Abstract
Background
Laparoscopic hepatectomy is progressively gaining popularity. However, it is still unclear whether the laparoscopic approach offers cost advantages compared with the open approach, especially when major hepatectomies are required. Data providing useful insights into the costs of the laparoscopic approach for clinicians and hospitals are needed. The aim of this study is to assess the financial implications of the laparoscopic approach for two standardized minor and major hepatectomies: left lateral sectionectomy and right hepatectomy.
Methods
A cost comparison analysis of patients undergoing laparoscopic right hepatectomy (LRH) and laparoscopic left lateral sectionectomy (LLLS) versus the open counterparts was performed. Data considered for the comparison analysis were operative costs (theatre cost, consumables and surgeon/anaesthetic labour cost), postoperative costs (hospital stay, complication management and readmissions) and overall costs.
Results
A total of 149 patients were included: 38 patients underwent LRH and 46 open right hepatectomy (ORH); 46 patients underwent LLLS and 19 open left lateral sectionectomy (OLLS). For LRH the mean operative, postoperative and overall costs were £10,181, £4,037 and £14,218; for ORH the mean operative, postoperative and overall costs were £6,483 (p < 0.0001), £10,304 (p < 0.0001) and £16,787 (p = 0.886). Regarding LLLS, the mean operative, postoperative and overall costs were £5,460, £2,599 and £8,059; for OLLS the mean operative, postoperative and overall costs were £5,841 (p = 0.874), £5,796 (p < 0.0001) and £11,637 (p = 0.0001).
Conclusion
Our data support the cost advantage of the laparoscopic approach for left lateral sectionectomy and the cost neutrality for right hepatectomy.
Similar content being viewed by others
References
Croome KP, Yamashita MH (2010) Laparoscopic vs open hepatic resection for benign and malignant tumors: An updated meta-analysis. Arch Surg 145:1109–1118
Nguyen KT, Marsh JW, Tsung A, Steel JJ, Gamblin TC, Geller DA (2011) Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal. Arch Surg 146:348–356
Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841
Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392
Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486
Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860
Abu Hilal M, Di Fabio F, Abu Salameh M, Pearce NW (2012) Oncological efficiency analysis of laparoscopic liver resection for primary and metastatic cancer: a single-center UK experience. Arch Surg 147:42–48
Abu Hilal M, Di Fabio F, Teng MJ, Lykoudis P, Primrose JN, Pearce NW (2011) Single-centre comparative study of laparoscopic versus open right hepatectomy. J Gastrointest Surg 15:818–823
Rowe AJ, Meneghetti AT, Schumacher PA, Buczkowski AK, Scudamore CH, Panton ON, Chung SW (2009) Perioperative analysis of laparoscopic versus open liver resection. Surg Endosc 23:1198–1203
Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, Gamblin TC (2010) Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol 17:998–1009
Polignano FM, Quyn AJ, de Figueiredo RS, Henderson NA, Kulli C, Tait IS (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22:2564–2570
Bhojani FD, Fox A, Pitzul K, Gallinger S, Wei A, Moulton CA, Okrainec A, Cleary SP (2012) Clinical and economic comparison of laparoscopic to open liver resections using a 2-to-1 matched pair analysis: an institutional experience. J Am Coll Surg 214:184–195
Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 250:825–830
Abu Hilal M, Di Fabio F, Teng MJ, Godfrey DA, Primrose JN, Pearce NW (2011) Surgical management of benign and indeterminate hepatic lesions in the era of laparoscopic liver surgery. Dig Surg 28:232–236
Strasberg SM (2005) Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system. J Hepatobiliary Pancreat Surg 12:351–355
Abu Hilal M, McPhail MJ, Zeidan B, Zeidan S, Hallam MJ, Armstrong T, Primrose JN, Pearce NW (2008) Laparoscopic versus open left lateral hepatic sectionectomy: a comparative study. Eur J Surg Oncol 34:1285–1288
Pearce NW, Di Fabio F, Teng MJ, Syed S, Primrose JN, Abu Hilal M (2011) Laparoscopic right hepatectomy: a challenging, but feasible, safe and efficient procedure. Am J Surg 202:e8–e52
Abu Hilal M, Underwood T, Taylor MG, Hamdan K, Elberm H, Pearce NW (2010) Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc 24:572–577
Reddy SK, Tsung A, Geller DA (2011) Laparoscopic liver resection. World J Surg 35:1478–1486
O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216
Pearce NW, Di Fabio F, Abu Hilal M (2011) Laparoscopic left hepatectomy with extraparenchymal inflow control. J Am Coll Surg 213:e23–e27
Kazaryan AM, Røsok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25:3881–3889
Abu Hilal M, Badran A, Di Fabio F, Pearce NW (2011) Pure laparoscopic en bloc left hemihepatectomy and caudate lobe resection in patients with intrahepatic cholangiocarcinoma. J Laparoendosc Adv Surg Tech A 21:845–849
Jain G, Parmar J, Mohammed MM, Bryant T, Kitteringham L, Pearce N, Abu Hilal M (2010) “Stretching the limits of laparoscopic surgery”: two-stage laparoscopic liver resection. J Laparoendosc Adv Surg Tech A 20:51–54
Van Dam RM, Wong-Lun-Hing EM, van Breukelen GJ, Stoot JH, van der Vorst JR, Bemelmans MH, Olde Damink SW, Lassen K, Dejong CH, Study Group OI (2012) Open versus laparoscopic left lateral hepatic sectionectomy within an enhanced recovery ERAS(R) programme (ORANGE II – Trial): study protocol for a randomized controlled trial. Trials 13:54
Van Dam RM, Hendry PO, Coolsen MM, Bemelmans MH, Lassen K, Revhaug A, Fearon KC, Garden OJ, Dejong CH (2008) Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection. Br J Surg 95:969–975
Disclosures
Authors Mohammed Abu Hilal, Francesco Di Fabio, Shareef Syed, Robert Wiltshire, Eleonora Dimovska, David Turner, John N. Primrose and Neil W. Pearce have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
Mohammed Abu Hilal and Francesco Di Fabio equally contributed to this study.
Oral presentation, International Hepato-pancreato-biliary Association 10th World Congress, Paris, 1–5 July 2012.
Rights and permissions
About this article
Cite this article
Abu Hilal, M., Di Fabio, F., Syed, S. et al. Assessment of the financial implications for laparoscopic liver surgery: a single-centre UK cost analysis for minor and major hepatectomy. Surg Endosc 27, 2542–2550 (2013). https://doi.org/10.1007/s00464-012-2779-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2779-1