Endometriosis Center, Department of Surgery, 522567Amsterdam University Medical Center, Amsterdam, the Netherlands.
MedValue, Nijmegen, the Netherlands.
Surg Innov. 2020 Dec;27(6):623-632. doi: 10.1177/1553350620944267. Epub 2020 Aug 25.
Laparoscopic treatment of deep endometriosis (DE) is associated with intra- and post-operative morbidity. New technological developments, such as haptic feedback in laparoscopic instruments, could reduce the rate of complications. The aim of this study was to assess the room for improvement and potential cost-effectiveness of haptic feedback instruments in laparoscopic surgery. To assess the potential value of haptic feedback, a decision analytical model was constructed. Complications that could be related to the absence of haptic feedback were included in the model. Costs of complications were based on the additional length of hospital stay, operating time, outpatient visits, reinterventions, and/or conversions to laparotomy. The target population consists of women who are treated for DE in the Netherlands. A headroom analysis was performed to estimate the maximum value of haptic feedback in case it would be able to prevent all selected intra- and post-operative complications. . A total of 9.7 intraoperative and 47.0 post-operative complications are expected in the cohort of 636 patients annually treated for DE in the Netherlands. Together, these complications cause an additional length of hospital stay of 432.1 days, 10.2 additional outpatient visits, 73.9 reinterventions, and 4.2 conversions. Most consequences are related to post-operative complications. The total additional annual costs due to complications were €436 623, amounting to €687 additional costs per patient. . This study demonstrated that the potential value for improvement in DE laparoscopic surgery by using haptic feedback instruments is considerable, mostly caused by the potential prevention of major post-operative complications.
腹腔镜治疗深部子宫内膜异位症（DE）与围手术期发病率有关。新的技术发展，如腹腔镜器械的触觉反馈，可以降低并发症的发生率。本研究旨在评估触觉反馈器械在腹腔镜手术中的改进空间和潜在的成本效益。为了评估触觉反馈的潜在价值，构建了一个决策分析模型。模型中纳入了可能与触觉反馈缺失相关的并发症。并发症的成本基于住院时间延长、手术时间、门诊就诊、再次干预和/或转为剖腹手术的额外费用。目标人群为在荷兰接受 DE 治疗的女性。进行了上限分析，以估计在触觉反馈能够预防所有选定的围手术期并发症的情况下，触觉反馈的最大价值。在荷兰，每年有 636 名患者接受 DE 治疗，预计每年会发生 9.7 例术中并发症和 47.0 例术后并发症。这些并发症总共导致 432.1 天的额外住院时间、10.2 次额外门诊就诊、73.9 次再次干预和 4.2 次转为剖腹手术。大多数后果与术后并发症有关。由于并发症导致的总额外年度成本为 436623 欧元，每位患者的额外成本为 687 欧元。本研究表明，使用触觉反馈器械改善 DE 腹腔镜手术的潜在价值相当可观，主要是因为可以预防主要的术后并发症。
