To the Editor.
—The cost of laparoscopic cholecystectomy can be lowered. In the recent Letters section of JAMA,1 the hospital cost was $4633 and $6750 at two different centers. Our group has done more than 1200 laparoscopic cholecystectomies. A recent audit of 50 cases (age less than 60 years, elective cases) showed an average hospital charge of $1817.Here are the ways we lower costs. We use electrosurgical dissection instead of laser2: savings, $546 to $800. We use reusable cannulas with limited use trocars instead of completely disposable systems: savings, $400 to $650. We use reusable graspers, scissors, dissectors, suctionirrigators: savings, $250 to $600. We do operative cholangiograms only when indicated, not routinely: savings, $300 to $500. There has been no reduction in quality of care; our morbidity, mortality, and operating efficiency compare favorably with all reports.3 An increasing number of patients are treated as outpatients with
Voyles CR. The Laparoscopic Dividend. JAMA. 1992;267(11):1469. doi:10.1001/jama.1992.03480110045027