Introduction of laparoscopic gastrectomy for gastric cancer in a Western tertiary referral centre: A prospective cost analysis during the learning curve

Table 1 Costs of disposable instruments for laparoscopic surgery and open surgery

Item	Price
Laparoscopic surgery
Ligasure Impact 5 mm, Medtronic, Ireland1	€ 448.22
Ligasure Impact 10 mm, Medtronic, Ireland1	€ 376.00
Autosuture endobag, endocatch, Medtronic, Ireland1	€ 63.56
Autosuture EndoGIA 12 mm, Medtronic, Ireland1	€ 203.00
Reload EndoGIA purple 45, Medtronic, Ireland1	€ 173.00
Reload EndoGIA purple 60, Medtronic, Ireland1	€ 176.00
Reload EndoGIA Gold 45, Medtronic, Ireland1	€ 181.00
Endopaddle 12 mm, Medtronic, Ireland1	€ 81.84
Alexis small/medium, applied medical	€ 31.00
Endoshear 5 mm, Medtronic, Ireland1	€ 73.50
EEA XL, Covidien United States	€ 439.62
EEA Orvil, Covidien United States	€ 94.20
Bladeless trocar 5 mm, Medtronic, Ireland1	€ 48.88
Bladeless trocar 5-12 mm, Medtronic, Ireland1	€ 48.88
Blunt trocar 5-12 mm, Medtronic, Ireland1	€ 47.81
Pyramidal bladed trocar 10-15 mm, Medtronic, Ireland1	€ 80.43
Hem-o-lok L filling, Weck United States	€ 23.00
Hem-o-lok XL filling, Weck United States	€ 23.00
Open surgery
Ligasure Impact, Medtronic, Ireland1	€ 343.80
Purssting stapler, Medtronic, Ireland1	€ 57.34
TA Green 30, Medtronic, Ireland1	€ 106.30
Reload TA Green 30, Medtronic, Ireland1	€ 60.50
TA Green 60, Medtronic, Ireland1	€ 110.09
Reload TA Green 60, Medtronic, Ireland1	€ 65.00
GIA Blue 60, Medtronic, Ireland1	€ 119.68
Reload GIA Blue 60, Medtronic, Ireland1	€ 75.51
GIA Blue 80, Medtronic, Ireland1	€ 147.48
Reload GIA Blue 80, Medtronic, Ireland1	€ 81.74
GIA Green 80, Medtronic, Ireland1	€ 148.96
Reload GIA Green 80, Medtronic, Ireland1	€ 81.74
CEEA 21, Medtronic, Ireland1	€ 408.97
CEEA 25, Medtronic, Ireland1	€ 384.48
CEEA 28, Medtronic, Ireland1	€ 388.33
CEEA 25 XL, Medtronic, Ireland1	€ 439.62

¹Formerly Covidien United States.

Table 2 Baseline characteristics n (%)

	Open gastrectomy (n = 25, 32%)	Laparoscopic gastrectomy (n = 52, 68%)	P value
Age	70.0 (± 10, 46-85)	68 ± 9, 50-87)	0.470
Sex (male/female)	17/8	32/20	0.623
BMI1	25 ± 4, 18-36	25 ± 5, 15-38	0.824
CCI2			0.158
0-2	16 (64)	27 (52)
3-4	7(28)	11 (21)
> 4	2 (8)	14 (27)
Tumour stage3			0.681
0	0 (0.0)	2 (4)
11	4 (16)	11 (21)
12	6 (24)	15 (29)
2	5 (20)	4 (8)
31	4 (16)	10 (19)
32	3 (12)	4 (8)
4	3 (12)	6 (11)
Subtotal gastrectomy	16 (64)	38 (73)	0.436
Total gastrectomy	9 (36)	14 (27)
Neoadjuvant chemotherapy	11 (44)	36 (69)	0.046

¹BMI: Body mass index in kg/cm²;

²CCI: Charlson comorbidity index;

³In accordance with tumor node metastasis 5^th edition.

Table 3 Primary outcome, costs of surgery, hospital admission and intensive care unit stay

Costs (in euro's)	Open gastrectomy (n = 25, 32.5%)	Laparoscopic gastrectomy (n = 52, 67.5%)	P value
Surgical instrumentation	1181 ± 680	2270 ± 670	< 0.001
Operating theatre use	2545 ± 1268	3819 ± 865	< 0.001
Ward stay	2218 ± 1810	1381 ± 1298	0.023
ICU stay	1729 ± 6499	716 ± 3299	0.366
Admission	3947 ± 6719	2097 ± 4419	0.153
Total costs	7673 ± 8064	8187 ± 4864	0.729

ICU: Intensive care unit.

Table 4 Secondary outcome parameters

	Open gastrectomy (n = 25, 32.5%)	Laparoscopic gastrectomy (n = 52, 67.5%)	P value
Intraoperative blood loss (mL)	592 (± 529, 100-2500)	267 (± 316, 20-2000)1	0.002
OR time (min)	191 (± 95, range 95-554)	286 (± 65, range 207-597)	< 0.001
Lymph node yield (n)	25 (± 10, 751)	26 (± 8, 10-47)	0.651
Any complication	15 (60%)	16 (31%)	0.025
Grade Clavien-Dindo ≥ 3a	7 (28%)	6 (12%)	0.104
Anastomotic leakage	3 (12%)	2 (4%)	0.322
Mean length of stay (d)	15 (± 14, 5-59)	9 (± 12, 2-84)	0.044
Mean ICU stay (d)	3 (± 10, 0-49)	1 (± 5, 0-35)	0.366
Readmission	4 (16%)	6 (12%)	0.720

¹Five missing values for intraoperative blood loss in laparoscopic group. ICU: Intensive care unit.