not requiring additional, concurrent procedures. Laparoscopic surgical sterilization was performed using a double-puncture technique with silicone band application. In each case either a standard, 10-mm laparoscope or a 2-mm micro-laparoscope was used, and the procedure was performed under general anesthesia. Postoperative pain management was achieved by nonsteroidal antiinflammatory drugs and/or narcotic analgesia. All cases were performed by residents under faculty supervision. Medical records and hospital billing records were reviewed, and a standardized telephone interview was conducted to assess postoperative quality of life and patient satisfaction.


RESULTS
Both techniques were comparable in cost effectiveness. There was no significant difference in operating room time, average operating room costs, average ancillary department costs, instrument and supply costs, or length of stay. Postoperative discomfort was significantly less with microlaparoscopy (P = .05), and patient satisfaction was higher in the microlaparoscopy group.


CONCLUSIONS
Microlaparoscopy and the standard laparoscopic approach for surgical sterilization are associated with similar hospital charges. Postoperative pain and overall patient satisfaction were significantly better with microlaparoscopy than standard laparoscopy.
Garcia
F A
FA
Department of Obstetrics and Gynecology, University of Arizona, Tucson 85724-5078, USA.
Steinmetz
I
I
Barker
B
B
Huggins
G R
GR
D001130:Arizona; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods / Q000523:psychology*; D008499:Medical Records; D010149:Postoperative Pain; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000191:economics* / Q000379:methods / Q000523:psychology*; D011795:Surveys and Questionnaires