Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA 91356, USA.
J Minim Invasive Gynecol. 2013 May-Jun;20(3):319-27. doi: 10.1016/j.jmig.2013.02.001.
Energy-based instrumentation has not only facilitated the rapid adoption of laparoscopic surgery, but could be considered essential for the completion of abdominal and pelvic procedures under endoscopic guidance. For decades, relatively simple and generic reusable monopolar and bipolar systems were the only options available. More recently, the available options for energy-based surgical instrumentation have become more crowded with the introduction of ultrasound-based cutting and sealing instruments and proprietary, impedance monitoring radiofrequency coagulation devices. Such instrumentation is presented as being easier to use as well as providing greater safety and efficacy. However, these new instruments typically require the expenditure of capital for proprietary energy generators and are usually designed to be for single use, a circumstance that increases per case costs, a circumstance that begs the question of value. Do the additional costs expended for the more expensive devices translate into reduced complications, faster operating time, or even wider access to minimally invasive procedures because they enable more surgeons to offer the service? Herein is explored the complex economic issues associated with the use of energy-based surgical devices as they apply to minimal access surgery in general and to laparoscopic procedures specifically.
能量外科设备不仅促进了腹腔镜手术的快速普及，而且对于在内镜引导下完成腹部和盆腔手术也被认为是必不可少的。几十年来，相对简单和通用的可重复使用的单极和双极系统是唯一可用的选择。最近，随着超声切割和密封器械以及专有的阻抗监测射频凝固设备的引入，能量外科器械的选择变得更加多样化。这些器械被宣传为使用更方便，并且提供更高的安全性和疗效。然而，这些新仪器通常需要为专有的能量发生器支出资本，并且通常设计为一次性使用，这种情况增加了每个病例的成本，这就引出了价值的问题。由于这些昂贵的设备使更多的外科医生能够提供服务，因此花费在这些设备上的额外成本是否会转化为减少并发症、缩短手术时间，甚至更广泛地开展微创程序？本文探讨了与能量外科器械的使用相关的复杂经济问题，这些问题适用于一般微创外科手术，特别是腹腔镜手术。
