Cost containment in laparoscopic radical nephrectomy: feasibility and advantages over open radical nephrectomy.
OBJECTIVE
To highlight the impact of the laparoscopic experience of the surgical team on achievement of satisfactory results with cost containment in performing laparoscopic radical nephrectomy (LRN).


METHODS
We compared the cost components of 15 consecutive uncomplicated LRNs performed in 2001 (LRN01) with 15 consecutive uncomplicated laparoscopic radical nephrectomies performed in 2003 (LRN03) and with 15 consecutive uncomplicated procedures performed at our institution by the same surgical team in the year 1999 matched for patient age, tumor size, and disease stage. The groups were comparable in demographics.


RESULTS
The operative times were 250, 225, and 195 minutes in the LRN01, LRN03, and open-surgery groups, respectively, while the lengths of postoperative stay were 3.8, 3.1, and 6.5 days. Operating room costs, excluding the disposable instruments, were 11.00 /min for the open surgery and 10.00 /min for laparoscopic nephrectomy, and the cost of the postoperative stay was 300 to 310 per day. The cost of disposable instruments was 952.18 for LRN01 and 146.37 for LRN03. The overall costs were 4155.00 for the open-surgery group, 4672.00 for LRN01, and 3336.37 for LRN03.


CONCLUSIONS
Cost containment in laparoscopic nephrectomy is possible. A proper team learning curve and the employment of reliable reusable instruments is the key to reducing costs, making this procedure as economically advantageous as the equivalent open procedure.
Guazzoni
Giorgio
G
Department of Urology, University Vita-Salute Scientific Institute H. San Raffaele Turro, Milan, Italy. guazzoni.giorgio@hsr.it
Cestari
Andrea
A
Naspro
Richard
R
Riva
Matteo
M
Rigatti
Patrizio
P
D003363:Cost Control / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D017743:Equipment Reuse / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D009392:Nephrectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies