Surgeons prefer laparoscopic hernia repair for much the same reasons patients do: less post-op pain and quicker recoveries. With careful case costing, lap hernia can also be profitable. We talked to David Moody, RN, BA, administrator of the Knightsbridge Surgery Center in Columbus, Ohio, to find out the keys to adding this minimally invasive technique to your facility.

1. Plan for a long learning curve
Knightsbridge, which hosts a variety of procedures ranging from colorectal to orthopedic surgeries, added lap hernias about 3 years ago. There is a significant learning curve associated with the technique, he says, and it takes a while for surgeons to get comfortable with the intricate movement of instruments it demands. He estimates that surgeons are truly at ease and expertly skilled at performing lap hernia after performing about 100 cases.

"Every hernia is different. But once surgeons get comfortable, many feel they would rather do lap if they have a choice," says Mr. Moody. From an administrator's standpoint, the key to negotiating the long learning curve is preaching patience among your surgeon group, he says. Remind your docs that the eventual payoff is improved patient outcomes and short case times (about 1 hour). Mr. Moody advises, however, to initially block out at least 90 minutes per procedure as surgeons get a feel for the challenging technique.

2. You'll need a pair of extra hands for the camera
In addition to a scrub nurse and a circulator, lap hernia requires an additional staffer to hold and operate the camera that gives surgeons views of the surgical site. At least 2 surgical staffers should be trained to serve as camera operators, says Mr. Moody. At the onset, he recommends training an experienced scrub nurse to handle the role. "It's not a difficult thing to do, but there's some technique to learn," he says. "You have to know what the surgeon's doing. You have to be able to anticipate his needs, and go where his eyes want you to go."

At Knightsbridge, most of the surgical team has been trained to use the camera, and many staffers have filled the role of camera operator. That includes Mr. Moody, who points out that, as the center's administrator, holding the camera during lap procedures gives him an opportunity to collaborate closely with the center's surgeons and get a good feel for how they like to work.

3. Capital outlay
Lap hernia procedures require large initial capital investments in imaging equipment and specialized instruments, and involve the recurring cost of disposable supplies. For example, you'll need 2 trocars at $65 to $90 each, and mesh to insert and position through them at about $190. A single-use stapling device (around $460) is needed to affix the mesh. Disposable supplies like a balloon dissector that creates the internal space in which the surgeon works can run upwards of $470. You also need trays of specialized surgical instruments. Knightsbridge purchased 2 trays at a total price of $21,000.

Then there's the imaging equipment. If your center performs other laparoscopic procedures or hosts surgeries requiring video towers, then you're a step ahead of the game. If not, then you're on the hook for purchasing laparoscopic cameras and video towers or carts. Knightsbridge upgraded its 8 lap cameras and 3 monitors to the tune of $158,000, says Mr. Moody.

He suggests conducting a thorough cost analysis to determine if these expenses make lap hernia feasible when compared to the expected reimbursement. Medicare's current reimbursement rate for abdominal hernia repair is $1,270. The total cost of the aforementioned disposables and implants necessary for a routine lap hernia surgery can run upwards of $1,300. That doesn't leave any wiggle room.

To make lap hernia profitable, says Mr. Moody, review exactly what your private insurance contracts pay you and try to negotiate beneficial reimbursement rates. Of course, there are ways to cut your costs in order to pump up the bottom line, he says, adding that most surgeons — especially those working in physician-owned facilities — will make responsible, cost-conscious decisions on supplies. For instance, a surgeon at Knightsbridge crafts his own plugs from pieces of flat, basic $30 surgical mesh and sees no difference in performance. The surgeon has since taught other doctors to do the same. Still, due diligence is needed, says Mr. Moody. Knightsbridge, for example, did a quality improvement study comparing case costs and outcomes between surgeons using meshes and plugs, with the cheaper meshes comparing favorably.

Beyond the bottom line
Ultimately, deciding to add laparoscopic hernia procedures should come down to more than just money, says Mr. Moody. "You get the same reimbursement for open and laparoscopic hernia repair," he says. "But if your surgeons believe they can do lap hernias and achieve better patient outcomes, then it may benefit your facility to host the cases."