Robert E. Glasgow, Kathy A. Adamson, Sean J. Mulvihill, University of Utah, Salt Lake City, UT

In 2001, a dedicated minimally invasive surgery (MIS) program was established at a large, university hospital. Changes implemented included improvement and standardization of equipment and instruments, uniform patient care protocols, and staff/surgeon education. The aim of this study is to evaluate the impact of this program on academic surgery practice, including surgical volumes and approaches, operating room efficiency, and cost. From January 1999 thru October 2003, hospital and departmental databases were reviewed for all records pertaining to general surgery cases. Data were analyzed monthly and are shown as the monthly mean (SEM) for each year studied. Data trends were analyzed by regression analysis. In 1999, 15.0 (0.1)% of all general surgery cases were MIS compared to 30.2 (0.1)% in 2003 (p<0.0001). During this period, the number of patients requiring open cholecystectomy or conversion from a laparoscopic to open approach decreased from 23.4% to 4.0% (p=0.0007). In 1999, 30% of appendectomies were laparoscopic compared to 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 (400) in 1999 to (175) in 2002 (p<0.001). For laparoscopic cholecystectomy, average disposable instrument costs decreased from to per case. Total operating room time per case 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 has 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 has resulted in a reduction in length of hospital stay and direct cost and has been accompanied by an improvement in surgical and operating room efficiency. A dedicated MIS program is an asset and worthwhile investment for academic surgery departments and hospitals.