Use of laparoscopic splenectomy in developing countries: Analysis of cost and strategies for reducing cost

Background: In general, laparoscopic surgery is more expensive than open surgery. However, recent reports showed lower overall cost. Patient and Methods: Fourteen patients underwent laparoscopic splenectomy (LS) and 15 patients open splenectomy (OS). Patients were evaluated with regard to blood loss, complication rate, length of hospital stay, operative time, presence of accessory spleens, hospital cost, and total cost. For the OS group, there was no laparoscopic instrument cost, and the total cost was equal to the hospital cost. In the LS group, total cost was calculated by adding the hospital cost to the cost of laparoscopic instruments. Results: The postoperative hospitalization was shorter in the LS group than the OS group (3.4 vs. 7.5 days), but the operating time was significantly longer for the LS group. The mean hospital cost was calculated as US$1055 in the LS group and $1664 in the OS group. The overall total cost was $1664 for the OS group and $2064 for the LS group. In the LS group, less morbidity and shorter postoperative hospital stay resulted in lower hospital cost. Conclusion: The cost for laparoscopic instruments is the main factor responsible for the high total cost of LS. Resterilization of disposable laparoscopic instruments is feasible and a more economic way of treatment compared with splenectomy with totally disposable laparoscopic instruments and has costs comparable to those of open surgery.