A cost-effectiveness evaluation of laparoscopic disposable versus nondisposable infraumbilical cannulas

Study Objective. To compare the safety and cost-effectiveness of disposable and nondisposable infraumbilical laparoscopic cannulas. Design. Retrospective review of consecutive laparoscopic procedures performed from July 1, 1988, to June 30, 1994. Setting. A university-affiliated hospital. Patients. The 10,459 consecutive women who underwent laparoscopies. Interventions. A 10-mm disposable cannula was used in 529 laparoscopies and a nondisposable cannula in 9930, based on physician preference. Measurements and Main Results. The only intraabdominal injuries associated with insertion of disposable and nondisposable cannulas were bowel injuries in one and three patients, respectively. The injury rates for the instruments were 19 and 3/10,000 cases, respectively, but were not statistically different (P <0.05, Fisher's two-tail exact test). The hospital cost per disposable cannula in 1994 was $63.71; the cost per procedure with the nondisposable cannula was amortized and was less than $1.35, including maintenance. Conclusion. Disposable cannulas were not cost effective and were associated with a higher but not statistically significant complication rate. Therefore, the more expensive disposable cannulas are not recommended.