title: The introduction of a laparoscopic liver surgery programme: a cost analysis of initial experience in a university hospital.
abstract: OBJECTIVE
  In the era of expanding costs of healthcare, this study was conducted to perform a cost analysis of introducing a laparoscopic liver surgery programme for left sided liver lesions.
  
  
  METHODS
  Consecutive patients treated by laparoscopic liver resections of left lateral segments were included. Controls were a group of 14 patients undergoing open resection for similar pathology. Primary outcomes were costs. Secondary outcomes were complications, conversions, blood loss, length of operation, and length of hospital stay.
  
  
  RESULTS
  The laparoscopic approach for hepatic left lateral resection (bisegmentectomy 2 and 3) was performed in fourteen patients (group I, median age 54 [range 26-82] years). In the open group, fourteen patients from a prospectively collected database with the same type of resection were selected (group II, median age 64 [range 29-76] years). Costs of theatre usage in the laparoscopic group were significantly lower (p=0.031). No significant differences in costs of disposable instruments, ward stay and total costs were observed between the two groups. There were three complications in the laparoscopic group compared with two complications in the open group. In the laparoscopic group there were 2 conversions (14%). Median blood loss was significantly lower in the laparoscopic group (50 mls [range 0-750], (p=0.001) versus the open group (500 mls [range 150-750]). Furthermore, operation time was also significantly lower in the laparoscopic group (116 [range 85-261] minutes) versus the open group (165 [range 96-217] minutes, p=0.016). Median length of stay was 6 [range 4-11] days in group I versus 6 [range 5-13] days in group II (p=0.508).
  
  
  CONCLUSIONS
  Costs of laparoscopic liver resections proved to be equivalent to open surgery. Furthermore, implementation of a laparoscopic liver resection programme seems feasible and safe with reduced blood loss and operation time and comparable morbidity and length of stay.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. jan@stoot.com
authors.forename: J H M B
authors.initials: JH
authors.lastname: Stoot
authors.forename: R M
authors.initials: RM
authors.lastname: van Dam
authors.forename: R J S
authors.initials: RJ
authors.lastname: Coelen
authors.forename: B
authors.initials: B
authors.lastname: Winkens
authors.forename: S W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: M H A
authors.initials: MH
authors.lastname: Bemelmans
authors.forename: C H C
authors.initials: CH
authors.lastname: Dejong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005260:Female; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D008113:Liver Neoplasms / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009426:Netherlands