title: Hand-assisted laparoscopic colectomy versus standard laparoscopic colectomy: a cost analysis.
abstract: OBJECTIVE
  There is a relative dearth of literature comparing hand-assisted (HALC) to standard (SLC) laparoscopic colectomies. HALC seems beneficial in terms of shorter operative times and lower conversion rates, but this is counterbalanced by a greater inflammatory response, larger incisions and higher direct costs. Nevertheless, these results are not consistent throughout existing studies and there are to date no detailed cost comparisons. Our hypothesis was that HALC would not incur significantly higher institutional costs compared with standard laparoscopic techniques.
  
  
  METHODS
  Patients undergoing either SLC or HALC between August 2004 and September 2006 were retrospectively reviewed. All patients were managed using a standard protocol. Outcomes assessed included operative times, conversion rates, pain scores, time to resolution of ileus, length of stay and complications. Total costs were calculated from the day of surgery. Statistical analyses included chi(2), Fisher's exact test, the Mann-Whitney U-test or nonparametric bootstrapping method.
  
  
  RESULTS
  Seventy-three patients underwent SLC while 101 had HALC. Demographics and indications for surgery in both groups were similar; the majority were performed for colorectal cancers. Operative times were shorter (147.5 vs 172.5 min, P < 0.05) and complication rates lower (28.7%vs 45.2%, P < 0.025) for HALC. There was no significant difference in the other clinical outcomes. Operative costs and cost of consumables were higher for HALC (US$4024.2 vs US$3568.1, P = 0.01 and US$1724.7 vs US$1302.7, P < 0.001, respectively). However, total costs were not significantly different (HALC US$8999.8, SLC US$7910.7, P = 0.11).
  
  
  CONCLUSIONS
  Institutional costs are not significantly higher for HALC compared with SLC.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore.
authors.forename: A C
authors.initials: AC
authors.lastname: Roslani
authors.forename: D C
authors.initials: DC
authors.lastname: Koh
authors.forename: C B
authors.initials: CB
authors.lastname: Tsang
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
authors.forename: W K
authors.initials: WK
authors.lastname: Cheong
authors.forename: H B
authors.initials: HB
authors.lastname: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000191:economics* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery; D012189:Retrospective Studies