An Analysis of Peri-Operative Factors and a Cost-Comparison of Single-Incision Versus Traditional Multi-Incision Laparoscopic Cholecystectomy

Catherine E Beck, MD, Jeffrey L Eakin, MD, Rebecca Detorre, David E Renton, MD. The Ohio State University Medical Center

Introduction: Recent technological advances in single-incision platforms has allowed many General Surgeons to add single-incision laparoscopic cholecystectomies (SILC) to their armamentarium. Nonetheless, typically, adopting new surgical technologies comes at a cost both in and outside of the operating room to the patient and the surgeon. We performed a retrospective case-matched comparison of single-incision and traditional multi-incision laparoscopic cholecystectomies (MILC) to evaluate the effects of SILC on peri-operative outcomes and patient cost.

Methods: This study was completed following approval by the Institutional Review Board at The Ohio State University. All statistical analysis were performed utilizing Microsoft® Excel® 2008 for Macintosh while using a p-value ≤ .05 for stastical significance. Sixty-five patients who underwent single-incision laparoscopic cholecystectomy were compared to a case matched population of individuals who underwent traditional MILC. We performed SILC using one of three commercially available single-incision platforms currently used for SILS choleycystectomies. All of the SILS platforms were places in a 2-centimeter supraumbilical incision.

Results: The average operative time for the SILC and MILC groups were 42 and 45 minutes respectively with no statistically significant difference between the two. Similarly, the average blood loss for the SILC and MILC groups were 14 and 11 milliliters respectively with no statistically significant difference. Moreover, there was no statistical difference between patient size for the average body mass index for those patients undergoing SILC and MILC were 28.4 kg/m2  and 32.2 kg/m2  respectively. The average peri-operative cost for SILC and MILC was $18,447 and $17,701 respectively and yielding a cost difference of $746. This cost difference was not stastically significant.

Conclusion: SILS cholecystectomy  can be performed efficiently with respect to EBL and operative time.While there was no statistical difference in cost at our instiitution the there was a noticeable difference in average price. Further research should be performed to assess the economic feasibility and trade-ff of increased cost versus the improved cosmesis and improved quality provided to the patient as well as a possibly a reduced post-operative analgesic requirements.