Low-cost laparoscopic cholecystectomy.
BACKGROUND
Hospital managers are continually trying to decrease the cost of patient care. The aim of this prospective study was to propose changes that would decrease the operating room costs of laparoscopic cholecystectomy without affecting clinical results.


METHODS
The study included 112 consecutive patients who underwent an elective cholecystectomy between January 1997 and December 2000. The procedure was changed in eight ways: the American position, open laparoscopy, reusable trocars, reusable instruments, bipolar coagulation of the cystic artery, intracorporeal ligature of the cystic duct, no use of suction lavage apparatus, and use of a surgical glove as a bag to extract the gallbladder. Complete compliance with the procedure, whether any abnormal operative events or complications occurred, the duration of hospitalization, and the material and labour costs of the procedure were recorded.


RESULTS
There were no abnormal operative events. Only two patients suffered from postoperative complications. The mean duration of hospitalization was 55.8 h. Fifteen patients (13.4 per cent) were not hospitalized overnight. The operating costs fell from 560 euros before the study to 330 euros in 2000.


CONCLUSIONS
By applying simple measures, it is possible to decrease the operating room cost of laparoscopic cholecystectomy whilst maintaining good results. Such measures should be applied to other laparoscopic procedures.
Champault
A
A
Service de Chirurgie Générale et Digestive, Hôpital Antoine Béclère, Université Paris-Sud, 157 Avenue de la Porte de Trivaux, 92 141 Clamart, France.
Vons
C
C
Dagher
I
I
Amerlinck
S
S
Franco
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000592:standards; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D042882:Gallstones / Q000191:economics / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011446:Prospective Studies; D011787:Quality of Health Care; D013997:Time Factors