title: Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy: a randomized controlled trial.
abstract: BACKGROUND
  The aim of this study was to compare micropuncture laparoscopic cholecystectomy (MPLC), with three 3.3-mm cannulas and one 10-mm cannula with conventional laparoscopic cholecystectomy (CLC).
  
  
  METHODS
  Patients were randomized to undergo either CLC or MPLC. The duration of each operative stage and the procedure were recorded. Interleukin-6 (IL-6), adrenocorticotropic hormone (ACTH), and vasopressin were sampled for 24 h. Visual analogue pain scores (VAPS) and analgesic consumption were recorded for 1 week. Pulmonary function and quality of life (EQ-5D) were monitored for 4 weeks. Statistical analysis was performed using the Mann-Whitney test or Fisher's exact test. Results are expressed as median (interquartile range).
  
  
  RESULTS
  Forty-four patients entered the study, but four were excluded due to unsuspected choledocholithiasis (n = 3) or the need to reschedule surgery (n = 1). The groups were comparable in terms of age, duration of symptoms, and indications for surgery. Total operative time was similar (CLC, 63 [52-81] min vs MPLC 74 [58-95] min; p = 0.126). However, time to place the cannulas after skin incision (CLC, 5:42 [3:45-6:37] min vs MPLC, 7:38 [5:57-10:15] min; p = 0.015) and to clip the cystic duct after cholangiography (CLC, 1:05 [0:40-1:35] min vs MPLC, 3:45 [2:26-7:49] min; p <0.001) were significantly longer for MPLC. Six CLC patients and one MPLC patient required postoperative parenteral opiates (p = 0.04). Oral analgesic consumption was similar in both groups (p = 0.217). Median VAPS were lower at all time points for MPLC, but this finding was not significant (p = 0.431). There were no significant differences in postoperative stay, IL-6, ACTH or vasopressin responses, pulmonary function, or EQ-5D scores.
  
  
  CONCLUSIONS
  The thinner instruments did not significantly increase the total duration of the procedure. MPLC reduced the use of parenteral analgesia postoperatively, which may prove beneficial for day case patients, but it did not have a significant impact on laboratory variables, lung function or quality of life.
authors.affiliation: The Academic Unit of Surgery, The University of Leeds and the Leeds Institute for Minimally Invasive Therapy (LIMIT), The General Infirmary at Leeds, Great George Street, Leeds, United Kingdom, LS1 3EX. wgainslie@btinternet.com
authors.forename: W G
authors.initials: WG
authors.lastname: Ainslie
authors.forename: J A
authors.initials: JA
authors.lastname: Catton
authors.forename: D
authors.initials: D
authors.lastname: Davides
authors.forename: S
authors.initials: S
authors.lastname: Dexter
authors.forename: J
authors.initials: J
authors.lastname: Gibson
authors.forename: M
authors.initials: M
authors.lastname: Larvin
authors.forename: M J
authors.initials: MJ
authors.lastname: McMahon
authors.forename: M
authors.initials: M
authors.lastname: Moore
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: Vezakis
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000698:Analgesia / Q000009:adverse effects / Q000379:methods; D002763:Cholecystectomy / Q000295:instrumentation / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010147:Pain Measurement / Q000379:methods; D011183:Postoperative Complications; D011677:Punctures / Q000379:methods*; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods; D013312:Stress, Physiological / Q000097:blood; D014667:Vasopressins / Q000097:blood; D014839:Vomiting / Q000209:etiology
chemical_list: D015850:Interleukin-6; D014667:Vasopressins; D000324:Adrenocorticotropic Hormone