SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

Anies A Mahomed,Stephen D Adams,Saidul Islam

doi:10.1155/2012/807609

Anies A Mahomed, Stephen D Adams + Show 1 more

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https://doi.org/10.1155/2012/807609

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Abstract

The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008–2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-Whitney U-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus £467; £942 versus £1127; £394 versus £495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus £400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.

Highlights

single-incision laparoscopic surgery (SILS) is increasingly being used by pediatric surgeons to perform common abdominal and urological procedures
Appendectomy, cholecystectomy, nephrectomy, hysterectomy, oophorectomy, adrenalectomy, gastric bypass, Nissen fundoplication, hernia repair, splenectomy, and colon resection are some of the procedures which are routinely undertaken by the SILS approach in some centres [1,2,3,4,5]
Recent publications have established the feasibility of SILS in the pediatric population [1,2,3,4,5]

Summary

Introduction

SILS is increasingly being used by pediatric surgeons to perform common abdominal and urological procedures. The proponents of SILS over SLS give reasons of cost efficiency (avoiding use of additional ports), cosmesis (due to fewer port site incisions), less post-operative pain and earlier recovery from surgery [6]. The major drawbacks reported for SILS are longer operative time due to a learning curve and reduced triangulation of instruments translating into poor ergonomics for the longer procedures. There is a paucity of information on the real cost of SILS surgery. The intention of this study in comparing costs and operative time of SILS versus SLS was to improve data to enable effective health care fiscal planning

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