A detailed analysis of the hospital-related costs of laparoscopic cholecystectomy in children was performed. Data on 10 laparoscopic cholecystectomies were collected prospectively. Pre-, intra- and postoperative variables were assessed by standardized questionnaires. The hotel costs and costs for nursing, physicians, medicaments and equipment were calculated in detail. Reusable instruments were assumed to be used for 50 operations per year over 5 years and the costs for disposable instruments were calculated for comparison. In addition, the data of 10 children who underwent open cholecystectomy were analyzed retrospectively. The mean hospital costs for one laparoscopic cholecystectomy was 3685 DM. The costs for the operation itself represented 36.5% of the hospital costs and were mainly due to expenses for surgeons and nurses. The costs for laparoscopic equipment and instruments represented only 8.5% of the total costs. If an open procedure instead of a laparoscopic operation had been performed with a similar duration of hospital stay, the hospital costs would have been reduced by 425 DM (11.5%). In laparoscopic cholecystectomy the costs for medical treatment in addition to the operation were 32.8% of the total costs and were mainly due to expenses for nursing and physicians, which added up to 165 DM per day. The hotel costs represented 30.7% of the total costs and added another 189 DM per day. Therefore, potential savings in the operation theatre are limited and most effective savings may be achieved by shortening the hospital stay. The use of disposable instruments would have increased the costs by 844 DM and already 20 operations per year would have been cheaper performed with reusable compared to disposable instruments. Reusable instruments are recommended. Additional 60 minutes operating time cost 312 DM (5.20 DM/minute) and therefore, laparoscopic training courses for surgeons may be cost-effective in order to reduce the costs for training in the operation theatre.