Elizabeth A Piontek, Bernadette McCrory, Justin D Johnson, Jacob M Oran and Chad A LaGrange
Background: With the emergence of Laparoendoscopic Single-Site Surgery (LESS) and its potential patient benefits, a cost comparison was conducted to enable informed decision-making for the selection of minimally invasive surgical approach type for nephrectomy.
Methods: A literature-based cost comparison of Hand-Assisted Laparoscopic (HAL), Conventional Laparoscopic (LAP), and LESS nephrectomies was conducted to determine whether the benefits of LESS offset the expense of this new technique and its expensive technologies. Using institutional rates the total cost of each approach was determined by summing the costs of instrumentation unique to each approach, Operative Time (OT) and patient length of stay (LOS). One-way and two-way sensitivity analyses were performed varying each of the costs to determine Cost-equivalence thresholds across the approaches.
Results: Based on the literature review (n=557), LESS was the most cost-effective due to short OT and LOS. OT would have to be less than 121 and 145 minutes or LOS would have to be less than 1.5 and 2.86 days for HAL and LAP to be more cost-effective than LESS, respectively.
Conclusion: The cost difference between LAP and LESS was minimal and small decreases in OT, LOS or both would result in a cost-advantage for LAP. Although LESS was the most economical approach, this preliminary cost analysis was based on the procedural outcomes of expert surgeons that were early-adopters of LESS. Prospective, controlled trials comparing HAL, LAP and LESS are critical for procedural optimization and cost control.