Total hysterectomy for benign pathologies: direct costs comparison betweenlaparoscopic and abdominal hysterectomy

Objectives: The aim of this study is a direct costs comparison between lapa roscopic and abdominal total hysterectomy when theses procedures are indica ted for benign pathologies. Study design: To this end we compared the direc t costs of total laparoscopic hysterectomy (TLH) calculated from a series o f 105 patients with that obtained for a comparable series of 30 patients wh o underwent hysterectomy by laparotomy. Results: The direct costs of total hysterectomy for a benign pathology by laparoscopic surgery and laparotomy are comparable (respectively 7693 French francs (FF) and 7759 FF). Whatever the type of operation the cost for staff represents 60% of the total cost. Expenditure for staff during the operation represents 41.0% of the total c ost of TLH (3154 FF/7693 EF) whereas it represents only 31.0% of the cost o f the operation when carried out by laparotomy (2406 FF/7759 FF) (P<0.0001) . Inversely the expenditure due to staff during the post operative phase re presents 24.1% of the total cost of the operation when laparotomy is used ( 1875 FF/7759 FF) and only 13.4% of the cost of the operation by laparoscopi c surgery (1029 FF/7693 FF) (P<0.0001). When the operation uses laparoscopi c surgery the increase in expenditure during the surgical act is compensate d by the statistically significant shortening in the hospital stay. Expendi ture connected with the laparoscopic surgery equipment is minimal compared to the costs connected with the staff. Conclusion: Provided that TLH is car ried out with reusable laparoscopic surgery equipment, by skilled surgeons working in suitable hospital structures making the particularly heavy inves tment in laparoscopic surgery equipment economically viable, TLH is an econ omically viable technique as an alternative to laparotomy. (C) 2000 Publish ed by Elsevier Science Ireland Ltd. All rights reserved.