Is laparoscopic surgery really worth it? The views of patients, hospital doctors and health care managers

Objective To determine the relative benefits of minimal access (MAS) as perceived by patients and health care professionals. Design Prospective descriptive study (design classification 111). Setting A large undergraduate teaching hospital in the North surgery Region. Subjects 100 patients (50 gynaecological, 50 antenatal), 70 obstetricians and gynaecologists, and 30 senior hospital managers. Interventions A specially designed questionnaire was used which included 44 pairs of clinical scenarios for laparotomy and laparoscopy. Each scenario consisted of different permutations of four of the variables, incision size, operating time, major complication rate, hospital stay and recovery time. Respondents were asked to select their preferred route of surgery. They also ranked, in order of priority, the above five variables together with treatment cost. Results MAS was preferred by the majority. Most patients chose endoscopy even if the operating time was four times longer and there was no reduction in hospitalization, and 25% accepted a quadrupling of the major complication rate. A minority of surgeons chose laparoscopy if the operating time exceeded 2 h or the risk of a major complication was increased fourfold. Most respondents preferred MAS, even if recovery time was equal to that of laparotomy. All respondents ranked complication rate as the main priority and cost as the least. Overall, patients were significantly more in favour of MAS than were surgeons, and the views of managers were in between the,views of these two groups. Conclusion Both health care professionals and patients, especially the latter, prefer MAS to conventional surgery, even if the operating time is longer and the major complication rate is higher.