Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial.
OBJECTIVE
The use of smaller instruments during laparoscopic cholecystectomy (LC) has been proposed to reduce postoperative pain and improve cosmesis. However, despite several recent trials, the effects of the use of miniaturized instruments for LC are not well established. We hypothesized that LC using miniports (M-LC) is safe and produces less incisional pain and better cosmetic results than LC performed conventionally (C-LC).


METHODS
A patient- and observer-blinded, randomized, prospective clinical trial.


METHODS
A tertiary care, university-based hospital.


METHODS
Seventy-nine patients scheduled for an elective LC who agreed to participate in this trial were randomized to undergo surgery using 1 of the 2 instrument sets. The criteria for exclusion were American Society of Anesthesiologists class III or IV, age older than 70 years, liver or coagulation disorders, previous major abdominal surgical procedures, and acute cholecystitis or acute choledocholithiasis.


METHODS
Laparoscopic cholecystectomy performed with either conventional or miniaturized instruments.


METHODS
Patients' age, sex, operative time, operative blood loss, intraoperative complications, early and late postoperative incisional pain, and cosmetic results.


RESULTS
Thirty-three C-LCs and 34 M-LCs were performed and analyzed. There were 8 conversions (24%) to the standard technique in the M-LC group. No intraoperative or major postoperative complications occurred in either group. The average incisional pain score on the first postoperative day was significantly less in the M-LC group (3.9 vs 4.9; P = .04). No significant differences occurred in the mean scores for pain on postoperative days 3, 7, and 28. However, 90% of patients in the M-LC group and only 74% of patients in the C-LC group had no pain (visual analog scale score of 0) at 28 days postoperatively (P = .05). Cosmetic results were superior in the M-LC group according to both the study nurse's and the patients' assessments (38.9 vs 28.9; P<.001, and 38.8 vs 33.4; P = .001, respectively).


CONCLUSIONS
Laparoscopic cholecystectomy can be safely performed using 10-mm umbilical, 5-mm epigastric, 2-mm subcostal, and 2-mm lateral ports. The use of mini-laparoscopic techniques resulted in decreased early postoperative incisional pain, avoided late incisional discomfort, and produced superior cosmetic results. Although improved instrument durability and better optics are needed for widespread use of miniport techniques, this approach can be routinely offered to many properly selected patients undergoing elective LC.
Novitsky
Yuri W
YW
Department of Surgery, University of Massachusetts Medical School, Worcester, USA. yuri.novitsky@carolinas.org
Kercher
Kent W
KW
Czerniach
Donald R
DR
Kaban
Gordie K
GK
Khera
Samira
S
Gallagher-Dorval
Karen A
KA
Callery
Mark P
MP
Litwin
Demetrius E M
DE
Kelly
John J
JJ
D000698:Analgesia / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D002764:Cholecystitis / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D008297:Male; D008904:Miniaturization; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome