Misal Meenal, Delara Ritchie, Wasson Megan N
Department of Gynecology, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Curr Opin Obstet Gynecol. 2020 Aug;32(4):243-247. doi: 10.1097/GCO.0000000000000636.
The United States has the highest healthcare costs among developed countries. This review evaluates surgical practices and equipment choices during endoscopic hysterectomy, highlighting opportunities for the gynecologic surgeon to reduce costs and maximize surgical efficiency.
There are opportunities to economize at every step of the endoscopic hysterectomy. When surgeons are provided education about instrumentation costs, the cost of hysterectomy has been shown to decrease. Colpotomy has been found to be the rate-limiting step in laparoscopic hysterectomy; use of a uterine manipulator likely saves time and money. When evaluating the economic impact of route of surgery, the cost differential between laparoscopic and robotic-assisted hysterectomy has decreased. Robotic-assisted hysterectomy may be more cost-effective in some cases, such as for larger uteri. From a systems-level perspective, dedicating a specific operating room team to the gynecology service can decrease operative time.
The gynecologic surgeon is best equipped to control surgery-related costs by making choices that improve surgical efficiency and decrease operating room time. If a costlier piece of equipment leads to a more efficient case, the choice may be more cost-effective. There are multiple systems-level changes that can be implemented to decrease surgery-related costs.
美国在发达国家中医疗保健成本最高。本综述评估了内镜下子宫切除术的手术操作和设备选择，强调了妇科外科医生降低成本并最大化手术效率的机会。
内镜下子宫切除术的每一步都有节约成本的机会。当向外科医生提供有关器械成本的教育时，子宫切除术的成本已显示会降低。阴道切开术已被发现是腹腔镜子宫切除术的限速步骤；使用子宫操纵器可能节省时间和金钱。在评估手术途径的经济影响时，腹腔镜和机器人辅助子宫切除术之间的成本差异已缩小。机器人辅助子宫切除术在某些情况下可能更具成本效益，例如对于较大的子宫。从系统层面来看，为妇科服务配备特定的手术室团队可以减少手术时间。
妇科外科医生最有能力通过做出提高手术效率和减少手术室时间的选择来控制与手术相关的成本。如果一件更昂贵的设备能带来更高效的手术，那么这种选择可能更具成本效益。可以实施多种系统层面的改变来降低与手术相关的成本。
