Optimizing Healthcare’s Greatest Currency: Time

Tim Buckley, VP of Commercial Operations at MedeonBio, Inc.

Surgeons and industry have worked hand in hand for decades to make procedures less invasive, safer, and faster. It’s now common for patients to have minimally invasive surgeries on an outpatient or short-stay bases, with low risk for complications. But the drive continues to streamline surgery and, along with it, reduce the costs of laparoscopic surgery today.

Most efforts have concentrated on reducing the costs of disposables. This is an important financial focus – by eliminating a few high-cost options in favor of moderately priced disposables, hospitals can lower costs without diminishing the quality of care.

But what about the cost associated with OR time? Most disposables cost less than a single minute in the OR. According to an analysis in the Journal of the American Medical Association, 1 minute costs about $37 ($20 in direct costs, $14 in wages and benefits, $3 in nonbillable supplies). It’s no surprise that the duration of laparoscopic surgery is strongly tied to the total cost per case. We can’t standardize surgery time like we can supplies – surgeons often face unique disease or anatomical attributes – so we need technologies that reduce time and create surgical predictability.

At Medeon, we’ve developed two of those technologies. The first, ClickClean? Laparoscope Lens Shield Device, an in-abdomen laparoscope lens cleaning device, solves the problem of the scope getting clouded or smeared with fluid and obstructing the surgeon’s view. Traditionally, surgeons and their scope technicians have had to repeatedly stop a procedure, remove and clean the scope, and reposition it to resume surgery. The scope needed to be cleaned about every 10 minutes, or 6 times per hour, and each cleaning required 1 minute. That’s 6 minutes times $37, or $222.

With ClickClean, a transparent sheath covers the scope, and when the view gets clouded or smeared, the surgeon or technician clicks a trigger to advance a fresh section of film into place over the tip. It takes just a few seconds, without removing the scope from the abdomen. That’s theoretically $222 saved. But to surgeons, even that large a savings is often just a side benefit.

“By far, the most important advantage of ClickClean is safety. We can’t perform surgery safely and precisely when we can’t see, and ClickClean lets us restore a clear view very easily throughout a procedure,” explains Jay Redan, MD, FACS. “The second benefit is less frustration. Rather than repeatedly interrupting surgery, we can click this device and continue undisrupted with less mental fatigue and the associated risk for errors. ClickClean saves time, but as a surgeon, I consider that an indirect benefit.”

Medeon has also developed AbClose?, which turns the complex and frustrating task of port site closure into a remarkably safe, easy and fast single-operator process, while reducing the risk for postoperative hernia. AbClose routinely shaves about 6 minutes ($222) off of abdominal laparoscopic procedures.

“AbClose is preloaded, precise, and predictable,” says Kirby Tran, MD, MMM. “I spent about 2-10 minutes closing the port site fascia with my old suture passer, but I now only need 1-2 minutes. It’s very satisfying to know that with AbClose, I will dependably and efficiently end procedures with complete closure and prevent the complication of postoperative hernia, which can require additional surgery. AbClose also eliminates a source of frustration at the end of surgery and lets me get high-risk patients out of the OR sooner.”

Even if the time savings do not directly result in the ability for a hospital to immediately add a patient to the schedule, those time allocations can be leveraged by the entire OR ecosystem in a patient and staff-focused fashion. Yes, these technologies have their own costs, but they arguably make surgery more predictable. Our industry will continue to collaborate with healthcare providers to further lower surgical costs while improving outcomes. Healthcare’s greatest currency is that of time, and it’s our duty to optimize it minute by minute.

1. Grimes KL, Scott C, McHenry CR. Cost variation and opportunities for cost reduction for laparoscopic cholecystectomy. Surgery. 2018 Mar;163(3):617-621.

2. Childers CP, Maggard-Gibbons M. Understanding Costs of Care in the Operating Room. JAMA Surg. 2018 Apr 18;153(4):e176233.

3. Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost Analysis and Supply Utilization of Laparoscopic Cholecystectomy. Minim Invasive Surg. 2018 Dec 10.