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PubMed1990

An audit of the usage of operating theatre time in a peripheral teaching surgical unit.

A recent report by the National Audit Office found that only 50% to 60% of weekday operating time was being used. This report was examined by the Committee of Public Accounts and much of the blame for underutilization of operating theatres was attributed to poor working practices among surgeons. We investigated theatre utilization in our hospital and found underutilization on the same scale as the National Audit Office. Twenty-five per cent of theatre sessions were not allocated for use, 23% of general surgical lists were cancelled and, of the lists which did take place, a further 23% of theatre time was not utilized. The single largest cause of underutilization was understaffing. To increase theatre utilization higher levels of staffing and expenditure are needed rather than changes in the working practices of surgeons.

Hospitals, Teaching↗

PubMed2002

Analysis of the time-reversal operator for scatterers of finite size.

Recently, it was shown that the time-reversal operator for a single, small spherical scatterer could have up to four distinguishable eigenstates [Chambers and Gautesen, J. Acoust. Soc. Am. 109, 2616-2624 (2001)]. In this paper, that analysis is generalized for scatterers of arbitrary shape and larger size. It is shown that the time-reversal operator may have an indefinitely large number of distinguishable eigenstates, with the exact number depending on the nature of the scatterer and the geometry of the time-reversal mirror. In addition, the case of a multiple number of well-separated scatterers is investigated, with the result that the total spectrum is the direct combination of the eigenstates associated with each scatterer. As an example, the singular value spectrum of the time-reversal operator for a linear array is calculated explicitly for bubbles and hard rubber spheres of finite size. Both resonance peaks and apparent crossing points can be observed in the spectrum as the size of the scatterer increases.

Journal Article↗

PubMed2001

Laparoscopic adrenalectomy. Personal experience in 78 patients.

Laparoscopic adrenalectomy has proved to be the technique of choice for the treatment of benign pathologies of the adrenals and also for the treatment of isolated adrenal metastases, especially arising from lung tumor, but it shouldn't be performed for primitive adrenal carcinoma. The harmonic scalpel is very useful for laparoscopic adrenalectomy showing a significant reduction in operative time. The Authors retrospectively investigated 78 laparoscopic adrenalectomies performed from April 1995 to April 2000 using a transperitoneal approach with the patient on a lateral position as suggested by Gagner. Special care was taken to improve the surgical approach to the adrenals also by means of new technological devices as the Harmonic scalpel. The 78 laparoscopic adrenalectomies were performed in 70 cases for benign neoplasms: incidentalomas 24, Cushing's disease 16, Conn's disease 20, pheochromocytomas 9, myelolipoma 1. In the remaining 8 patients laparoscopic adrenalectomy was performed in 7 cases for isolated adrenal masses (5 metastases, 2 adenomas) in neoplastic patients, and in 1 patient for a preoperatively diagnosed adrenal carcinoma. Patients operated for functioning neoplasms had all remission or improvement of symptoms and humoral parameters; patients operated for isolated adrenal metastases showed this survival: 3 patients 3 years asymptomatic and disease free, 1 patient 18 months, and 3 patients are still alive and healthy after 6-12-15 months. A fast onset of local recurrence was seen in a patient operated for a preoperatively diagnosed adrenal carcinoma. We analyzed the operating time dividing the patients in three groups: a) 14 patients operated in the first semester of 1998 when we completed the training curve (average operative time 120.7 minutes); b) 14 patients operated from 1998-1999 (average operative time 118 minutes); c) the last 14 patients (operated from December 1999 to April 2000) where surgery was performed using the Harmonic scalpel (HS) (average operative time 94 minutes). The analysis of the average operative time comparing groups B and C using T-Student Test showed a significant reduction (p = 0.004). The morbility rate was 2.6%, mortality 1.3%, and a conversion rate of 2.6%. Laparoscopic approach results to be an extremely reliable procedure also for the treatment of incidentalomas up to 4-5 cm in which the incidence of adrenal carcinoma is about 13%. Doubts may yet result for the treatment of adrenal carcinomas preoperatively diagnosed. When laparoscopic adrenalectomy in performed using HS the operative time is significantly reduced and surgery is easier.

Adrenalectomy↗

PubMed2001

Hospital profitability per hour of operating room time can vary among surgeons.

The operating margins (i.e., profits) of hospitals are decreasing. An important aspect of a hospital's finances is the profitability of individual surgical cases, which is measured by contribution margin. We sought to determine the extent to which contribution margin per hour of operating room (OR) time can vary among surgeons. We retrospectively analyzed 2848 elective cases performed by 94 surgeons at the Stanford University School of Medicine. For each case, we subtracted variable costs from the total payment to the hospital to compute contribution margin. We found moderate variability in contribution margin per hour of OR time among surgeons, relative to the variability in contribution margins per OR hour among each surgeon's cases (Cohen's f equaled 0.29, 95% lower confidence interval bound 0.27). Contribution margin per OR hour was negative for 26% of the cases. These results have implications for hospitals for which OR utilization is extensive, and for which elective cases are only scheduled if they can be completed during regularly scheduled hours. To increase or achieve profitability, managers need to increase the hours of lucrative cases, rather than encourage surgeons to do more and more cases. Whether the variability in contribution margin among surgeons should be used to more optimally (profitably) allocate OR time depends on the scheduling objectives of the surgical suite.

Aged↗

PubMed1999

How long does laparoscopic surgery really take? Lessons learned from 1000 operative laparoscopies.

The purpose of this study was to assess the operating time of the most common gynaecological laparoscopic procedures. We analysed retrospectively 1000 consecutive operative laparoscopies on a procedure-by-procedure basis. Diagnostic laparoscopy and laparoscopic sterilization were specifically excluded from the analysis. The various laparoscopic procedures were grouped and analysed under six major categories. The average operating time for all cases was 76.9 min (range 10-400). In 38 cases (3.8%) the laparoscopic procedure was converted to laparotomy. The average operating time for treating ectopic pregnancy and tubal disease was approximately 60 min (range 13-240). Surgery for endometriosis and ovarian cysts averaged 72 min (range 10-240). Laparoscopic myomectomy and hysterectomy averaged 113 and 131 min respectively (range 25-400). Our results show that while the operating time for most operative laparoscopies is less than 75 min, the range of operating times is great. The relative lack of predictability in procedure times means that the efficient utilization of fixed theatre sessions is difficult.

Adolescent↗

PubMed2006

The effect of learning curve on the outcome of caesarean section.

OBJECTIVE: To evaluate the operative outcomes when trainees first perform caesarean sections independently. DESIGN: A retrospective study in a tertiary obstetric unit. POPULATION: Five hundred caesarean sections, which represented the first 50 caesarean sections performed independently by each of ten trainees, were studied. METHODS: The effect of learning curve on outcome was analysed. MAIN OUTCOME MEASURES: Total operative time, incision-to-delivery interval, operative blood loss, Apgar score, cord arterial pH, incidence of neonatal intensive care unit admission, postoperative complication rates and duration of hospitalisation. RESULTS: The mean operative time for the first five cases by trainees was 52.2 +/- 11.4 minutes. It progressively decreased and reached 39.6 +/- 8.4 minutes for the 46th to 50th cases. The operative time was significantly longer in the first 15 caesarean sections (P < 0.05). Moreover, the incision-to-delivery interval was also longer during the first five cases (P= 0.02). Besides the time of the operation, the trend for operative blood loss stabilised after the first ten caesarean sections (P < 0.05). Otherwise, there were no significant differences among other outcome variables. CONCLUSION: This study shows that trainees need to perform 10-15 caesarean sections before their skills become more proficient. Senior obstetricians may need to provide guidance to the trainees during their first independent 15 caesarean sections.

Apgar Score↗

PubMed2002

Comparison of local, spinal, and general anaesthesia for inguinal herniorrhaphy.

OBJECTIVE: To compare local, spinal, and general anaesthesia for inguinal hemiorraphy in otherwise healthy patients with respect to duration of operation, time in operating room, postoperative pain, complications, rehabilitation, and satisfaction. DESIGN: Prospective randomised controlled trial. SETTING: University hospital, Turkey. SUBJECTS: Seventy-five men with unilateral primary inguinal hernias, Nyhus type II and III, and ASA I and II. INTERVENTIONS: Lichtenstein repairs with standard local, spinal, or general anaesthesia. MAIN OUTCOME MEASURES: Duration of operation and anaesthesia, postoperative pain scores, analgesic requirements, complications, length of hospital stay, postoperative rehabilitation, and satisfaction. RESULTS: With local anaesthesia, we recorded shorter time spent in the operating room, lower incidence of nausea and urinary retention, and more satisfaction. In the local and spinal anaesthetic groups, postoperative analgesic requirements and length of hospital stay were less than in the general anaesthesia group. CONCLUSIONS: Local anaesthesia is suitable for day-case hernia repair with fewer postoperative problems and less analgesia requirement. Patients also reported greater satisfaction. Local anaesthesia may be preferred to other methods.

Anesthesia, General↗

PubMed2003

In-line image projection accelerates task performance in laparoscopic appendectomy.

BACKGROUND: In laparoscopy, the monitor usually is placed at or above eye level across from the operating surgeon. Position of the endoscopic image at hand level has been shown in a laboratory model to facilitate task performance. The authors tested the hypothesis that in-line image projection reduced operating time for a standardized procedure. METHODS: Children undergoing laparoscopic appendectomy were assigned randomly according to video image position: (1) at the top of the laparoscopy tower in front of the surgeon ("overhead") or (2) on a screen placed on the patient's abdomen ("in-line"). Operating time was recorded for each operation, and patients were stratified according to severity of appendicitis and training level of the operating surgeon. Statistical analysis was performed using Student's t, chi2 tests, and analysis of variance with post-hoc Fisher test (P <.05. significant). RESULTS: One hundred eight children, aged 2 to 17 years, underwent a laparoscopic appendectomy during a 26-month period. Fifty-four were assigned to the in-line projection screen and 54 to the overhead monitor. Operating time was significantly shorter (P =.013) when in-line projection was used (46.8 +/- 10.2 v. 52.2 +/- 15.1 minutes with overhead monitor). By analysis of variance (ANOVA) the only factors that significantly affected operating time were use of in-line projection (P =.030), severity of appendicitis (P =.002), and training level of the operating surgeon (P =.047). CONCLUSIONS: Placing the endoscopic image in the same field as the surgeon's hands decreases operating time by 10%, even for procedures that, like appendectomy, do not require complex suturing skills. This decrease in operating time occurs independently of the surgeon's level of proficiency or the degree of difficulty of the operation.

Adolescent↗

PubMedDate not supplied

Personal experience of laparoscopic cholecystectomy.

BACKGROUND/AIMS: We performed laparoscopic cholecystectomy with a surgical team consisting of the same operator and the same first assistant to evaluate a personal learning curve of laparoscopic cholecystectomy. METHODOLOGY: In the 135 patients who underwent the laparoscopic cholecystectomy, operative complications, postoperative complications and operative time were evaluated on the basis of using different camera assistants and the chronological advancement of the same operator and the same first assistant. RESULTS: The average operative time was 120 +/- 54 minutes. The operative time was statistically longer in the first ten cases. The major complication during operation, which was ligation of the common bile duct, occurred in the 7th case. The other operative complications, such as minor bile duct injury or mild bleeding, occurred occasionally in spite of experience or inexperience; the operative complications, however, tended to occur under the same camera assistant. On the other hand, the operative time was not related to the use of different camera assistants. CONCLUSIONS: From the personal learning curve of laparoscopic cholecystectomy, operative time is relatively longer in the early 10 cases. Complications tend to occur under the same camera assistant.

Cholecystectomy, Laparoscopic↗

PubMed2005

Division of pedicles by stapling during cytoreductive surgery for ovarian cancer.

OBJECTIVE: To determine the potential of dividing vascular pedicles by stapling to reduce operative time, blood loss, and morbidity associated with cytoreductive operations for advanced ovarian cancer. METHODS: A case-control study was undertaken to compare operative outcomes for patients undergoing primary cytoreductive operations for ovarian cancer using two different operative strategies. Between 2002 and 2004, both stapling and conventional techniques were used to divide vascular pedicles for 50 consecutive patients requiring modified posterior exenterations (en-bloc resection of internal reproductive organs, pelvic peritoneum, and recto-sigmoid colon) and upper abdominal procedures in the context of primary cytoreduction for stage IIIC and IV ovarian cancer. The operative time, blood loss, transfusion rate, hospitalization, and incidence of complications were compared to outcomes of 50 consecutive patients operated on between 1994 and 1997 for whom stapling was not used to divide pedicles (chi-square test for binomial data, and t-test analysis for continuous data). RESULTS: Both groups were equivalent with respect to disease severity, extent of upper abdominal surgery, and cytoreductive outcomes. The group for whom stapling devises were used to divide pedicles had a significantly reduced total operative time 179 min vs. 284 min, P < 0.001), estimated blood loss (1170 ml vs. 1782 ml, P = 0.004), and transfusion rate (3.6 units packed red cells vs. 5.0 units packed red blood cells, P = 0.03). CONCLUSION: Stapling of vascular pedicles significantly reduces the operative time and blood loss for patients undergoing extensive primary cytoreductive operations for advanced ovarian cancer.

Adult↗

PubMed1995

Evaluation and the learning curve of the first one hundred laparoscopic hysterectomies.

BACKGROUND: We analyzed the first one hundred laparoscopic hysterectomies done by one senior gynecologist to study the learning curve and complications of this technique. METHODS: One hundred laparoscopic hysterectomies done for uterine fibroid (64%), menorrhagia (20%), adenomyosis or endometriosis (10%), cervical dysplasia (3%) and endometrial cancer (3%) were studied. RESULTS: No conversion to laparotomy was needed. The weight of the uterus ranged from 70 to 470 grams (mean 206 g) and the operating time ranged from 45 to 245 minutes (mean 109 min). The mean operating time was reduced from 180 to 75 minutes. The uterine weight and the weight of the patient had a positive correlation to operating time. The use of automatic staplers or clips did not reduce the operating time. Ten complications occurred: one perforation of the urinary bladder, five bleedings and four pelvic infections. CONCLUSION: The operating time was clearly shortened during the first one hundred laparoscopic hysterectomies. The rate of the complications did not fall similarly. Technical complications (bladder perforation and intraoperative bleeding) occurred in the beginning. Complications like infection and bleeding do not seem to disappear with experience. Laparoscopic hysterectomy appears to be as safe as abdominal or vaginal hysterectomy and the postoperative convalescence time is short. It is clearly an acceptable alternative to hysterectomy.

Adult↗

PubMed2001

The tail of the learning curve for laparoscopic cholecystectomy.

BACKGROUND: This study estimates the number of laparoscopic cholecystectomies required until improvement ceases, assesses the magnitude of such improvement, and provides some insight into the mechanism by which it takes place. METHODS: Data from 500 consecutive laparoscopic cholecystectomies were analyzed from a prospective data base for number of short and long operations and operative time. RESULTS: There was a 40% decrease (P <0.05) in average operative time over the first 200 operations. Significant decrease in the number of longer operations, increase of shorter cases, and decrease in the range of operative time were noted. The major contributor was a marked shortening of longer cases, without much increased speed of shorter operations. CONCLUSIONS: For laparoscopic cholecystectomy, improvement persists for about 200 operations, resulting in a 40% reduction in operative time. The primary mechanism of improvement seems to be an ability to deal more effectively with difficult cases.

Cholecystectomy, Laparoscopic↗

PubMed2005

Thirty robotic adrenalectomies: a single institution's experience.

BACKGROUND: Robotic adrenalectomy is a minimally invasive alternative to traditional laparoscopic adrenalectomy. To date, only case reports and small series of robotic adrenalectomies have been reported. This study presents a single institution's series of 30 robotic adrenalectomies, and evaluates the procedure's safety, efficacy, and cost. METHODS: Thirty patients underwent robotic adrenalectomy at the Johns Hopkins Hospital between April 2001 and January 2004. Patient morbidity, hospital length of stay, operative time, and conversion rate to traditional laparoscopic or open surgery are presented. Improvement in operative time with surgeon experience is evaluated. Hospital charges are compared to charges for traditional laparoscopic and open adrenalectomies performed during the same time period. RESULTS: Median operative time was 185 min. Patient morbidity was 7%. There were no conversions to traditional laparoscopic or open surgery. The median hospital stay was 2 days. Operative time improved significantly by 3 min with each operation. Hospital charges for robotic adrenalectomy (12,977 dollars) were not significantly different than charges for traditional laparoscopic (11,599 dollars) or open adrenalectomy (14,600 dollars). CONCLUSIONS: Robotic adrenalectomy is a safe and effective alternative to traditional laparoscopic adrenalectomy.

Adrenalectomy↗

PubMed2004

Comparison of Gas-less laparoscopy-assisted surgery, hand-assisted laparoscopic surgery and pure laparoscopic surgery for radical nephrectomy.

BACKGROUND: We report our experience with Gas-less laparoscopy-assisted surgery (Gas-less LAS), hand-assisted laparoscopic surgery (HALS) and pure laparoscopic surgery (LS) for renal carcinoma and compare the characteristics and usefulness of these methods. METHODS: Seventeen, 14 and 16 patients were subjected to Gas-less LAS, HALS and LS, respectively. The study started with Gas-less LAS and then gradually shifted to HALS and LS. We evaluated the operative and postoperative parameters for each group. The learning curve effect was evaluated based on data from the first 10 cases of each group, which were operated on by the same surgeon and operation team. RESULTS: The learning curve of operation times in the LS group demonstrated that the operation time for this procedure is acceptable even in early-stage cases. Differences in mean operative time between the three surgical groups, excluding the conversion cases, were not statistically significant; however, there was a significant difference in blood loss volume between the groups (P </= 0.001). Operation time tended to be shorter in Gas-less LAS and the frequency of parental analgesia administration tended to be reduced in the LS group when compared to the other two groups. Of the total 47 patients treated, two cases were converted to open surgery. The major postoperative complication was one case of brain infarction in the HALS group. One patient in the LS group developed a lung metastasis 11 months after the operation. CONCLUSION: As minimally invasive operative techniques, these three methods do not differ significantly in terms of surgical outcome; however, LS tended to be slightly superior in terms of postoperative pain control and cosmetic appearance.

Carcinoma, Renal Cell↗

PubMed1988

Factors influencing bleeding during transurethral prostatectomy.

Operating time, the weight of the prostate, blood loss, and bleeding rate (ml/min) were recorded during transurethral prostatectomy in 417 patients. There were significant correlations between prostate weight and blood loss (r = .589; P less than 0.001) and between operating time and blood loss (r = .551; P less than 0.0001). Bleeding rate was significantly correlated with prostate weight (r = .399; P less than 0.0001) but not with operating time. Results of multiple regression analysis confirmed that bleeding was more closely related to prostate weight than to operating time. Operating time appears to be an iatrogenic factor in blood loss during transurethral prostatectomy.

Adult↗

PubMed2004

[Introduction of laparoscopic splenectomy for the treatment of immune thrombocytopenic purpura].

AIM OF THE STUDY: Was to evaluate retrospectively the outcomes and efficacy of the laparoscopic splenectomies for ITP patients, performed at our institution over a period of 7 years and to compare these results with those after open splenectomies. PATIENTS AND METHODS: We collected and analyzed data of 22 consecutive adult patients with ITP who underwent either laparoscopic (LS gr., n = 9) or open (OS gr., n = 13) splenectomy at Hospital of Kaunas University of Medicine between the years 1996 and 2002. The indications for splenectomy in these patients were unsuccessful treatment with corticosteroids or other medications and/or the requirement of high dosages of steroids for prolonged periods of time to maintain platelet count > 50 G/L before operation. Prior to surgery, all patients were treated with corticosteroids and/or intravenous immunoglobulin to raise the platelet count and to minimize the risk of intraoperative bleeding. The efficacy of the operation was evaluated by counting platelets one day before surgery and on the first and fifth postoperative day. Data chosen for analysis included age, gender, weight, height, American Society of Anaesthesiologists (ASA) score, number of converted patients, estimated blood loss during operation, operating time, postoperative secretion through the drains, morbidity, mortality and postoperative hospital stay. RESULTS: There were no significant differences between LS and OS groups according patients age, weight, height, gender and ASA score. The mean operative time was 138.8 +/- 50.1 min in LS group and was significantly longer than operative time in OS group (102.3 +/- 21.3 min). One patient was converted to open splenectomy because of severe bleeding from splenic hilum. Postoperative complications occurred in one patient from each group. The mean intraoperative blood loss was 460 +/- 125 ml in LS group and 510 +/- 140 ml in OS group (p > 0.05). Postoperative secretion through the drains and postoperative secretion time in LS group was significantly lower and shorter than in OS group. Postoperative hospital stay in LS group (5 +/- 1.1 days) was significantly shorter than in OS group (8 +/- 1.4 days). After splenectomy, there was an immediate increase in the platelet count of all patients in both groups. Between the day before surgery and the first postoperative day, the mean platelet count rose significantly from 75 +/- 57.0 G/L to 117 +/- 84.2 G/L in LS group and from 64 +/- 60.1 G/L to 122 +/- 79.3 G/L in OS group. Between the first postoperative day and the fifth postoperative day, the mean platelet count also rose significantly in both groups: from 117 +/- 84.2 G/L to 259 +/- 151.0 G/L in LS group and from 122 +/- 79.3 G/L to 258 +/- 158.4 G/L in OS group. In the immediate postoperative period (five days after operation), all LS group and OS group patients responded to the splenectomy. CONCLUSIONS: Laparoscopic or open splenectomy are equally efficacious in patients with ITP, with an immediate response rate of 100 % in our study. Our study results show that open splenectomy appears superior to laparoscopic procedure in terms of shorter operative time. Laparoscopic splenectomy appears superior to open procedure in terms of postoperative hospital stay, postoperative drainage time, less postoperative secretion through the drains. These two approaches are similar with regard to blood loss during operations and the rate of postoperative complications.

Adrenal Cortex Hormones↗

PubMed2005

Trans-obturator vaginal tape (TOT) for female stress incontinence: one year follow-up in 120 patients.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of a new minimally invasive surgical procedure, the Trans-obturator Vaginal Tape (TOT) in the treatment of female urodynamic stress incontinence (USI) and to analyse functional results and quality of life after one year of follow up. MATERIAL AND METHOD: 120 consecutive women with stress urinary incontinence underwent the procedure since February 2002 under general or loco-regional anesthesia. Minimum follow up was one year (range 12-30 months). Mean age was 58 years (range 31-86). 70% of the patients had pure USI. 5 patients were previously operated for USI. In 10 cases, concomitant repair of pelvic floor defects was mandatory. Collection of the data included operative time, pre- and post-operative complications. Patients were post-operatively assessed at one week, one month and one year. A validated urinary incontinence-specific measure of Quality of Life (QoL) questionnaire (Contilife) was sent and completed 12 months after surgery. RESULTS: The mean operative time was 12 min (range 6-30) with a catheterisation time of 0,9 day (range 0-2). No severe bleeding was observed. There were 13 minor lateral tears of the vagina without any sequelae. Three perforations of the urethra and one of the bladder occurred during the learning phase. In two cases a re-intervention was necessary for tape removal when the injury was not recognised during the procedure. Two transient urinary retention needed a supra pubic catheter and tape release. Eleven women presented transient voiding outflow obstruction. After one month, 93% patients were cured with no pad and a negative cough test with a full bladder. Uroflowmetry did not show any significant changes between pre- and post-operative time in all the population. De novo urgency occurred only in 2.5% and persistent dysuria (Qmax <10 ml/s and/or post-void residual volume >120 cc) in 4%. 80% of patients were completely dry after one year and 12% were greatly improved. According to the pre-operative maximal urethral closure pressure, continence rate was 86% above 30 cm H2O and 76% below 30 cm H2O respectively. Global satisfaction of women at 1 year was 78% with good scores based on daily and effort activities, self-image, emotional and sexual activities. CONCLUSIONS: TOT is a safe and effective new minimal invasive procedure for USI with a low rate of complications. To confirm the success of TOT, longer follow up in large population is mandatory to assess the reliability of this attractive technique.

Adult↗

PubMed2003

Cost comparison of hand assisted laparoscopic nephrectomy and open nephrectomy: analysis of individual parameters.

PURPOSE: Hand assisted laparoscopic nephrectomy (HAL) is an effective approach to nephrectomy that is less morbid than open nephrectomy (ON). In response to budgetary pressure at our large county hospital we reviewed the published experience and identified the cost components of HAL that could be targeted to decrease procedure cost. MATERIALS AND METHODS: A comprehensive literature review of HAL and ON was performed and certain parameters were abstracted, including operative (OR) time, operative equipment and hospital stay (LOS). Using these data the projected overall cost and individual cost centers at our institution for HAL and ON were compared. Decision tree analysis models were devised to estimate the cost of each treatment using computer software. One and 2-way sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost. RESULTS: The literature showed 6 and 9 reports on 127 and 419 patients for ON and HAL, respectively. LOS was 5 and 3 days for ON and HAL, respectively. OR time was 169 and 204 minutes for ON and HAL, respectively. Based on a review of the costs at our institution ON was a less costly procedure by $205 ($6,882 vs $7,087 US dollars). The slight cost superiority of the open approach was due to significantly lower costs associated with operating room time and equipment. On the other hand, HAL demonstrated a cost advantage for LOS. One-way sensitivity analyses showed that HAL was less costly if HAL OR time was less than 184 minutes, LOS following HAL was less than 2.5 days or HAL OR supply costs were less than $718 US dollars. Two-way sensitivity analysis demonstrated that HAL was cost advantageous if performed in less than 3 hours and the patient was discharged home within 3 postoperative days. CONCLUSIONS: Primary cost variables for nephrectomy include OR time, LOS stay and equipment cost. Using published data and decision tree analysis ON is slightly less costly by $205 US dollars than HAL at our institution. However, HAL can be more cost-effective than ON when OR time and LOS are low. Our model identifies several measures that can be used at any institution to render HAL economically superior to ON.

Cost-Benefit Analysis↗