Reusable single-port access device shortens operative time and reduces operative costs.
BACKGROUND
In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy.


METHODS
We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis.


RESULTS
SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p < 0.001). Prices of disposable SPL instruments and multiport access devices as well as extraction bags from different manufacturers were used to calculate the cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy.


CONCLUSIONS
Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.
Department of General Surgery, Hadassah-Hebrew University Medical Center, PO Box 12000, 91120, Jerusalem, Israel, noams@hadassah.org.il.
Noam
N
Shussman
Asaf
A
Kedar
Ram
R
Elazary
Mahmoud
M
Abu Gazala
Avraham I
AI
Rivkind
Yoav
Y
Mintz
D000368:Aged; D002763:Cholecystectomy / Q000295:instrumentation / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation; D003082:Colectomy / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D017743:Equipment Reuse / Q000191:economics*; D005260:Female; D042882:Gallstones / Q000601:surgery; D005743:Gastrectomy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D013156:Splenectomy / Q000295:instrumentation