The benefits of a dedicated minimally invasive surgery program to academic general surgery practice.

In 2001, a dedicated minimally invasive surgery (MIS) program was established at a large university hospital. Changes included improvement and standardization of equipment and instruments, patient care protocols, standardized orders, and staff education. The aim of this study was to evaluate the impact of this program on an academic surgery practice. From January 1999 through October 2003, hospital and departmental databases were reviewed for all records pertaining to general surgery cases. Data trends were analyzed by regression analysis and are expressed as mean +/- SEM. In 1999, 15.0 +/- 0.1% of all general surgery cases were MIS cases compared with 30.2 +/- 0.1% in 2003 (P < 0.0001). During this period, the number of patients requiring conversion from a laparoscopic to an open approach decreased from 14.4% to 4.0% (P = 0.0007). In 1999, 30% of appendectomies were laparoscopic, compared with 92% in 2003 (P < 0.0001). This increase in the rate of laparoscopic appendectomy resulted in a decrease in average length of hospital stay for all patients with acute appendicitis, from 5.5 +/- 1.0 days in 1999 to 2.7 +/- 0.2 days in 2003 (P < 0.0001), and a decrease in total hospital cost per case, from 6569 +/- 400 US dollars in 1999 to 4819 +/- 175 US dollars in 2002 (P < 0.001). Total operating room time per case for cholecystectomy decreased from 131 +/- 3.7 to 108 +/- 3.2 minutes (P < 0.0001), and actual surgery time decreased from 95 +/- 4.1 to 74 +/- 4.0 minutes (P = 0.0006). Implementation of a dedicated MIS program resulted in a significant increase in the number of MIS cases and percentage of general surgery cases performed by MIS. This increase in the utilization of MIS resulted in reduced length of stay and cost and has been accompanied by improvements in operating room efficiency. Changes in practice associated with development of an MIS program have had measurable institutional benefits.