Single-Port Verses Two-Port Verses Traditional Four-Port Cholecystectomy: Outcomes and Cost Benefit Comparison Analysis

Michael W Parra, MD, Edgar B Rodas, MD, Mark L Christensen, MSIV, Jakub Bartnik, MSIV. Boward General Hospital, Fort Lauderdale, FL

Abstract

Introduction: In recent years new methods of laparoscopic cholecystectomy have evolved. Theoretically, these newer methods provide improved cosmetic results and a decrease in postoperative pain but a detailed comparative cost benefit analysis of these procedures has been lacking. The purpose of this study is to compare cost, patient outcomes and patient satisfaction of these three laparoscopic cholecystectomy techniques.
Methods: A retrospective study of 30 consecutive patients who underwent cholecystectomy by the same surgeon between September 2007 and March 2010. Of these, 10 underwent four-port cholecystectomy(FPC), 10 underwent two-port cholecystectomy(TPC) and 10 underwent single-port cholecystectomy(SPC). Patients were compared in age, gender, pre-operative diagnosis, intraoperative time, postoperative complications, and hospital stay. A patient satisfaction phone survey was conducted and information was obtained comparing scar appearance, postoperative pain and hospital course.
Results: Of the 30 cholecystectomy cases, there were 2 minor complications (one FPC and one TPC). A conversion to open surgery was needed early in a SPC due to dense adhesions. One TPC was followed immediately by a TAH BSO & cystoscopy effecting the op-time and length of hospital stay. Operation times (FPC: 49 min – TPC: 71 min – SPC: 69 min) was shortest for the FPC and similar for the TPC and the SPC. Hospital stay (FPC: 1.132 days – TPC: 1.667 days – SPC: 1.332 days) were similar among all three procedures. Overall hospital costs were lowest for the TPC. The cost of the FPC was approximately one and one half times the cost of the TPC. The SPC cost was significantly higher at about three to four times that of the TPC. The patient satisfaction phone survey related to the patients scar appearance, postoperative pain, and hospital course showed no significant differences between all three techniques.
Conclusions: Newer methods of cholecystectomy are safe and result in comparable patient satisfaction. The cost of single-port cholecystectomy, however, is significantly higher and will therefore limit its use in many instances. Two-port cholecystectomy is the most cost-effective method and has the greatest potential of improvement over the traditional four-port technique especially in developing countries.