Novel Technique for Significant Cost Reduction in Laparoscopic Inguinal Hernia Repair

dmitry nepomnayshy, MD, anton galitsky, MD, desmond birkett, MD. lahey clinic

OBJECTIVES: Growth in healthcare costs is a significant concern for sustainable healthcare delivery around the world. In our institution, we have seen a 50% -100% rise in the costs of operating room supplies over the last decade. For the first time, we were made aware of the actual costs of surgical supplies for all our procedures. In an effort to reduce costs, we have developed a novel technique in laparoscopic inguinal hernia repair. We have no conflicts of interest with any of the supplying vendors in this report.

DATA: Actual O.R. supply costs for 10 cases before and after the change in technique and video.

METHODS. The video shows the following technique. Total extra-peritoneal repair (TEPP) with 3D BardTM mesh using a Gelport Balloon 12mm Trocar and two 5mmx55 trocars from AppliedTM. Camera dissection is used to create the pre-peritoneal working space. We apply a long suture to the mesh prior to insertion. The mesh is positioned appropriately and a transfacial suture passer is used to attach the mesh in position. Local anesthetic is instilled into the working space and it is allowed to collapse under direct vision. We have eliminated the use of Triangular Balloon, Oval Dissection Balloon and Protack – CovidienTM.

RESULTS: The average total supply cost per laparoscopic inguinal hernia was $1,358.77. By following the new technique, we were able to reduce our total cost to $542.49 per case.

CONCLUSIONS: As part of an effort to contain growing supply costs, we have been able to reduce the cost associated with laparoscopic inguinal hernia repair by 60% with the technique described. It is likely that many other opportunities for cost containment remain as total supply costs in the O.R. at Lahey Clinic have not decreased but at least have stabilized. (Figure 1). Surgeons should play an important role in helping contain overall healthcare costs. Knowing the actual cost of surgical equipment and supplies is a good place to start.