Cost considerations in trauma and emergency laparoscopy

Summary BACKGROUND: There are a number of laparoscopic procedures in trauma and emergency surgery that to some extent at least have passed the test of being safe and feasible with short-term results equaling those of the open procedure. The only justification for an increase in total costs, however, is improved outcome. If the actual procedure inside the body is identical whether performed laparoscopically or openly, and both methods yield comparable short-term outcomes, the differences in the morbidity and costs are attributable to the size of the access wound (affecting the hospital and recovery times), the length of the operation, and the equipment needed. METHODS: Cost analyses in trauma and emergency laparoscopy, limited to those laparoscopic procedures in trauma and emergency surgery which to some extent have passed the test of feasibility and efficacy are reviewed. RESULTS: Currently available evidence on the use of laparoscopy in most trauma and emergency procedures or management strategies offers little support from the cost efficacy point of view to favor the minimally invasive alternative. There are some procedures, however, such as laparoscopic resection of uncomplicated sigmoid diverticulitis, laparoscopic cholecystectomy for acute cholecystitis, or the management of ectopic pregnancy, for which the lower community cost might justify the somewhat higher hospital costs associated with the laparoscopic approach. CONCLUSIONS: Until properly designed, controlled studies show true improvement in cost efficacy of the minimally invasive alternative in individual surgical procedures or management strategies, a critical view in applying laparoscopy in trauma and emergency surgery must be maintained.