LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.34635/rpc.607 |
Resumo: | Introduction: The rational use of resources and the need to standardize procedures are today’s priorities for the sustainability of health care, and a drive force to raise surgical results. The aims of this study are to evaluate the adoption of a low cost laparoscopic cholecystectomy protocol, identify predictive factors for difficult cases, and evaluate the economical impact of this strategy. Material and Methods: Two teams led by the same surgeon, done and prospectively recorded 100 consecutives laparoscopic cholecystectomies between the 8th of April and the 18th of November 2014. Excluding criteria were acute cholecystitis at the emergency unit, common bile duct lithiasis and suspicious of gallbladder cancer. Interventions were video recorded and main steps photographed. Data included demographic, operative risk, BMI, previous biliary symptoms, biochemistry and ultrasound registries, protocol fulfilment, surgery time, surgical landmarks identification and postoperative evolution. Statistical analysis used SPSS® with Student-t test and one-way Anova tests. Significant statistical results for p<0,05. Results: three quarters of females, an average of 53 years old and medium BMI of 27. Total time of surgery of 39 minutes, including 7 minutes for gallbladder hilum ligation. Fulfillment of low-cost protocol in 93% of the cases. All patients were discharged home within 23 hours after the operation. Risk factors for prolonged surgery time and protocol break were obesity, male gender and previous biliary events. Conversion rate nil. No major complications. Series total costs with disposable surgical instruments of 574 Euros. Conclusion: Low-cost approach for laparoscopic cholecystectomy can be introduced with a protocol starting with low risk patients. Economic impact can be highly relevant. Clinical risks seem to be negligible. |
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LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIESLAPAROSCOPIA POR CUSTO MÍNIMO – ESTUDO PROSPETIVOOBSERVACIONAL DE 100 COLECISTECTOMIAS CONSECUTIVASIntroduction: The rational use of resources and the need to standardize procedures are today’s priorities for the sustainability of health care, and a drive force to raise surgical results. The aims of this study are to evaluate the adoption of a low cost laparoscopic cholecystectomy protocol, identify predictive factors for difficult cases, and evaluate the economical impact of this strategy. Material and Methods: Two teams led by the same surgeon, done and prospectively recorded 100 consecutives laparoscopic cholecystectomies between the 8th of April and the 18th of November 2014. Excluding criteria were acute cholecystitis at the emergency unit, common bile duct lithiasis and suspicious of gallbladder cancer. Interventions were video recorded and main steps photographed. Data included demographic, operative risk, BMI, previous biliary symptoms, biochemistry and ultrasound registries, protocol fulfilment, surgery time, surgical landmarks identification and postoperative evolution. Statistical analysis used SPSS® with Student-t test and one-way Anova tests. Significant statistical results for p<0,05. Results: three quarters of females, an average of 53 years old and medium BMI of 27. Total time of surgery of 39 minutes, including 7 minutes for gallbladder hilum ligation. Fulfillment of low-cost protocol in 93% of the cases. All patients were discharged home within 23 hours after the operation. Risk factors for prolonged surgery time and protocol break were obesity, male gender and previous biliary events. Conversion rate nil. No major complications. Series total costs with disposable surgical instruments of 574 Euros. Conclusion: Low-cost approach for laparoscopic cholecystectomy can be introduced with a protocol starting with low risk patients. Economic impact can be highly relevant. Clinical risks seem to be negligible. Introdução: A racionalização de recursos e a necessidade de padronização de técnicas para avaliar resultados, são hoje indispensáveis para a sustentabilidade e incremento de qualidade da cirurgia. Os objetivos deste trabalho são avaliar a implementação de um programa de custo mínimo para colecistectomia por via laparoscópica, identificar fatores preditivos de cumprimento de protocolo de custo mínimo, e avaliar o impacto económico desta estratégia. Material e métodos: Duas equipas lideradas pelo mesmo cirurgião, realizaram e registaram prospectivamente 100 colecistectomias consecutivas entre 8 de abril e 18 de novembro de 2014. Excluíram-se todos os casos de colecistite aguda em urgência, exploração da via biliar principal por litíase e suspeita de carcinoma da vesícula. As cirurgias foram gravadas em vídeo e fotografados os pontos determinantes. Analisaram-se dados demográficos, risco cirúrgico, IMC, história prévia biliar, estudo analítico e ecográfico, cumprimento do protocolo, tempos da cirurgia, identificação de estruturas, pós-operatório imediato e na primeira consulta. Exportação de dados para SPSS® e utilização dos testes de t de Student e One-Way Anova. Considerou-se significância estatística para p<0,05. Resultados: 76% do sexo feminino; idade média de 53,3 anos; IMC 26,87; tempo cirúrgico médio 39 min; tempo médio de laqueação do hilo vesicular 7 min; protocolo totalmente cumprido a “custo mínimo” em 93% dos casos; internamento menor do que 23 horas em 100%; uma infeção de ferida operatória; nenhuma conversão para laparotomia; nenhuma complicação major; Fatores com impacto no tempo e dificuldade: obesidade, género masculino, história prévia de litíase biliar complicada. Gastos totais de 574 Euros em toda a série com material descartável. Discussão: A abordagem de custo mínimo para a colecistectomia laparoscópica pode ser implementada de forma sistemática com um impacto económico muito relevante. Os riscos da sua implementação parecem mínimos ou inexistentes. Sociedade Portuguesa de Cirurgia2021-01-20info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.34635/rpc.607https://doi.org/10.34635/rpc.607Revista Portuguesa de Cirurgia; No 49 (2020): Number 49 - December 2020; 24-33Revista Portuguesa de Cirurgia; No 49 (2020): Number 49 - December 2020; 24-332183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spcir.com/index.php/spcir/article/view/607https://revista.spcir.com/index.php/spcir/article/view/607/580Copyright (c) 2021 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessVilaça, JaimeLencastre, LuísMiranda, FranciscoCabral, JorgeFonte Boa, Ana2024-02-22T22:32:52Zoai:revista.spcir.com:article/607Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:10:57.913163Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES LAPAROSCOPIA POR CUSTO MÍNIMO – ESTUDO PROSPETIVOOBSERVACIONAL DE 100 COLECISTECTOMIAS CONSECUTIVAS |
title |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
spellingShingle |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES Vilaça, Jaime |
title_short |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
title_full |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
title_fullStr |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
title_full_unstemmed |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
title_sort |
LAPAROSCOPY AT MINIMAL COST – PROSPECTIVE OBSERVATIONAL STUDY OF 100 CONSECUTIVE CHOLECYSTECTOMIES |
author |
Vilaça, Jaime |
author_facet |
Vilaça, Jaime Lencastre, Luís Miranda, Francisco Cabral, Jorge Fonte Boa, Ana |
author_role |
author |
author2 |
Lencastre, Luís Miranda, Francisco Cabral, Jorge Fonte Boa, Ana |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Vilaça, Jaime Lencastre, Luís Miranda, Francisco Cabral, Jorge Fonte Boa, Ana |
description |
Introduction: The rational use of resources and the need to standardize procedures are today’s priorities for the sustainability of health care, and a drive force to raise surgical results. The aims of this study are to evaluate the adoption of a low cost laparoscopic cholecystectomy protocol, identify predictive factors for difficult cases, and evaluate the economical impact of this strategy. Material and Methods: Two teams led by the same surgeon, done and prospectively recorded 100 consecutives laparoscopic cholecystectomies between the 8th of April and the 18th of November 2014. Excluding criteria were acute cholecystitis at the emergency unit, common bile duct lithiasis and suspicious of gallbladder cancer. Interventions were video recorded and main steps photographed. Data included demographic, operative risk, BMI, previous biliary symptoms, biochemistry and ultrasound registries, protocol fulfilment, surgery time, surgical landmarks identification and postoperative evolution. Statistical analysis used SPSS® with Student-t test and one-way Anova tests. Significant statistical results for p<0,05. Results: three quarters of females, an average of 53 years old and medium BMI of 27. Total time of surgery of 39 minutes, including 7 minutes for gallbladder hilum ligation. Fulfillment of low-cost protocol in 93% of the cases. All patients were discharged home within 23 hours after the operation. Risk factors for prolonged surgery time and protocol break were obesity, male gender and previous biliary events. Conversion rate nil. No major complications. Series total costs with disposable surgical instruments of 574 Euros. Conclusion: Low-cost approach for laparoscopic cholecystectomy can be introduced with a protocol starting with low risk patients. Economic impact can be highly relevant. Clinical risks seem to be negligible. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-01-20 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.34635/rpc.607 https://doi.org/10.34635/rpc.607 |
url |
https://doi.org/10.34635/rpc.607 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/607 https://revista.spcir.com/index.php/spcir/article/view/607/580 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2021 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2021 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
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Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No 49 (2020): Number 49 - December 2020; 24-33 Revista Portuguesa de Cirurgia; No 49 (2020): Number 49 - December 2020; 24-33 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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