Department of Hepato-Biliary and Pancreatic Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
Surg Endosc. 2013 Jul;27(7):2542-50. doi: 10.1007/s00464-012-2779-1. Epub 2013 Jan 26.
Laparoscopic hepatectomy is progressively gaining popularity. However, it is still unclear whether the laparoscopic approach offers cost advantages compared with the open approach, especially when major hepatectomies are required. Data providing useful insights into the costs of the laparoscopic approach for clinicians and hospitals are needed. The aim of this study is to assess the financial implications of the laparoscopic approach for two standardized minor and major hepatectomies: left lateral sectionectomy and right hepatectomy.
A cost comparison analysis of patients undergoing laparoscopic right hepatectomy (LRH) and laparoscopic left lateral sectionectomy (LLLS) versus the open counterparts was performed. Data considered for the comparison analysis were operative costs (theatre cost, consumables and surgeon/anaesthetic labour cost), postoperative costs (hospital stay, complication management and readmissions) and overall costs.
A total of 149 patients were included: 38 patients underwent LRH and 46 open right hepatectomy (ORH); 46 patients underwent LLLS and 19 open left lateral sectionectomy (OLLS). For LRH the mean operative, postoperative and overall costs were £10,181, £4,037 and £14,218; for ORH the mean operative, postoperative and overall costs were £6,483 (p < 0.0001), £10,304 (p < 0.0001) and £16,787 (p = 0.886). Regarding LLLS, the mean operative, postoperative and overall costs were £5,460, £2,599 and £8,059; for OLLS the mean operative, postoperative and overall costs were £5,841 (p = 0.874), £5,796 (p < 0.0001) and £11,637 (p = 0.0001).
Our data support the cost advantage of the laparoscopic approach for left lateral sectionectomy and the cost neutrality for right hepatectomy.
腹腔镜肝切除术逐渐受到欢迎。然而，与开放手术相比，腹腔镜手术是否具有成本优势尚不清楚，尤其是在需要进行大肝切除术时。临床医生和医院需要了解提供有关腹腔镜手术成本的有用见解的数据。本研究旨在评估两种标准化小肝切除术和大肝切除术（左外叶切除术和右肝切除术）腹腔镜方法的财务影响。
对接受腹腔镜右肝切除术（LRH）和腹腔镜左外叶切除术（LLLS）与开放手术的患者进行了成本比较分析。比较分析中考虑的数据包括手术成本（手术室成本、耗材和外科医生/麻醉师劳动力成本）、术后成本（住院时间、并发症管理和再入院）和总成本。
共纳入 149 例患者：38 例患者接受了 LRH 和 46 例开放右肝切除术（ORH）；46 例患者接受了 LLLS 和 19 例开放左外叶切除术（OLLS）。LRH 的平均手术、术后和总费用分别为 10181 英镑、4037 英镑和 14218 英镑；ORH 的平均手术、术后和总费用分别为 6483 英镑（p<0.0001）、10304 英镑（p<0.0001）和 16787 英镑（p=0.886）。对于 LLLS，平均手术、术后和总费用分别为 5460 英镑、2599 英镑和 8059 英镑；OLLS 的平均手术、术后和总费用分别为 5841 英镑（p=0.874）、5796 英镑（p<0.0001）和 11637 英镑（p=0.0001）。
我们的数据支持左外叶切除术腹腔镜方法的成本优势，以及右肝切除术的成本中性。
