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The “all-in-one” appendectomy: quick, scarless, and less costly
Journal of Pediatric Surgery, 12/16/2011
Stylianos S et al. – The authors conclude that the all–in–one laparoscopic appendectomy technique is quick, scarless, and less costly than conventional multi–port techniques. Wider application of the all–in–one technique seems indicated.
Methods- During 2009, 508 children underwent LAP APPY at the institution including 398 (78%) for acute, non-perforated appendicitis.
- The “all-in-one” operative procedure involves use of a single instrument through a side-arm viewing operative laparoscope which is inserted through a single, trans-umbilical port.
- Successful procedure completion rates and operative times (“cut-to-close”) were determined.
- The data for surgeon-directed, disposable supply costs per procedure were collated by Child Health Corporation of America and compared with 2009 LAP APPY data (n = 5692) from 17 other children's hospitals in the United States.
- The authors successfully completed 359 (90.2%) LAP APPY procedures using the all-in-one technique resulting in no appreciable scar.
- Additional ports were used in 9.8% and there were no conversions to open procedures.
- Median operative time for the all-in-one technique was 24 minutes (5-66 min).
- The median surgeon-directed, disposable supply cost was the lowest in the study group and significantly less than the other 17 children's hospitals ($166 vs $748, P < .001).
- Median variation of supply costs among surgeons within each institution was $448 ($3-$870).
- Aggregate savings of nearly $1.3 million are predicted if all study surgeons were to reduce their disposable costs per procedure to the 25th percentile ($551).
