Cost containing strategies in video-assisted thoracic surgery

Video-assisted thoracic surgery (VATS) is a new surgical approach that has been utilized in the recent five years. At the present time, its utilization is moving from the academic centers to the community hospital setting. While VATS permits a less invasive approach to surgical diseases of the chest, cost is one aspect that is seldom discussed. In Asia, cost containment is essential for the survival of this approach. In this report, we present the cost containing technique of VATS on 1661 patients over the last five years. The surgical techniques of dissection, suturing, hemostasis, and tissue approximation that are familiar to us in the open setting were modified and used in this approach. Conventional instruments such as sponge-forceps, right-angled hemostat, electrocautery as well as suction tube were used to enhance the cost savings during VATS. It is our experience that through (1) careful patient selection, (2) stringent use of expensive consumables, and (3) application of modified techniques based on traditional surgical principles, substantial savings in VATS will be generated.