Doctor says laparoscopic surgery a money loser: one surgeon's experience.

LAS VEGAS -- Surgeons spend more time but make less money when they perform hysterectomies and myomectomies in Medicare and managed care patients using a laparoscopic rather than an open approach.

Compared with open surgeries, laparoscopically assisted vaginal hysterectomy (LAVH) took 59% longer to complete, and laparoscopic myomectomy took 38% longer in a study conducted by Dr. Marlan Schwartz, who is in private practice in Piscataway, N.J.

He based that statement on a review of hospital records for a 9-month period during which he performed 28 hysterectomies (18 were done as LAVHs) and 16 myomectomies (10 were laparoscopically assisted procedures). Medicare and managed care plans paid him an average of $443 less for each LAVH than for a total abdominal hysterectomy and $123 less for a laparoscopic myomectomy than for an open myomectomy, he said at an international congress of the Society of Laparoendoscopic Surgeons.

"I think we really need to reevaluate our approach to certain procedures until we're fairly recognized and compensated for our skills," Dr. Schwartz said.

One way that these findings have changed Dr. Schwartz's practice is that now when he offers the option of a laparoscopic procedure to a patient and she hesitates or is reluctant, he no longer tries to convince her of the benefits of laparoscopic surgery, which include less pain, easier wound care, and faster return to normal activity.

Instead of spending the extra time in the operating room doing a laparoscopic procedure, Dr. Schwartz commented, "I could be in my office, I could be home with my kids, I could be doing a lot of other things" and make the same amount of money, or more, by doing an open surgery.

Laparoscopic hysterectomies and myomectomies benefit hospitals and insurers as well as patients by shortening the length of hospitalization, reducing infection and complication rates, and requiring less pain medication. "What's the benefit to me? I don't know," except maybe personal satisfaction, he said.