In Pursuit of the Most Cost-Effective Laparoscopic Appendicectomy: A Review of the Literature

Purpose To review the literature and identify the most economical techniques for laparoscopic appendicectomy (LA) that do not compromise on patient care. Methods We performed a search of the Cochrane Library, PubMed, EMBASE and Google Scholar for papers published between January 2001 and January 2021. The outcomes of the included studies were then grouped by theme of cost analysis, with the main areas of focus being the use of disposable equipment, appendiceal stump closure, and retrieval of the appendix. Results After screening a total of 254 search results, 40 studies were included, representing 13 285 patient outcomes, having two main areas of focus: the use of reusable or disposable equipment and the different methods of appendiceal stump closure. Use of disposable instruments has been cost effective in LA in 2 studies. However, use of reusable trocars has reduced cost of procedure by euro250 in another study. Appendiceal stump closure using ligature, endoloops or Endoclips had been cost-effective compared to Endostaplers in 25 studies. This can save up to euro350. Endoscopic specimen bags are single use and represent further disposable equipment costs. The use of a sterile glove to replace this piece of kit can further provide cost benefit as shown in 2 studies. Conclusion Laparoscopic appendicectomy can be performed in a variety of ways with equivocal patient safety. We present the use of extracorporeal ligature of the appendiceal base, combined with the use of a surgical glove retrieval system as the most economic technique in laparoscopic appendicectomy.