Abstract
Introduction
An important fact when facing new technologies is their cost for the Health Publishes. The purpose of this paper is to compare the costs of performing TEM with harmonic scalpel and classic monopolar scalpel and to analyze complications.
Methods
Operation time, blood loss, and hospital stay were recorded to determine the cost of the TEM procedure. We also recorded early and late complications. Patients were divided in two groups: harmonic scalpel group (UC) and monopolar scalpel group (MS).
Results
TEM for curative intention was used in 330 rectal tumors from January 1997 to January 2010. A total of 229 patients met the criteria for this study: UC group (n = 87) and MS group (n = 142). Patients from the UC group developed fewer complications (16%) than patients from the MS group (23%). The difference of mean stay between groups was 1.5 days (95% confidence interval, 0.7; 2.2 days; P < 0.001) in favor of the UC group.
Conclusions
Harmonic scalpel provides a safer, easier, and more precise surgical section through clean, bloodless, and better visualized operative field. The additional cost of UC was compensated with the decrease in the health resources (mainly hospital stay).
Similar content being viewed by others
References
Büess G, Hutterer F, Theis J, Böbel M, Isselhard W, Pichlmaier (1984) Das system für die transanale endoskopische rektumoperation. Chirurg 55:677–680
Maslekar S, Pillinger SH, Monson JR (2007) Transanal endoscopic microsurgery for carcinoma of the rectum. Surg Endosc 21:97–102
Middleton PF, Sutherland LM, Maddern GJ (2005) Transanal endoscopic microsurgery: a systematic review. Dis Colon Rectum 48:270–284
Ramirez JM, Aguilella V, Gracia JA, Ortego J, Escudero P, Valencia J, Esco R, Martinez M (2009) Local full-thickness excision as first line treatment for sessile rectal adenomas: long-term results. Ann Surg 249:225–228
Lirici MM, Di Paola M, Ponzano C, Hüscher CG (2003) Combining ultrasonic dissection and the Storz operation rectoscope. Surg Endosc 17(8):1292–1297
Langer C, Liersch T, Süss M (2003) Surgical cure for early rectal carcinoma and large adenoma: transanal endoscopic microsurgery (using ultrasound or electrosurgery) compared to conventional local and radical resection. Int J Colorectal Dis 18:222–229
Hermsen PE, Ayodeji ID, Hop WH, Tetteroo GW, de Graff GV (2009) Armonic long shears further reduce operation time in transanal endoscopic microsurgery. Surg Endosc 23:2124–2130
Ayodeji ID, Hop WC, Tetteroo GW, Bonjer HJ, de Graff GV (2004) Ultracision harmonic scalpel and multifunctional TEM400 instrument complement in transanal endoscopic microsurgery: a prospective study. Surg Endosc 2:245–250
Carpenter J, Bithell J (2000) Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med 19:1141–1164
Jiang H, Zhou XH (2004) Bootstrap confidence intervals for medical costs with censored observations. Stat Med 23:3365–3376
Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236
Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D, Reed S (2005) Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA task force Report. Value Health 8:521–533
Ramirez JM, Aguilella V, Valencia J, Gracia JA, Escudero P, Ortego J, Martinez M (2010) Endoscopic surgery with curative intention for malignant rectal tumors. Long-term oncologic results. Endoscopy Published ahead of print
Bretagnol F, Merrie A, George B (2007) Local excision of rectal tumours by transanal endoscopic microsurgery. Br J Surg 94:627–633
Lezoche E, Guerrieri M, Paganini AM, Feliciotti L (2002) Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg 26:1170–1174
Lezoche E, Guerrieri M, Paganini AM, Baldarelli M, De Sanctis A, Lezoche G (2005) Long-term results in patients with T2–3 N0 distal rectal cancer undergoing radiotherapy before transanal endoscopic microsurgery. Br J Surg 92:1546–1552
Langer C, Markus P, Liersch T, Füzesi L, Becker H (2001) Ultracision or high-frequency knife in transanal endoscopic microsurgery (TEM)? Surg Endosc 15:513–517
Ito M, Sugito M, Kobayashi A, Nishizawa I, Tsunoda I, Saito N (2009) Influence of learning curve on short-term results after laparoscopic resection for rectal cancer. Surg Endosc 23:403–408
Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D, Mokart D, Houvenaeghel G, Giovannini M, Delpero JM (2010) The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg 251:249–253
Gracia Solanas JA, Ramírez Rodríguez JM, Aguilella Diago V, Elía Guedea M, Martínez Díez M (2006) A prospective study of the functional and anatomic consequences of transanal endoscopic microsurgery. Rev Esp Enferm Dig 98:234–240
Disclosures
Drs. J. A. Gracia, J. M. Ramirez, D. Callejo, M. Elia, S. Maeso, V. Aguilella, and M. Martinez have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gracia, J.A., Ramirez, J.M., Callejo, D. et al. Efficiency and outcomes of harmonic device in transanal endoscopic microsurgery compared with monopolar scalpel. Surg Endosc 25, 3209–3213 (2011). https://doi.org/10.1007/s00464-011-1695-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-011-1695-0