title: Costs and benefits of laparoscopic cholecystectomy: abdominal wall lifting vs. pneumoperitoneum procedure.
abstract: OBJECTIVE
  Gasless laparoscopic surgery using the abdominal wall lifting (AWL) method was first developed in Japan and has been used in various surgical fields. The AWL method allows the use of conventional reusable surgical instruments. The purpose of this study was to compare the cost-effectiveness of laparoscopic cholecystectomy (LSC) using the AWL method in relation to that using pneumoperitoneum (P) method.
  
  
  METHODS
  Retrospective analysis of 431 LSC procedures between 1991 and 2004 was performed. The two surgical groups consisted of consecutively operated patients with a diagnosis of cholecystolithiasis or gallbladder polyps. One group consisted of 224 LSC procedures performed using the P method from 1992 to 1998 and the other group comprised 207 LSC performed using the AWL method from 1998 to 2004. All instruments used in the P method were disposable, whereas trocars, scissors, dissectors, graspers and L-hook electrodes (excluding clips) used in the AWL method were reusable. Hospital expenses, length of hospital admission and complication rates were analyzed.
  
  
  RESULTS
  Mean hospital cost per case for LSC using the AWL method (dollars 6743) was 7% less expensive than that using the P method (dolars 7215). Costs of operative equipment contributed to the difference (mean dollars 912 per case) in total cost. Conversion to open cholecystectomy occurred in 6 cases (2.9%) using the AWL method and 7 cases (3.1%) using the P method. There were no significant differences in length of hospital admission or complication rates between the two groups.
  
  
  CONCLUSIONS
  LSC using AWL method was less expensive than that using P method. This is mainly due to the use of reusable instruments in the AWL method. If LSC is performed using the AWL method instead of using disposable equipment, considerable savings can be achieved without compromising patient safety.
authors.affiliation: Department of Surgery, National Kochi Hospital, Kochi, Japan. masa1192@tokushima-med.jrc.or.jp
authors.forename: M
authors.initials: M
authors.lastname: Ishikawa
authors.forename: T
authors.initials: T
authors.lastname: Nakagawa
authors.forename: M
authors.initials: M
authors.lastname: Nishioka
authors.forename: S
authors.initials: S
authors.lastname: Ogata
authors.forename: T
authors.initials: T
authors.lastname: Miyauchi
authors.forename: Y
authors.initials: Y
authors.lastname: Kashiwagi
authors.forename: N
authors.initials: N
authors.lastname: Uemura
authors.forename: S
authors.initials: S
authors.lastname: Inoue
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D003362:Cost-Benefit Analysis; D004209:Disposable Equipment; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D013523:Surgical Equipment