To the Editor.—Your two commentaries in the November 1992 issue make a fascinating contrast. Dr Rutkow1 has given a timely warning on the way surgeons are being manipulated by surgical technology and corporate interests. It is, therefore, surprising to find Dr Basso and his colleagues2 being so uncritical. They produce no evidence suggesting that laparoscopic cholecystectomy is cheaper. Indeed, the initial studies from the United States and from Britain suggest that it is more expensive overall because of greater operating room costs, especially if disposable items are used. Basso et al mentioned only the cost of suture material, but nothing about clips, disposable trochars and instruments, or length of the operation.
There is no substitute for proper, prospective, randomized, controlled trials to determine the true cost savings, if any, of the new procedure. In our own trial (one of at least three in Britain), randomization between small-incision