Background: Laparoscopic cryoablation (LCA), partial nephrectomy (LPNx) and hand-assisted nephrectomy (HALNx) are often replacing open surgical techniques for the small renal tumor due to their decreased morbidity, faster recovery and similar efficacy. We analyzed total hospital costs comparing these minimally invasive techniques to conventional surgery.

Methods: Between March 2000 and July 2005, 184 patients underwent surgery for a small, organ-confined renal tumor. All patients had been carefully selected based on the following criteria: tumor size less than 3.5 cm, absence of local and systemic spread, and the ability to tolerate general anesthesia. The distribution of patients between surgical procedures was as follows: group-1 HALNx (53 patients), group 2- LPNx (n=20), group 3- open radical nephrectomy(ORNx ) (n=20), group 4- open partial nephrectomy (OPNx)(n=71) and group 5- LCA (n=20). The total direct hospital and pathology professional costs were analyzed for each procedure.

Results: Patients undergoing OPNx with a mean age of 58 (±13) years were significantly younger than in those undergoing HALNx (63 ±11, p=0.03), ORNx (62 ±13, p=0.04) and LCA (65 ±9, p=0.01) years respectively. The mean length of stay (LOS) in the LCA group (2.0±1.2 days) was significantly lower than that for HALNx (3.2±1.6 days), LPNx (3.8±1.9 days), ORNx (4.4±1.8 days) and OPNx (4.0±1.5 days) (p<0.005). Higher surgical costs were seen in the LCA group ( ±), LPNx (±) and HALNx (,335±) compared with ORNx (±) (p<0.0005) and OPNx (±1109) (p<0.05) groups. However the total non-surgical costs were significantly less in groups undergoing LCA (±) and HALNx (± ) compared to open surgery- ORNx (±) and OPNx (±) (p<0.05). Total hospital costs were lower in HALNx (±) and LCA ( ±) groups compared to other groups but differences were insignificant (p≥0.05). Pathology professional fees for HALNx (±) and LCA (±) were lower than in LPNx ( ±) and OPNx ( ±841) groups (p<0.05).

Conclusions: While the surgical cost for minimally invasive procedures remains modestly higher than open surgery due to equipment costs, there is a reduction in hospital expenses associated with minimally invasive surgery due to earlier discharge and therefore less reliance on hospital services.