Cost-benefit analysis of laparoscopic versus laparotomy salpingo-oophorectomy for benign tubo-ovarian disease.

Abstract

STUDY OBJECTIVE:

To compare laparoscopy and laparotomy adnexectomy with respect to operating time, complications, length of hospitalization, convalescence, effectiveness, and surgical and equipment cost.

DESIGN:

A comparison of 30 consecutive patients undergoing laparoscopic adnexectomy from January 1990 to July 1991, and 27 consecutive patients who underwent adnexectomy by laparotomy from January 1985 to December 1990.

SETTING:

Private practice of one surgeon (GAV), and Department of Obstetrics and Gynecology, Lawson Research Institute, St. Joseph's Health Care Center, London, Ontario, Canada.

PATIENTS:

All patients had had a hysterectomy with preservation of at least one adnexa. The indications for adnexectomy were chronic pelvic pain or adnexal mass less than 6 cm diameter, with benign characteristics defined by sonography and tumor markers.

INTERVENTIONS:

Laparoscopic adnexectomy was performed by three-puncture technique with bipolar coagulation and endoloop ligation of the pedicle. Dissection and resection were performed with the carbon dioxide laser or scissors.

RESULTS:

Differences were noted between laparoscopy and laparotomy (mean +/- SD) in operating time (90 +/- 40 vs 65 + 20 min, p < 0.01), complications (11% vs 18.5%, p < 0.05), effectiveness (72% vs 72%), length of hospitalization (1.7 +/- 1.0 vs 7.1 +/- 1.2 days, p < 0.05), convalescence (2.2 +/- 1.7 vs 9.5 +/- 5.2 wks, p < 0.05), surgical cost ($1603 vs $5158), and equipment cost ($198,048 vs $17,345).

CONCLUSIONS:

Operating time, complications, safety, efficiency, and effectiveness were comparable for the two procedures. Markedly reduced hospitalization in the laparoscopy group resulted in a mean saving per patient of $3555. These women also had shorter convalescence and earlier return to normal activities and employment. The cost of laparoscopic equipment appears prohibitive, but it pays for itself after 50 surgical procedures.

• Authors: G A Vilos, M M Alshimmiri
• Journal: The Journal of the American Association of Gynecologic Laparoscopists (J Am Assoc Gynecol Laparosc) Vol. 2 Issue 3 Pg. 299-303 (May 1995) ISSN: 1074-3804 [Print] United States
• PMID: 9147861 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Biomarkers, Tumor
• Carbon Dioxide

Topics

• Adult
• Aged
• Biomarkers, Tumor (analysis)
• Carbon Dioxide
• Chronic Disease
• Cost Savings
• Cost-Benefit Analysis
• Costs and Cost Analysis
• Dissection
• Electrocoagulation
• Fallopian Tube Diseases (diagnostic imaging, surgery)
• Fallopian Tubes (diagnostic imaging, surgery)
• Female
• Hospitalization
• Humans
• Hysterectomy (adverse effects, economics, instrumentation)
• Laparoscopes
• Laparoscopy (adverse effects, economics)
• Laparotomy (adverse effects, economics, instrumentation)
• Laser Therapy
• Length of Stay
• Ligation (methods)
• Middle Aged
• Ovarian Diseases (diagnostic imaging, surgery)
• Ovariectomy (adverse effects, economics, instrumentation)
• Pelvic Pain (diagnostic imaging, surgery)
• Safety
• Time Factors
• Treatment Outcome
• Ultrasonography