title: Outpatient laparoscopic hysterectomy in a rural ambulatory surgery center.
abstract: OBJECTIVE
  To evaluate a cost-optimized operative technique for outpatient laparoscopic hysterectomy in a rural ambulatory surgery center focusing on shortening hospital stay and substitution of expensive disposable laparoscopic instruments with standard surgical techniques.
  
  
  METHODS
  Prospective feasibility and observational study (Canadian Task Force classification II-3).
  
  
  METHODS
  Rural ambulatory surgery center in Lamar, Alabama.
  
  
  METHODS
  Fifty-two women.
  
  
  METHODS
  Outpatient laparoscopic hysterectomy.
  
  
  RESULTS
  From September 2001 through September 2003, 52 consecutive procedures with a modified classical intrafascial supracervical hysterectomy (CISH) technique without disposable instruments have been performed on patients with an average age of 42.2 years (range 25-62 years) and a follow-up of 12.5 months (range 0.4-23.6 months). Mean postoperative length of stay was 6 hours, 79 minutes (range 3 hours, 10 minutes-17 hours, 30 minutes), and overall length of stay was 11 hours, 37 minutes (range 6 hours, 45 minutes-22 hours, 50 minutes). Five patients (9.6%) stayed overnight, three for medical and two for social reasons. With an average of 2 hours, 14 minutes, the operating room time was about 1 hour longer than with disposable instruments. Health insurance reimbursement for the ambulatory surgery center was on average $1814.11. No complications occurred, and no readmission to the hospital was necessary.
  
  
  CONCLUSIONS
  Outpatient laparoscopic hysterectomy is feasible and safe and can be performed cost effectively in ambulatory surgery centers, even in rural areas. Development of a protocol with patient selection, preoperative and postoperative patient teaching, caring family environment, and round-the-clock medical telephone backup is necessary.
authors.affiliation: Department of Surgery, Lamar Regional Healthcare Center, Sulligent, Alabama, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Morrison
authors.forename: Volker R
authors.initials: VR
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000407:Alabama; D000556:Ambulatory Surgical Procedures; D016063:Blood Loss, Surgical; D015897:Comorbidity; D004412:Dysmenorrhea / Q000453:epidemiology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay; D008595:Menorrhagia / Q000453:epidemiology / Q000601:surgery; D008599:Menstruation Disturbances / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D019035:Rural Health Services / Q000191:economics