LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES

Abstract

Introduction: The rational use of resources and the need to standardize procedures are today’s priorities for the sustainability of health care, and a drive force to raise surgical results. The aims of this study are to evaluate the adoption of a low cost laparoscopic cholecystectomy protocol, identify predictive factors for difficult cases, and evaluate the economical impact of this strategy. 

Material and Methods: Two teams led by the same surgeon, done and prospectively recorded 100 consecutives laparoscopic cholecystectomies between the 8th of April and the 18th of November 2014. Excluding criteria were acute cholecystitis at the emergency unit, common bile duct lithiasis and suspicious of gallbladder cancer. Interventions were video recorded and main steps photographed. Data included demographic, operative risk, BMI, previous biliary symptoms, biochemistry and ultrasound registries, protocol fulfilment, surgery time, surgical landmarks identification and postoperative evolution. Statistical analysis used SPSS® with Student-t test and one-way Anova tests. Significant statistical results for p<0,05.

Results: three quarters of females, an average of 53 years old and medium BMI of 27. Total time of surgery of 39 minutes, including 7 minutes for gallbladder hilum ligation. Fulfillment of low-cost protocol in 93% of the cases. All patients were discharged home within 23 hours after the operation. Risk factors for prolonged surgery time and protocol break were obesity, male gender and previous biliary events. Conversion rate nil. No major complications. Series total costs with disposable surgical instruments of 574 Euros.

Conclusion: Low-cost approach for laparoscopic cholecystectomy can be introduced with a protocol starting with low risk patients. Economic impact can be highly relevant. Clinical risks seem to be negligible.