January 1996
LAPAROSCOPY REDUCES RECOVERY TIME AND COSTS FOR HYSTERECTOMY
A study by Matel et al. comparing laparoscopically assisted vaginal hysterectomy (LAVH) with total abdominal hysterectomy (TAH) found that the laparoscopic approach offered several advantages, including shorter hospitalization and reduced hospital costs.
The study (Journal of Laparoendoscopic Surgery, December 1995), which compared 106 women who underwent LAVH with 106 women who underwent TAH, found a decrease in postoperative narcotic use coupled with an average hospital stay of 3.5 days for laparoscopic patients vs. 6.4 days for traditional patients. While laparoscopic procedures took longer and resulted in higher operating room costs, shorter hospital stays for laparoscopic patients reduced overall costs to an average of $4,073 compared with an average of $4,700 for TAH patients. "A shorter postoperative stay is associated with a more rapid return to the home and to full activity," the study concludes. "The true economic benefit of an earlier return to work, if demonstrated, is likely to be considerable. . . LAVH is an attractive alternative to TAH."
NEW TECHNOLOGY INCREASES SAFETY, REDUCES COSTS FOR REMOVAL OF PELVIC MASSES
Researchers report that recent advances in laparoscopic instrumentation increases safety and reduces costs for patients undergoing laparoscopic colpotomy -- the removal of pelvic masses through the vagina.
By combining an endoscopic light source (Pelosi IlluminatorTM, Apple Medical Corporation, Bolton. MA) with the cutting and visual capabilities of the VISIPORT* optical trocar system (United States Surgical Corporation, Norwalk, CT), doctors at Pelosi Women's Medical Center, Bayonne, NJ, have been able to perform a true visually guided, laparoscopic cul-de-sac entry through the vagina.
"Because of the VISIPORT*'s cutting mechanism, it requires less insertion force than standard blind trocars," says Dr. Marco A. Pelosi, inventor of the Pelosi IlluminatorTM along with his son Marco A. Pelosi, III. "As a result, there is less chance of accidentally injuring vascular and cystic structures. In addition, VISIPORT* can also accommodate the Pelosi IlluminatorTM, which lights the cul-de-sac as the cutting mechanism passes through. This helps reduce the chance of injury to surrounding structures and eliminates the expense of an additional laparoscope," Dr. Pelosi concludes.
An article describing the technique in 35 patients will appear in an issue of The Journal of Reproductive Medicine in the near future.
LAPAROSCOPY OFFERS COST-EFFECTIVE TREATMENT FOR ESOPHAGEAL ACHALASIA
A recent study by Ancona et al. (The American Journal of Surgery) found that laparoscopic surgery is preferable to a traditional "open" approach when treating esophageal achalasia, a condition in which the esophagus cannot properly relax, making swallowing difficult.
Surgical correction--called the Heller-Dor procedure--involves reducing the resistance of the lower esophageal sphincter, a circular band of muscles that acts as a valve between the esophagus and the stomach.
The study compares the experience of 34 patients who underwent a Heller-Dor procedure at the University of Padua (Padua, Italy). Researches report that while laparoscopic and traditional surgery have comparable short-term results, patients who underwent laparoscopic surgery (17) saved an average of $383. Although instrumentation costs were higher in these cases, researchers attribute their cost savings to a shorter average hospital stay of 4 days vs. 10 days with traditional surgery. In addition, laparoscopic patients returned to normal activities an average of 2 weeks earlier than traditional patients, leading researchers to conclude that overall savings would be higher if productivity gains were considered.
"The cost-benefit analysis of surgical procedures for esophageal achalasia will lead to the laparoscopic Heller-Dor being considered the most viable and cost-effective alternative to the open technique," the study concludes.
LAPAROSCOPIC SPLENECTOMY PROMISING FOR CHILDREN AND ADULTS WITH ITP
According to a recent article in Laparoscopic Surgery Update, surgeons from around the world are now recommending laparoscopic splenectomy for children and adults suffering from idiopathetic thromobocytopenic purpura (ITP), a disorder involving hemorrhaging that is marked by a reduction of blood platelets.
Dr. Oded Zamir reports good results after performing the procedure on 8 patients at Hadassah University Hospital in Jerusalem, Israel. All patients recovered without complications, required minimal pain medication and had increased platelet counts within 15 months postoperatively. Similar results were reported in Germany and Japan, where, along with ITP patients, laparoscopic splenectomy was used to treat children and adults with Hodgkin's Disease, a hereditary disorder and abnormally low platelets associated with HIV or hairy cell leukemia.
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