title: A randomized multicenter study of minilaparotomy cholecystectomy versus laparoscopic cholecystectomy with ultrasonic dissection in both groups.
abstract: OBJECTIVE
  Ultrasonic dissection (UsD) has been used in laparoscopic cholecystectomy (LC), though it is not the golden standard technique. Applying UsD to cholecystectomy by minilaparotomy (MC) is less common and there are no prospective randomized trials comparing these two techniques. Therefore, we conducted the present study to investigate the use of the UsD in the MC versus the LC procedure.
  
  
  METHODS
  Initially 104 patients with non-complicated symptomatic gallstone disease were randomized into MC (n = 53) or LC (n = 51) groups, both groups using UsD, over a period of 2 years (2013-2015). The study groups were similar in terms of age and American Society of Anesthesiologists (ASA) physical status score.
  
  
  RESULTS
  The demographic variables and the surgical data were similar in the study groups. Similar low postoperative pain scores were reported in the two study groups during the first four hours after surgery. The incidence of nausea/vomiting was similar between the two study groups, 47% in the MC group versus 42% in the LC group. However, the patients in the MC group were treated more frequently with antiemetics, the incidence being 39% in the MC group versus 21% in the LC group (p = 0.02). The pain at rest at 24h after the surgery was similar in the two study groups, but the LC patients reported less pain at the normal activity, the mean of numerical rating scale (NRS) of 0-10 score being 3.9 in the MC group versus 2.9 in the LC group (p = 0.05), and the pain at the quick movement/coughing, the mean NRS being 4.9 in the MC group versus 3.2 in the LC group (p = 0.005). The length of sick leave was 17.4 days in the MC group and 14.4 days in the LC group (p = 0.05).
  
  
  CONCLUSIONS
  Our results suggest that both MC and LC are feasible and safe options for mini-invasive cholecystectomy. A new finding with clinical relevance in the present work is a relatively similar short-term outcome in the MC and LC although the LC patients reported significantly lower pain score 24 hours postoperatively and a shorter convalescence.
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Samuli
authors.initials: S
authors.lastname: Aspinen
authors.affiliation: b Department of Surgery , Helsinki University Central Hospital , Helsinki , Finland ;
authors.forename: Jukka
authors.initials: J
authors.lastname: Harju
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Mari
authors.initials: M
authors.lastname: Kinnunen
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Petri
authors.initials: P
authors.lastname: Juvonen
authors.affiliation: c Department of Anaesthesia and Operative Services , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kokki
authors.affiliation: a Department of Surgery , Kuopio University Hospital and School of Medicine, University of Eastern Finland , Kuopio , Finland ;
authors.forename: Matti
authors.initials: M
authors.lastname: Eskelinen
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D003289:Convalescence; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D018582:Sick Leave / Q000706:statistics & numerical data; D059708:Ultrasonic Surgical Procedures / Q000009:adverse effects; D014839:Vomiting / Q000188:drug therapy / Q000209:etiology
chemical_list: D000932:Antiemetics
keywords: cholecystectomy; laparoscopy; minilaparotomy; ultrasonic dissection