Cost-Effective and Potential Benefits in Three-Port Hand-Assisted Laparoscopic Sigmoidectomy

Natthawut Phothong MD*,**, Thawatchai Akaraviputh MD*, Vitoon Chinswangwatanakul MD*, Asada Methasate MD*, Atthaphorn Trakarnsanga MD*

Affiliation : * Minimally Invasive Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand

Objective : To demonstrate potential benefits of three-port hand-assisted laparoscopic sigmoidectomy (HALS) compared with open sigmoidectomy (OS) in terms of short-term outcomes and cost-benefit. Material and Method: A retrospective review of a database of cases that matched 100 sigmoid cancer patients treated with sigmoidectomy at the Department of Surgery, Siriraj Hospital was performed. Short-term outcomes and costs of treatment were collected and analyzed.
Results : There were no differences in age, gender, body mass index, American Society of Anesthesiologists’ score, Charlson comorbidity index score, and previous surgery between OS and HALS groups. The three-port HALS group had significantly less blood loss (50 (5-400) mL vs. 120 (10-1,000) mL, p<0.001), faster time to regular diet (64.620.7 hours vs. 97.652.5 hours, p<0.001), and lower pain score (4.31.7 vs. 5.31.6, p = 0.008). The hospital-stay related cost was significantly lower in HALS group ($114 ($47-$789) vs. $190 ($57-$1,462), p<0.001). The low rate of infection was a major contributory factor (12% vs. 0%, p = 0.03). This was further emphasized in subgroup analysis of surgical site infection (SSI). While there are great benefits, the operative cost is higher in HALS. However, there is no significant difference in total costs of OS and HALS (US $2,243 ($1,321-$5,241) vs. $1,942 ($1,427-$11,910), p = 0.054).
Conclusion : Simplified three-port HALS can be successfully performed with superior short-term outcomes and preserved oncologic outcomes. Cost-benefit advantage was highlighted especially in the area of high rate of SSI.

Keywords : Hand-assisted laparoscopic sigmoidectomy, Short-term outcomes, Cost analysis

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