Laparoscopic hysterectomy compared with abdominal and vaginal hysterectomy in a community hospital.

STUDY OBJECTIVE

To compare costs of laparoscopic hysterectomy with those of abdominal and vaginal hysterectomies in a community hospital.

DESIGN

Retrospective review. Study cases were controlled for severity of pathology and extent of surgery performed laparoscopically. Charges were corrected for inflation.

SETTING

Rural community hospital, fee for service practice.

PARTICIPANTS

Women undergoing hysterectomy during the study period.

INTERVENTIONS

Hysterectomy performed with or without laparoscopy.

MEASUREMENTS AND MAIN RESULTS

Operating times, operating room charges, total hospital charges, uterine weight, length of hospital stay, and complications were tabulated for laparoscopic, abdominal, and vaginal hysterectomies, with and without bilateral salpingo-oophorectomy. The use of a video monitor and disposable instruments was associated with increased costs and longer operating times. With reusable instruments and a simple operating technique performed while looking down an operating laparoscope, laparoscopic hysterectomy was less costly than abdominal hysterectomy. Laparoscopy without treatment of concurrent pathology before vaginal hysterectomy was associated with increased costs. Vaginal hysterectomy was faster and less expensive than any other form of hysterectomy. Some abdominal hysterectomies could possibly have been performed vaginally. There was no advantage in studying patients undergoing hysterectomy with bilateral salpingo-oophorectomy separately from those undergoing hysterectomy alone. Complications were similar in all groups.

CONCLUSIONS

Laparoscopic hysterectomy performed with a simple electrosurgical technique and reusable instruments, and without a video monitor was less expensive than abdominal hysterectomy. The video control and disposable instruments were associated with longer operating times and higher charges.