LAPAROSCOPIC HYSTERECTOMY COMPARED WITH ABDOMINAL AND VAGINAL HYSTERECTOMY IN A COMMUNITY-HOSPITAL

Study Objective. To compare costs of laparoscopic hysterectomy with th ose of abdominal and vaginal hysterectomies in a community hospital. D esign. Retrospective review. Study cases were controlled for severity of pathology and extent of surgery performed laparoscopically. Charges were corrected for inflation. Setting. Rural community hospital, fee for service practice. Participants, Women undergoing hysterectomy duri ng the study period. Interventions. Hysterectomy performed with or wit hout laparoscopy. Measurements and Main Results. Operating times, oper ating room charges, total hospital charges, uterine weight, length of hospital stay, and complications were tabulated for laparoscopic, abdo minal, and vaginal hysterectomies, with and without bilateral salpingo -oophorectomy. The use of a video monitor and disposable instruments w as associated with increased costs and longer operating times. With re usable instruments and a simple operating technique performed while lo oking down an operating laparoscope, laparoscopic hysterectomy was les s costly than abdominal hysterectomy. Laparoscopy without treatment of concurrent pathology before vaginal hysterectomy was associated with increased costs. Vaginal hysterectomy was faster and less expensive th an any other form of hysterectomy. Some abdominal hysterectomies could possibly ha ve been performed vaginally. There was no advantage in st udying patients undergoing hysterectomy with bilateral salpingo-oophor ectomy separately from those undergoing hysterectomy alone. Complicati ons were similar in all groups. Conclusions. Laparoscopic hysterectomy performed with a simple electrosurgical technique and reusable instru ments, and without a video monitor was less expensive than abdominal h ysterectomy. The video control and disposable instruments were associa ted with longer operating times and higher charges.