• Jaime Vilaça Luz Saúde – Hospital da Luz Arrábida e Hospital da Luz Aveiro – ICVS-3B’s, Universidade do Minho, Braga
  • Luís Lencastre Luz Saúde – Hospital da Luz Arrábida
  • Francisco Miranda Luz Saúde – Hospital da Luz Aveiro
  • Jorge Cabral Luz Saúde – Hospital da Luz Aveiro
  • Ana Fonte Boa Luz Saúde – Hospital da Luz Arrábida – Centro Hospitalar Vila Nova de Gaia – Espinho


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. 


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1. Fingar KR (Truven Health Analytics), Stocks C (AHRQ), Weiss AJ (Truven Health Analytics), Steiner CA (AHRQ). Most Frequent Operating Room Procedures Performed in U.S. Hospitals 2003-2012. HCUP Statistical Brief #186. December 2014. Agency for Healthcare Research and Quality, Rockville, MD. Operating-Room-Procedures- United-States- 2012.pdf.
2. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut And Liver [Gut Liver] 2012 Apr; Vol. 6 (2), pp. 172-87.
3. Richard C Frazee, Victoria G Elliott, Wilma Larsen, Seth Lerner, Keith W Minnis, Court Huber, James Nolan, Harry Papaconstantinou, W Roy Smythe. Can Laparoscopic Cholecystectomy Be Performed with a Positive Margin at Medicaid Reimbursement Rates? j.jamcollsurg.2013.12.031
4. Heather H. Adkins, Thomas J. Hardacker, Eugene P. Ceppa. Examining variation in cost based on surgeon choices for elective laparoscopic cholecystectomy. Surg Endosc
DOI 10.1007/s00464-015-4553-7 (published online: 20th October 2015)
5. Stefanidis D, Chintalapudi N, Anderson-Montoya B, Oommen B, Tobben D, Pimentel M. How often do surgeons obtain the critical view of safety during laparoscopic cholecystectomy? Surg Endosc. 2016 May 3. [Epub ahead of print]
6. M. von Strauss und Torney, S. Dell-Kuster, R. Mechera, R. Rosenthal, I. Langer. The cost of surgical training: analysis of operative time for laparoscopic cholecystectomy. Surg Endosc (2012) 26:2579–2586 DOI 10.1007/s00464-012-2236-1
7. Matthew Gitelis, Yalini Vigneswaran,
Michael B. Ujiki, Woody Denham, Mark Talamonti, Joseph P. Muldoon, John G. Linn. Educating surgeons on intraoperative disposable supply costs during laparoscopic cholecystectomy: a regional health system’s experience. The American Journal of Surgery (2015) 209, 488-492
8. Marco von Strauss und Torney, Salome Dell-Kuster, Henry Hoffmann, Urs von Holzen, Daniel Oertli, Rachel Rosenthal. Microcomplications in laparoscopic cholecystectomy: impact on duration of surgery and costs. Surg Endosc
DOI 10.1007/s00464-015-4512-3
9. Costantini R, Caldaralo F, Palmieri C, Napolitano L, Aceto L, Cellini C, Innocenti P. Risk factors for conversion of laparoscopic cholecystectomy. Ann Ital Chir. 2012 May-Jun;83(3):245-52.
10. Ciara R. Huntington, Tiffany C. Cox, Laurel J. Blair, Tanushree Prasad, Amy E. Lincourt, B. Todd Heniford, Vedra A. Augenstein. Nationwide variation in outcomes and cost of laparoscopic procedures. Surg Endosc (2016) 30:934–946 DOI 10.1007/s00464-0154328-1
11. Jeffrey R. Avansino, Adam B. Goldi, Renelle Risley, John H.T. Waldhausen, Robert S. Sawin. Standardization of operative equipment reduces cost. Journal of Pediatric Surgery (2013) 48, 1843–1849
12. Steven M Strasberg, L Michael Brunt. Rationale and Use of the Critical View
of Safety in Laparoscopic Cholecystectomy. J Am Coll Surg Vol. 211, No. 1, July 2010
13. Michael Sugrue, Shaheel M Sahebally, Luca Ansaloni and Martin D Zielinski. Grading operative findings at laparoscopic cholecystectomy- a new scoring system. World Journal of Emergency Surgery (2015) 10:14
14. V. Stanisic, M. Milicevic, N. Kocev, M. Stojanovic, D. Vlaovic, I. Babic, N. Vucetic. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. EurRevMedPharmacolSci 2014; 18: 1204-1211
How to Cite
VILAÇA, Jaime et al. LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES. Revista Portuguesa de Cirurgia, [S.l.], n. 49, p. 24-33, jan. 2021. ISSN 2183-1165. Available at: <>. Date accessed: 22 june 2024. doi:
Original Papers