Laparoscopic Subtotal Hysterectomy:
Implications and Cost-effectiveness, Our First Experience
Department of Obstetrics & Gynaecology, Wishaw General Hospital, NHS Lanarkshire
SUMMARY
Laparoscopic subtotal hysterectomy (LASH) has been performed in our district general hospital since 2008 for benign gynaecological menstrual abnormalities. Of the 60 consecutive cases analysed, there was a low incidence of complications, minimal blood loss and short hospital stay.
INTRODUCTION
The laparoscopic approach for subtotal hysterectomy has gained popularity and acceptance amongst surgeons and patients, with shorter recovery time, return to work and normal sexual function. These translate themselves into improved health outcomes for the patients as well providing a cost-effective surgical treatment option.
MATERIALS & METHODS
Information on women undergoing LASH was collected from 60 consecutive cases between August 2008 – December 2011. The data was retrieved from case-records and logged on a computerised database.
Data on operative indications, safety and the cost of inpatient LASH in our DGH were the primary outcomes measured.
The surgical approach was through four laparoscopic ports as previously described by Errian et al. using disposable instruments.
RESULTS
The main indication for LASH was menorrhagia. 88.3% of patients had failed medical or hormonal manipulation.
The mean operating theatre time was 2.3 hours (range 1 hour – 5 hours) with mean blood loss of 99ml. Inpatient stay was on average 1.7 nights (range 1-5).
There was one pelvic haematoma, two wound infections and a case of ureteric oedema. Two patients had neuralgic pain at the port site insertion points 6 weeks post op.
The average operative cost was £1348.44 with an average cost of hospital stay of £826.20, giving a total cost per procedure of £2714.20. The average cost of an abdominal hysterectomy is approximately £2213.20.
DISCUSSION
Health
The reduced blood loss, shorter hospital stay and quicker recovery work in the favour of choosing LASH.
Cost
A recent analysis comparing endometrial ablation techniques, hysterectomy and the Mirena IUS found the incremental cost effectiveness ratio for first-line hysterectomy compared to second generation endometrial ablation and IUS use is £970 and £1440 per additional QALY respectively.
The cost of laparoscopic hysterectomy has also been shown to be comparable to abdominal hysterectomy. A consideration might be given to reducing cost for LASH procedures by using reusable equipment.