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Background: Single incision laparoscopic surgery (SILS), particularly laparoscopic cholecystectomy (SILS-C), has been advocated as both a means of improving standard 4-port laparoscopic cholecystectomy (LC) and as a stepping-stone to natural orifice trans-luminal endoscopic surgery (NOTES). Data has been conflicting as to whether SILS-C accomplishes its main goals of improved cosmesis and less pain, while meeting all other requirements of a cholecystectomy. We performed a value analysis of SILS-C compared to standard LC using the generally accepted definition of value = quality/costs.
Methods: The direct supply costs for both SILS-C and LC from our institution were obtained. In addition, the extant literature on SILS-C was review for operating room costs, as well as measures of quality pertaining to pain control and cosmesis were obtained. The incremental costs of each unit of improvement in quality were calculated.
Results: The direct supply costs of SILS-C was \,582.90 compared to \.30 for LC. Published operating room costs were \,109 for SILS-C compared to \,069 for LC. However, average reimbursement was \,602 for SILS-C compared to \,403 for LC. Assessment of pain varied among study, however, standardizing assessment of pain across studies was done, with SILS-C having a 0.1 unit improvement, for a cost of \ per unit improvement using published operating room costs. Assessment of cosmesis yield a cost for unit improvement varied between \-\. These costs would be more is just the direct supply costs were the primary driver of value and reimbursement is less.
Conclusions: It does not appear that SILS-C provides value for the patient and hospital. Improved pain control and cosmesis is not consistent among studies published, and the costs for each unit improvement variable depending on which costs data are important, but consistently higher. Couple this with less reimbursement, the value of SILS-C is questionable.