Cost-efficiency of Single-port When Compared to Conventional Laparoscopic Colectomy

Barlas Sulu, MD, Hasan T Kirat, MD, Meagan Costedio, MD, Emre Gorgun, MD, Ravi P Kiran, MD. Cleveland Clinic Foundation



Background: The aim of this study is to investigate whether single-port laparoscopic colectomy is associated with increased costs when compared with conventional laparoscopic colectomy

Methods: Patients undergoing single-port laparoscopic colectomy between 2007 and 2010 with available cost data (Group SPL) were matched to those with conventional laparoscopic colectomy (Group CL) for age (within 10 years), gender, American Society of Anesthesiologists class, body mass index (within 5 kg/m2), operation type and year (within 3 years). Direct costs for the two groups were compared using appropriate statistical tests.

Results: There were 90 patients in SPL group and 90 patients in CL group. Age (48.7±18.2 vs. 48.1±18.1, p=0.79), gender (male gender, n=46, 51.1% vs. n=45, 50%, p=0.88), body mass index (kg/m2 25.8±5 vs. 25.6±5.2, p=0.82), American Society of Anesthesiologists class (class II, n=66, 73.3% vs. n=66, 73.3%, p=1) and diagnosis (benign, n=71, 78.9% vs. n=72, 80 %, p=0.85) were similar in groups SPL and CL. Type of surgery, estimated blood loss and length of hospital stay were also similar (Table). Operation time was significantly shorter for Group SPL (minutes, 136.1±178.6 vs. 217.9±91.2, p=<0.001), hence anesthesia cost was significantly lower for Group SPL (p=0.003). Total direct costs (p=0.5), operating room (p=0.65), nursing, (p=0.13), pharmacy (p=0.6), radiology (p=0.27), professional (p=0.38) and pathology/laboratory (p=0.46) costs were however similar between groups

Conclusions: Single-port laparoscopic colectomy can be performed with comparative costs to conventional laparoscopic colectomy thus confirming the feasibility and safety of the technique. The additional finding that operating time can be reduced when the single-port technique is adopted by surgeons already facile with the conventional laparoscopic technique, suggests that increasing experience may be associated with reduced costs when compared to conventional laparoscopic colectomy.



Variable Group SPL (n=90) Group CL (n=90) P value
Type of Operation                                              1
Right hemicolectomy 26 (28.9%)                        26 (28.9%)                         
Total abdominal colectomy with EI 23 (25.6%) 23 (25.6%)  
Sigmoid colectomy 12 (13.3%) 12 (13.3%)  
Total proctocolectomy with IPAA 12 (13.3%) 12 (13.3%)  
Ileocecal resection 10 (11.1%) 10 (11.1%)  
Total abdominal colectomy with IRA 3 (3.3%) 3 (3.3%)  
Low anterior resection 2 (2.2%) 2 (2.2%)  
Left hemicolectomy 2 (2.2%) 2 (2.2%)  
Estimated blood loss, ml 124.4 ±108.4 157.2 ±154.5 0.17
Operation time (minutes) 136.1 ±178.6 217.9 ±91.2 <0.001
Length of hospital stay, days (mean) 6.5 ±4.7 7.6 ±6 0.06
EI: End ileostomy, IRA: Ileorectal anastomosis, IPAA: Ileal pouch-anal anastomosis      


Session Number: Poster – Poster Presentations
Program Number: P106
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