title: Comparative financial analysis of minimally invasive surgery to open surgery for small renal tumours < or =3.5 cm: a single institutional experience.
abstract: OBJECTIVE
  We analysed total hospital costs by comparing minimally invasive surgery (MIS) procedures, such as laparoscopic cryoablation (LCA), laparoscopic partial nephrectomy (LPN), and hand-assisted laparoscopic nephrectomy (HALN), with conventional surgery.
  
  
  METHODS
  Between March 2000 and July 2005, 184 consecutive patients underwent surgery for a small, organ-confined renal tumour < or =3.5 cm in diameter. The distribution of patients among the surgical procedures was: HALN (n=53); LPN (n=20); open radical nephrectomy (ORN; n=20); open partial nephrectomy (OPN; n=71); and LCA (n=20). Total hospital costs were analysed for each procedure.
  
  
  RESULTS
  Patients undergoing OPN at a mean age of 58+/-13 yr were significantly younger those undergoing HALN, ORN, and LCA. The mean hospital length of stay in the LCA group (2.0+/-1.2 d) was shorter than all other groups (p<0.05). Higher surgical costs occurred with LCA, LPN, and HALN compared (p<0.05) with ORN and OPN. However, total financial costs were lower for LCA and HALN with more obvious differences between LCA and the other four groups.
  
  
  CONCLUSIONS
  The costs of MIS remain competitive with traditional surgery. Although the surgical costs were higher, LCA had the lowest total hospital costs for the renal tumour < or =3.5 cm at our institution. Long-term oncologic efficacy studies will be needed to fully appreciate the cost-efficacy ratio of MIS.
authors.affiliation: Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Mouraviev
authors.forename: Israel
authors.initials: I
authors.lastname: Nosnik
authors.forename: Cary
authors.initials: C
authors.lastname: Robertson
authors.forename: David
authors.initials: D
authors.lastname: Albala
authors.forename: Philip
authors.initials: P
authors.lastname: Walther
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000191:economics* / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000191:economics* / Q000379:methods*