Ishikawa M, Nakagawa T, Nishioka M, Ogata S, Miyauchi T, Kashiwagi Y, Uemura N, Inoue S
Department of Surgery, National Kochi Hospital, Kochi, Japan.
Hepatogastroenterology. 2006 Jul-Aug;53(70):497-500.
BACKGROUND/AIMS: Gasless laparoscopic surgery using the abdominal wall lifting (AWL) method was first developed in Japan and has been used in various surgical fields. The AWL method allows the use of conventional reusable surgical instruments. The purpose of this study was to compare the cost-effectiveness of laparoscopic cholecystectomy (LSC) using the AWL method in relation to that using pneumoperitoneum (P) method.
Retrospective analysis of 431 LSC procedures between 1991 and 2004 was performed. The two surgical groups consisted of consecutively operated patients with a diagnosis of cholecystolithiasis or gallbladder polyps. One group consisted of 224 LSC procedures performed using the P method from 1992 to 1998 and the other group comprised 207 LSC performed using the AWL method from 1998 to 2004. All instruments used in the P method were disposable, whereas trocars, scissors, dissectors, graspers and L-hook electrodes (excluding clips) used in the AWL method were reusable. Hospital expenses, length of hospital admission and complication rates were analyzed.
Mean hospital cost per case for LSC using the AWL method (dollars 6743) was 7% less expensive than that using the P method (dolars 7215). Costs of operative equipment contributed to the difference (mean dollars 912 per case) in total cost. Conversion to open cholecystectomy occurred in 6 cases (2.9%) using the AWL method and 7 cases (3.1%) using the P method. There were no significant differences in length of hospital admission or complication rates between the two groups.
LSC using AWL method was less expensive than that using P method. This is mainly due to the use of reusable instruments in the AWL method. If LSC is performed using the AWL method instead of using disposable equipment, considerable savings can be achieved without compromising patient safety.
背景/目的：使用腹壁提升（AWL）方法的无气腹腹腔镜手术最早在日本开发，并已应用于各个外科领域。AWL方法允许使用传统的可重复使用的手术器械。本研究的目的是比较使用AWL方法与使用气腹（P）方法进行腹腔镜胆囊切除术（LSC）的成本效益。
对1991年至2004年间的431例LSC手术进行回顾性分析。两个手术组由连续接受手术的胆囊结石或胆囊息肉诊断患者组成。一组包括1992年至1998年使用P方法进行的224例LSC手术，另一组包括1998年至2004年使用AWL方法进行的207例LSC手术。P方法中使用的所有器械均为一次性使用，而AWL方法中使用的套管针、剪刀、剥离器、抓钳和L形钩电极（不包括夹子）均可重复使用。分析了住院费用、住院时间和并发症发生率。
使用AWL方法进行LSC的平均每例住院费用（6743美元）比使用P方法（7215美元）便宜7%。手术设备成本导致了总成本的差异（平均每例912美元）。使用AWL方法有6例（2.9%）转为开腹胆囊切除术，使用P方法有7例（3.1%）。两组之间的住院时间或并发症发生率没有显著差异。
使用AWL方法进行LSC比使用P方法成本更低。这主要是由于AWL方法使用了可重复使用的器械。如果使用AWL方法而不是一次性设备进行LSC，可以在不影响患者安全的情况下实现可观的节省。
