title: Effect of a disposable automated suturing device on cost and operating room time in benign total laparoscopic hysterectomy procedures.
abstract: OBJECTIVE
  To determine the effect of a disposable automated laparoscopic suturing device, the Endo Stitch (ES) (Covidien, Mansfield, MA, USA), on hospital cost and surgical time in patients undergoing a benign total laparoscopic hysterectomy procedure compared with the use of the da Vinci surgical system (Intuitive Surgical, Sunnyvale, CA, USA) or traditional laparoscopic suturing technique.
  
  
  METHODS
  The Premier Perspective Database (Premier, Charlotte, NC, USA) was used to identify all inpatient hospital discharges with the primary procedure of a total laparoscopic hysterectomy (International Classification of Diseases, Ninth Revision, Clinical Modification code 68.41) for benign conditions between January 1, 2009, and June 30, 2011. Patients were further categorized into 3 groups: (1) those for whom the ES was used during the laparoscopic hysterectomy procedure, (2) those for whom robotic assistance (RA) was used, and (3) those for whom neither ES nor RA (NER) was used. Multivariate analysis was performed to examine the association among the ES, RA, and NER groups with respect to hospital cost, length of stay, and surgery time. The multivariate analysis controlled for the patient's age, race, severity of illness, and comorbid conditions, as well as hospital characteristics, such as bed size, region, and teaching status.
  
  
  RESULTS
  A total of 9308 patients undergoing an inpatient total laparoscopic hysterectomy procedure between January 1, 2009, and June 30, 2011, were eligible for the study. The ES was used in 974 of the patients (10%), RA was used in 3971 (43%), and neither technique was used in 4363 (47%). After adjusting for confounding variables, the mean hospital cost was $1769 (P = .0332) lower, with a 42-minute (P < .001) surgery time savings, for the ES group compared with the RA group. The mean hospitalization cost for the ES group was also $634 (P < .0879) less expensive, with a 21-minute (P = .0131) surgery time savings, compared with the NER group.
  
  
  CONCLUSIONS
  Use of a disposable automated laparoscopic suturing device, the ES, is significantly more cost-effective than the use of the da Vinci surgical system or traditional laparoscopic suturing techniques for the performance of a total laparoscopic hysterectomy procedure for benign conditions.
authors.affiliation: Department of Obstetrics and Gynecology, USF Health Center for Advanced Medical Learning and Simulation, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; Speaker and consultant for Covidien, Stryker, and Boston Scientific. shart1@health.usf.edu.
authors.forename: Stuart
authors.initials: S
authors.lastname: Hart
authors.affiliation: Healthcare Economics and Outcomes Research, Covidien, Mansfield, MA, USA; Employee of Covidien.
authors.forename: Lobat
authors.initials: L
authors.lastname: Hashemi
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA; Speaker and consultant for Covidien, consultant and stock for Transenterix, and advisory board for CareFusion.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Sobolewski
mesh_terms: D000328:Adult; D004209:Disposable Equipment; D004867:Equipment Design; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods*; D010535:Laparoscopy / Q000191:economics*; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics; D013536:Suture Techniques / Q000295:instrumentation*; D014591:Uterine Diseases / Q000601:surgery*