Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures

Roumm, Adam R.; Pizzi, Laura; Goldfarb, Neil I.; Cohn, Herbert
September 2005
Surgical Innovation;Sep2005, Vol. 12 Issue 3, p261
Academic Journal
journal article
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.


Related Articles

  • Laparoscopic Surgery–15 Years After Clinical Introduction. Bittner, Reinhard // World Journal of Surgery;Jul2006, Vol. 30 Issue 7, p1190 

    The article reflects on the development of laparoscopic surgery. The author agreed in the contribution of laparoscopic surgery in enhancing surgical techniques thus providing patient who undergone the operation with less complications and shorter hospitalization but criticizes the expensiveness...

  • Perspectives of Laparoscopic Donors Toward a New Procedure: Transvaginal Donor Nephrectomy. Olakkengil, Santosh Antony; Norwood, Michael G.A.; Strickland, Andrew D.; Behnia-Willison, Fariba; Mohan Rao, Manchala; Hewett, Peter J. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Dec2010, Vol. 20 Issue 10, p803 

    Background: Interest in natural orifice transluminal endoscopic surgery (NOTES) is increasing. Transvaginal NOTES (TVNOTES) donor nephrectomy with subsequent removal of the kidney via the vagina is technically possible. This approach may minimize the surgical insult to the donor and allow...

  • The use of self-gripping (Progripâ„¢) mesh during laparoscopic total extraperitoneal (TEP) inguinal hernia repair: a prospective feasibility and long-term outcomes study. Bresnahan, Erin; Bates, Andrew; Wu, Andrew; Reiner, Mark; Jacob, Brian // Surgical Endoscopy;Sep2015, Vol. 29 Issue 9, p2690 

    Background: The use of self-gripping mesh during laparoscopic TEP inguinal hernia repairs may eliminate the need for any additional fixation, and thus reduce post-operative pain without the added concern for mesh migration. Long-term outcomes are not yet prospectively studied in a controlled...

  • Laparoscopic Surgery by Single Incision: Future of Minimal Access Surgery. Mishra, R. K. // World Journal of Laparoscopic Surgery;Sep-Dec2010, Vol. 3 Issue 3, preceding p109 

    The author explores the application of single incision laparoscopic surgery (SILS). He explains the process of conducting SILS. He claims that increasing uptake of minimally invasive techniques has impacted several areas of surgery. He addresses the lack of informaiton on the etiology, biology...

  • Laparoscopic, minilaparoscopic and single-port hysterectomy: perioperative outcomes. Fanfani, Francesco; Fagotti, Anna; Rossitto, Cristiano; Gagliardi, Maria; Ercoli, Alfredo; Gallotta, Valerio; Gueli Alletti, Salvatore; Monterossi, Giorgia; Turco, Luigi; Scambia, Giovanni // Surgical Endoscopy;Dec2012, Vol. 26 Issue 12, p3592 

    Objective: This study was designed to compare perioperative outcomes and postoperative pain of standard laparoscopic (S-LPS), minilaparoscopic (M-LPS), and laparoendoscopic single-site (LESS) hysterectomy. Methods: A single-institutional, matched, retrospective, cohort study was performed....

  • Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Zornig, C.; Mofid, H.; Emmermann, A.; Alm, M.; von Waldenfels, H.-A.; Felixmüller, C. // Surgical Endoscopy;Jun2008, Vol. 22 Issue 6, p1427 

    Laparoscopic surgery has dramatically improved surgical care of patients reducing postoperative pain, wound infection rate, hospital stay, inability to work, risk of hernia, and cosmetic result. Natural orifice transluminal endoscopic surgery (NOTES) is even less traumatic to the abdominal wall...

  • Single-Incision Laparoscopic Placement of an Adjustable Gastric Band versus Conventional Multiport Laparoscopic Gastric Banding: A Comparative Study. SABER, ALAN A.; EL-GHAZALY, TAREK H.; ELAIN, ALAIN; DEWOOLKAR, ADITYA V. // American Surgeon;Dec2010, Vol. 76 Issue 12, p1328 

    Single-incision laparoscopic surgery (SILSâ„¢) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery nationwide. Having achieved a rapid crossover to the realm of advanced surgical procedures, SILSTM has shown remarkable versatility and...

  • Single-incision laparoscopic cholecystectomy: is it more than a challenge? Ersin, Sinan; Firat, Ozgur; Sozbilen, Murat // Surgical Endoscopy;Jan2010, Vol. 24 Issue 1, p68 

    Single-incision laparoscopic surgery (SILS) is a promising technique with regard to reducing postoperative pain, decreasing complications, and improving cosmesis. Between September 2008 and April 2009, 20 patients underwent cholecystectomy via SILS. The umblicus was the access point of entry to...

  • Single incision laparoscopic surgery for appendicectomy: a retrospective comparative analysis. Chow, Andre; Purkayastha, Sanjay; Nehme, Jean; Darzi, Lord; Paraskeva, Paraskevas // Surgical Endoscopy;Oct2010, Vol. 24 Issue 10, p2567 

    Background: Single incision laparoscopic surgery (SILS) may further reduce the trauma of surgery leading to reduced port site complications and postoperative pain. The improved cosmetic result also may lead to improved patient satisfaction with surgery. Methods: Data were prospectively collected...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics