Background. The long learning curve and the common opinion that laparoscopic liver resections (LLRs) have higher costs are limiting the widespread utilization of this technique. Aim of the present study was to perform a cost-effectiveness analysis of LLR vs liver resections with standard approach. Material and methods. From August 2011 to November 2011, 25 liver resections were performed, 18 of them (72%) with a laparoscopic approach and 7 (28%) with an open approach. Hepatic resections requiring bile duct or vascular reconstruction or focal lesions not amenable to a parenchyma-sparing technique were not considered for laparoscopic approach. CUSA-Excel© was utilized as liver transecting device in open approach whereas Sonosurg© was utilized for LLRs. We prospectively collected the number and type of disposable materials used for surgery such as: trocars, vascular staplers and refills, clips, stitches, sutures, irrigation suction, disposable materials for CUSA and Sonosurg, argon beamer, endobags. Results. The mean operation time was 356±123 min vs 186±75 min (p<0.001) whereas the mean postoperative stay was 3.7±2.6 days vs 8.7±2.1 days for laparoscopic and open approach, respectively (p=0.001). Type of resections in LLR vs open patients were respectively: 0 vs 3 right hepatectomy, 3 vs 1 left hepatectomy, 7 vs 2 segmentectomy, 8 vs 1 wedge resection. According to the actual marketing price for Belgium, LLRs resulted in an average intraoperative per/operation surplus costs of 310€ (1406±96€ vs 1096±86€ for LLR and open approach respectively, p<0.001). The main costs for LLR were vascular stapler and refills (391€), trocars (351€), and clips (301€). The main costs for open approach were the disposable CUSA materials (426€) and sutures/stiches (202€). The cost of a day in hospital stay is 600 €, consequently the overall cost saving was 2690€. Conclusions. LLRs require significant higher intraoperative costs and longer operation time compared to the open approach. However the higher intraoperative costs are entirely compensated and overcome by the inferior costs of the shorter postoperative stay. A randomized prospective comparative study is necessary to avoid operation selection bias.

LAPAROSCOPIC LIVER RESECTIONS VERSUS OPEN APPROACH: A PROSPECTIVE INTRAOPERATIVE COST-EFFECTIVENESS ANALYSIS / Montalti, R; Verhaevert, A; De Gezelle, L; Louagie, L; Rogiers, X; Troisi, Roberto. - (2012). (Intervento presentato al convegno • 10th World Congress of the International Hepato-Pancreato-Biliary Association tenutosi a Paris, France. nel July 1-5, 2012).

LAPAROSCOPIC LIVER RESECTIONS VERSUS OPEN APPROACH: A PROSPECTIVE INTRAOPERATIVE COST-EFFECTIVENESS ANALYSIS

Montalti R
;
Troisi Roberto
2012

Abstract

Background. The long learning curve and the common opinion that laparoscopic liver resections (LLRs) have higher costs are limiting the widespread utilization of this technique. Aim of the present study was to perform a cost-effectiveness analysis of LLR vs liver resections with standard approach. Material and methods. From August 2011 to November 2011, 25 liver resections were performed, 18 of them (72%) with a laparoscopic approach and 7 (28%) with an open approach. Hepatic resections requiring bile duct or vascular reconstruction or focal lesions not amenable to a parenchyma-sparing technique were not considered for laparoscopic approach. CUSA-Excel© was utilized as liver transecting device in open approach whereas Sonosurg© was utilized for LLRs. We prospectively collected the number and type of disposable materials used for surgery such as: trocars, vascular staplers and refills, clips, stitches, sutures, irrigation suction, disposable materials for CUSA and Sonosurg, argon beamer, endobags. Results. The mean operation time was 356±123 min vs 186±75 min (p<0.001) whereas the mean postoperative stay was 3.7±2.6 days vs 8.7±2.1 days for laparoscopic and open approach, respectively (p=0.001). Type of resections in LLR vs open patients were respectively: 0 vs 3 right hepatectomy, 3 vs 1 left hepatectomy, 7 vs 2 segmentectomy, 8 vs 1 wedge resection. According to the actual marketing price for Belgium, LLRs resulted in an average intraoperative per/operation surplus costs of 310€ (1406±96€ vs 1096±86€ for LLR and open approach respectively, p<0.001). The main costs for LLR were vascular stapler and refills (391€), trocars (351€), and clips (301€). The main costs for open approach were the disposable CUSA materials (426€) and sutures/stiches (202€). The cost of a day in hospital stay is 600 €, consequently the overall cost saving was 2690€. Conclusions. LLRs require significant higher intraoperative costs and longer operation time compared to the open approach. However the higher intraoperative costs are entirely compensated and overcome by the inferior costs of the shorter postoperative stay. A randomized prospective comparative study is necessary to avoid operation selection bias.
2012
LAPAROSCOPIC LIVER RESECTIONS VERSUS OPEN APPROACH: A PROSPECTIVE INTRAOPERATIVE COST-EFFECTIVENESS ANALYSIS / Montalti, R; Verhaevert, A; De Gezelle, L; Louagie, L; Rogiers, X; Troisi, Roberto. - (2012). (Intervento presentato al convegno • 10th World Congress of the International Hepato-Pancreato-Biliary Association tenutosi a Paris, France. nel July 1-5, 2012).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/759576
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