Towards cost saving in surgery without compromising safety: stapleless laparoscopic splenectomy in a developing country—a prospective cohort study

BackgroundMinimally invasive surgery has been steadily growing in popularity. Control of splenic hilar vessels is the most delicate step during laparoscopic splenectomy (LS). In the earlier eras of LS, hilar vessels were controlled using clips and/or ligation. Laparoscopic staples were later introdu...

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Bibliographic Details
Published in:BMJ open quality 2023-01, Vol.12 (1), p.e002068
Main Authors: Lasheen, Omar, Yehia, Mohamed, Salah, Ayman, Mikhail, Sameh, Hassan, Ahmed
Format: Article
Language:English
Subjects:
Abdomen
Cohort analysis
Comparative effectiveness research
Cost Savings
Cost-effectiveness
Developing Countries
Dissection
Equipment and Supplies
Equipment Safety
Hematology
Humans
Laparoscopy
Laparoscopy - adverse effects
Laparoscopy - methods
Minimally invasive surgery
Original Research
Patients
Prospective Studies
Spleen
Splenectomy - adverse effects
Splenectomy - methods
Surgery
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Summary:BackgroundMinimally invasive surgery has been steadily growing in popularity. Control of splenic hilar vessels is the most delicate step during laparoscopic splenectomy (LS). In the earlier eras of LS, hilar vessels were controlled using clips and/or ligation. Laparoscopic staples were later introduced and have arguably led to an increase in popularity of LS. They do not abolish potential complications of splenectomy and theoretically represent an added operative cost.In this study, we aimed to assess the safety and efficacy of stapleless LS (using knots, haemostatic devices and clips) compared with the now more conventional stapled LS.MethodsA pilot randomised prospective study was conducted in a university hospital between September 2018 and April 2020. It included 40 patients randomly assigned to two equal groups: (1) 20 patients: stapleless LS and (2) 20 patients: LS using laparoscopic staples.We compared operative time, intra and postoperative complications and postoperative recovery.ResultsThere was no statistically significant difference between both groups across all comparative outcomes.ConclusionBoth techniques are comparable in terms of safety and operative time. In terms of cost efficiency, we recommend more comprehensive analyses of hospital costs.
ISSN:2399-6641
2399-6641
DOI:10.1136/bmjoq-2022-002068