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Basso et al. Mini-invasive distal pancreatectomy

Table 3: Correlations between OT or hospital LoS and age, BMI, and IB
ODP LDP
Parameters
R Regression line equation P-value R Regression line equation P-value
OT/age -0.0015 Age = 68.6746 - 0.0029 OT 0.9963 0.3378 Age = 61.2656 + 0.0754 OT 0.2259
OT/BMI 0.7873 BMI = 13.2375 + 0.0692 OT 0.0024 0.5337 BMI = 20.2266 + 0.0620 OT 0.0739
OT/IB 0.6159 IB = 0.5848 OT - 14.6706 OT 0.0330 0.7973 IB = 67.5333 + 0.9181 OT 0.0019
LoS/age 0.5780 Age = 43.3988 + 2.4269 LoS 0.0490 0.1556 Age = 50.6381 + 1.5396 LoS 0.6291
LoS/OT 0.4487 OT = 17.1067 + 9.4382 LoS 0.1434 0.5979 OT = 110.7816 + 10.7280 LoS 0.0399
LoS/IB 0.1482 IB = 98.0898 + 5.8427 LoS 0.6357 0.8284 IB = 14.1113 - 3.2334 LoS 0.0009
OT: operative time; LoS: length of stay; BMI: body mass index; IB: intraoperative bleeding; ODP: open distal pancreatectomy; LDP:
laparoscopic distal pancreatectomy
Table 4: Hospital length of stay, median operative costs, and total costs according to the type of pancreatectomy
Parameters LDP ODP P-value
Hospital length of stay (days) 8.08 ± 1.88 11.17 ± 1.64 0.0003
Estimated median operative costs (Euros):
Spleen-preserving 1,401 863
No spleen-preserving 1,641 986
Estimated hospital stay costs (Euros):
Median (range) 3,768 (2,355-5,652) 5,416.5 (4,239-6,594)
Mean 3,807.25 ± 885.92 5,259.5 ± 773.5 0.0004
Estimated median total costs (Euros) 5,169 6,279.5
ODP: open distal pancreatectomy; LDP: laparoscopic distal pancreatectomy
A The patients were started on a fluid diet on the 1st
postoperative day and the diet was advanced to soft
food as tolerated (LDP 2.4 ± 0.7 vs. ODP 3.4 ± 1.4
days). The hospital LoS was 8.1 ± 1.88 days (median
8, range 5 to 12) in LDP vs. 11.2 ± 1.6 (median 11,
range 9 to 14) days in ODP, and the readmission rate
was 8.3% in both groups. One patient in both groups
developed a pancreatic fistula (Grade B), but no
perioperative mortality occurred.

For a single LDP, a cost of €1,401 was calculated
(energy devices, disposable trocars, and Endopouch),
increased to €1,641 in cases of no spleen-preserving
LDP (9 patients), which required a vascular cartridge
B and Haemoclips. For the open approach, an
additional cost of €863 was required for the use of the
Harmonic Focus, sutures, and more gauzes (€986 for
non-spleen-preserving procedures). The global cost
for LDP was €537 more than for an open surgery for
each procedure. Calculating intra- and post-operative
costs, we found an additional cost of €402 per patient
for the minimally invasive technique.

The cost for a single day of hospital stay was on average
€471 in our region (Lombardy). Thus, calculating the
costs for the longer LoS in ODP vs. LDP (median
11.5 vs. 8.0), showed that there is a cost advantage
favoring the minimally invasive approach vs. the open
Figure 2: Relationship between operative time (min), body mass technique (€3,807.25 ± 885.92 vs. €5,259.5 ± 773.5).
2
index (kg/cm ) and intraoperative bleeding (mL) in (A) laparoscopic Table 4 summarizes LoS and total costs of patients
distal pancreatectomy patients and (B) open distal pancreatectomy
patients who underwent LDP vs. ODP.
136 Mini-invasive Surgery ¦ Volume 1 ¦ September 30