title: Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial.
abstract: BACKGROUND
  The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS). These new techniques are considered to be painless procedures, but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy. In this randomized control study, we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy.
  
  
  METHODS
  Forty patients (34 women and 6 men) were randomly assigned to two groups. In group A (n = 20) four-port classic laparoscopic cholecystectomy was performed. Patients in group B (n = 20) underwent SILS cholecystectomy. In all patients, preincisional local infiltration of ropivacaine around the trocar wounds was performed. Infusion of ropivacaine solution in the right subdiaphragmatic area at the beginning of the procedure plus normal saline infusion in the same area at the end of the procedure was performed in all patients as well. Shoulder tip and abdominal pain were registered at 2, 6, 12, 24, 48, and 72 h postoperatively using visual analog scale (VAS).
  
  
  RESULTS
  Significantly lower pain scores were observed in the SILS group versus the classic laparoscopic cholecystectomy group after the first 12 h for abdominal pain, and after the first 6 h for shoulder pain. Total pain after the first 24 h was nonexistent in the SILS group. Also, requests for analgesics were significantly less in the SILS group, while no difference was observed in incidence of nausea and vomiting between the two groups.
  
  
  CONCLUSIONS
  SILS cholecystectomy, as well as the invisible scar, has significantly lower abdominal and shoulder pain scores, especially after the first 24 h postoperatively, when this pain is nonexistent. (Registration Clinical Trial number: NTC00872287, www.clinicaltrials.gov ).
authors.affiliation: Departments of Surgery, G Hatzikosta General Hospital, Hippocratus 3, Stavraki, GR-45332 Ioannina, Greece.
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Tsimoyiannis
authors.forename: Konstantinos E
authors.initials: KE
authors.lastname: Tsimogiannis
authors.forename: George
authors.initials: G
authors.lastname: Pappas-Gogos
authors.forename: Charalampos
authors.initials: C
authors.lastname: Farantos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Benetatos
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Mavridou
authors.forename: Adamantia
authors.initials: A
authors.lastname: Manataki
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D014472:Umbilicus