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 19 February 2018

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News

Clinical trial: mini-vs conventional laparoscopic cholecystectomy

Research in the latest Archives of Surgery shows that mini-laparoscopic techniques decrease early postoperative incisional pain, avoid late incisional discomfort, and produce superior cosmetic results.

News image

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The use of smaller instruments during laparoscopic cholecystectomy has been proposed to reduce postoperative pain and improve cosmesis.

However, despite several recent trials, the effects of the use of miniaturized instruments for laparoscopic cholecystectomy are not well established.

Dr Yuri Novitsky and colleagues assessed whether laparoscopic cholecystectomy using miniports is safe.

The research team also evaluated whether this technique produces less incisional pain and better cosmetic results than conventional laparoscopic cholecystectomy.

The team conducted a patient- and observer-blinded, randomized, prospective clinical trial in a tertiary care, university-based hospital.

90% with mini-laparoscopy vs 74% in the conventional group had no postoperative pain
Archives of Surgery

The team randomized 79 patients, scheduled for an elective laparoscopic cholecystectomy, to undergo surgery using 1 of the 2 instrument sets.

The criteria for exclusion included American Society of Anesthesiologists class III or IV categories, and age older than 70 years.

Liver or coagulation disorders, previous major abdominal surgical procedures, and acute cholecystitis or acute choledocholithiasis were also exclusion factors.

Laparoscopic cholecystectomy was performed with either conventional or miniaturized instruments.

The team's main outcome measures were patients' age, sex, operative time, operative blood loss, and intraoperative complications.

In addition, early and late postoperative incisional pain, and cosmetic results were also assessed as outcome measures.

The research team performed 33 conventional laparoscopic cholecystectomies and 34 laparoscopic cholecystectomy using miniports.

The team found 8 conversions to the standard technique in the laparoscopic cholecystectomy using miniports 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 laparoscopic cholecystectomy using miniports.

The team noted no significant differences in the mean scores for pain on postoperative days 3, 7, and 28.

However, 90% of patients in the laparoscopic cholecystectomy using minports group had no pain at 28 days postoperatively.

In the conventional group, 74% had no pain at 28 days postoperatively.

Cosmetic results were superior with laparoscopic cholecystectomy using miniports according to both the study nurse's and the patients' assessments.

The team noted that laparoscopic cholecystectomy can be safely performed using 10-mm umbilical, 5-mm epigastric, 2-mm subcostal, and 2-mm lateral ports.

Dr Novitsky's team concluded, “The use of mini-laparoscopic techniques resulted in decreased early postoperative incisional pain, avoided late incisional discomfort, and produced superior cosmetic results.”

“This approach can be routinely offered to many properly selected patients undergoing elective laparoscopic cholecystectomy.

“However, improved instrument durability and better optics are needed for widespread use of miniport techniques.”

Arch Surg 2005: 140(12): 1178-83
04 January 2006

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