title: Laparoscopic adrenalectomy: a cost analysis of three approaches.
abstract: Laparoscopic adrenalectomy (LA) is the current standard for treatment of benign adrenal disease and is performed more often now in the setting of malignant disease. Three surgical approaches, the lateral transperitoneal technique, the lateral retroperitoneal technique, and the posterior technique are utilized commonly. While advantages of each approach are advocated, a cost analysis is not available. This article analyzes the operating costs of the three approaches. The operative costs of 51 unilateral LA at the Cleveland Clinic Foundation from 1998 to 2002 were analyzed for comparison. Patients were grouped according to one of the three laparoscopic approaches--transperitoneal (group A), lateral retroperitoneal (group B), and posterior (group C). For each group, n=17. Perioperative characteristics and operative cost were analyzed. The groups were compared using single factor ANOVA analysis. Significance was assigned for P<0.05. The average costs of unilateral LA were $2,885, $3,219, and $2,850 for groups A, B, and C, respectively (P=0.20). Differences were not statistically significant. Six bilateral procedures were performed. There were no significant differences for these six cases. However, the cohort was too small for an appropriate power analysis. LA is commonly performed utilizing one of three surgical approaches. Our data demonstrates no significant difference in operative cost between the respective techniques. Operative costs should not be a factor in choosing a laparoscopic approach for unilateral adrenal disease.
authors.affiliation: Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Houssam
authors.initials: H
authors.lastname: Farres
authors.forename: Joshua
authors.initials: J
authors.lastname: Felsher
authors.forename: Jason
authors.initials: J
authors.lastname: Brodsky
authors.forename: Allan
authors.initials: A
authors.lastname: Siperstein
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
mesh_terms: D000307:Adrenal Gland Diseases / Q000601:surgery*; D000315:Adrenalectomy / Q000191:economics*; D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies