Costs and benefits of laparoscopic surgery--a review of the literature.

The purpose of this paper is to look at the cost-effectiveness of laparoscopic surgery in relation to conventional open surgery. It focuses both on the results and the methods, and aims to identify the need for further studies as well as the appropriate methods of economic evaluation. We searched the literature and identified studies in which "cost" or "cost-effectiveness" was mentioned in relation to open and laparoscopic surgery. Laparoscopic and open surgery were compared for gallbladder disease, inguinal hernia and gastro-oesophageal reflux disease (GORD). Finally, we reviewed studies that focused on cost comparisons of disposable compared with reusable instruments in laparoscopic surgery. We found that the evidence on whether laparoscopic surgery results in lower costs for the health care system than open operations is not conclusive. There are, however, indications that it results in savings in indirect costs from reduced periods of sick leave. There is also an indication that reusable instruments resulted in lower costs for each operation than disposable instruments. We conclude that a prospective, randomised study is the preferred study design in the early stage of the development of a new technique, when it is not fully obvious what the indications for the new technique are. This should be considered when doing economic evaluations of new indications for laparoscopic surgery, for example appendicectomy and non-inguinal hernia repair.