A cost effective analysis of a laparoscopic versus an open left lateral sectionectomy in a liver transplant unit.
BACKGROUND
This study aimed to assess the cost effectiveness of a laparoscopic left lateral sectionectomy (LLLS) compared with an open (OLLS) procedure and its role as a training operation as well as the learning curve associated with a laparoscopic approach.


METHODS
Between 2004 and 2013, a prospectively maintained database was reviewed. LLLS were compared with age- and sex-matched OLLS. In addition, the outcomes of LLLS with a consultant as the primary surgeon were compared with those performed by trainees.


RESULTS
Forty-three LLLS were performed during the study period. LLLS was a significantly cheaper operation compared with OLLS (P = 0.001, £3594.14 versus £5593.41). The median hospital stay was shorter in the laparoscopic group (P = 0.002, 3 versus 7 days). No difference was found in outcomes between a LLLS performed by a trainee or consultant (operating time, morbidity or R1 resection rate). The procedure length was significantly shorter during the later half of the study period [120 versus 129 min (P = 0.045)].


CONCLUSIONS
LLLS is a significantly cost effective operation compared with an open approach with a reduction in hospital stay. In addition, it is suitable to use as a training operation.
Department of Hepatobiliary and Transplant Surgery, St James University Hospital, Leeds, UK.
Richard
R
Bell
Sanjay
S
Pandanaboyana
Faisal
F
Hanif
Nehal
N
Shah
Ernest
E
Hidalgo
J Peter A
JP
Lodge
Giles
G
Toogood
K Raj
KR
Prasad
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000191:economics; D003362:Cost-Benefit Analysis; D004503:Education, Medical, Graduate / Q000191:economics; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000191:economics* / Q000193:education / Q000379:methods; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000193:education / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay / Q000191:economics; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics* / Q000193:education / Q000379:methods; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D017064:Process Assessment, Health Care / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult