Analysis of perioperative factors and cost comparison of single-incision and traditional multi-incision laparoscopic cholecystectomy.
BACKGROUND
Recent technological advances in single-incision platforms have allowed many general surgeons to add single-incision laparoscopic cholecystectomy (SILC) to their armamentarium. However, adopting new surgical technologies comes at a cost to the patient and the surgeon. This study compared retrospective case-matched SILC and traditional multi-incision laparoscopic cholecystectomy (MILC) to evaluate the effects of SILC on perioperative outcomes and patient cost.


METHODS
The study compared 50 patients who underwent SILC with a case-matched population of individuals who underwent traditional MILC. The SILC technique was performed using one of three commercially available single-incision platforms currently used for single-incision laparoscopic surgery (SILS) cholecystectomies. All the SILS platforms were placed in a 2-cm supraumbilical incision. All statistical analyses were performed using Microsoft Excel 2008 for Macintosh, with statistical significance determined by a p value of 0.05 or less.


RESULTS
The average operative time was 42 min for the SILC group and 45 min for the MILC group. The difference was not statistically significant. Similarly, the average estimated blood loss was 14 ml for the SILC group and 11 ml for the MILC group. Again, the difference was not statistically significant. Moreover, the body mass index (BMI) did not differ statistically between the SILC group (28.4 kg/m(2)) and the MILC group (32.2 kg/m(2)). The average patient cost was $18,447 for SILC and $17,701 for MILC, yielding a cost difference of $746. This difference was not statistically significant.


CONCLUSIONS
At the authors' institution, SILS cholecystectomy was performed with blood loss, operating room time, and cost equal to that for MILC. Further research is necessary to assess the economic feasibility of SILC and the trade-off of cost with the improved cosmesis, decreased pain, greater patient satisfaction, reduced postoperative analgesic requirement, and faster return to work to determine the overall value and superiority of SILC compared with MILC.
Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, Columbus, OH 43210, USA. catherine.beck@osumc.edu
Catherine
C
Beck
Jeffrey
J
Eakin
Rebecca
R
Dettorre
David
D
Renton
D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015992:Body Mass Index; D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D005705:Gallbladder Diseases / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D061646:Operative Time; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome