Comparative financial analysis of minimally invasive surgery to open surgery for small renal tumours < or =3.5 cm: a single institutional experience.

OBJECTIVE: We analysed total hospital costs by comparing minimally invasive surgery (MIS) procedures, such as laparoscopic cryoablation (LCA), laparoscopic partial nephrectomy (LPN), and hand-assisted laparoscopic nephrectomy (HALN), with conventional surgery.

METHODS: Between March 2000 and July 2005, 184 consecutive patients underwent surgery for a small, organ-confined renal tumour < or =3.5 cm in diameter. The distribution of patients among the surgical procedures was: HALN (n=53); LPN (n=20); open radical nephrectomy (ORN; n=20); open partial nephrectomy (OPN; n=71); and LCA (n=20). Total hospital costs were analysed for each procedure.

RESULTS: Patients undergoing OPN at a mean age of 58+/-13 yr were significantly younger those undergoing HALN, ORN, and LCA. The mean hospital length of stay in the LCA group (2.0+/-1.2 d) was shorter than all other groups (p<0.05). Higher surgical costs occurred with LCA, LPN, and HALN compared (p<0.05) with ORN and OPN. However, total financial costs were lower for LCA and HALN with more obvious differences between LCA and the other four groups.

CONCLUSIONS: The costs of MIS remain competitive with traditional surgery. Although the surgical costs were higher, LCA had the lowest total hospital costs for the renal tumour < or =3.5 cm at our institution. Long-term oncologic efficacy studies will be needed to fully appreciate the cost-efficacy ratio of MIS.