Microlaparoscopic cholecystectomy. Less invasive gallbladder surgery

We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC).

Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics, history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was 78 kg (range, 48-119) and average height was 163 cm.

Operative time for MLC was 72+/-25 min (range, 35-140), somewhat less than the referenced standard of 79+/-27 min (p = 0.1). The skin-to-trocar time (6+/-2 vs. 13+/-77 min) and intraoperative cholangiogram time (9+/-8 vs. 11+/-6 min) were significantly shorter (p<0.01 and p<0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74+/-21 min (range, 44-118) compared to 75+/-27 min (range, 35-140) for PGY3 and 53+/-5 (range, 43-59) for PGY5. Patient weight influenced time. Patients <65 kg averaged 56 +/-12 min; 66-80 kg, 72+/-24 min; 81-95 kg, 78+/-26 min; and >95 kg, 85+/-22 min. Previous abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of adhesions, wall thickening, or need for better retraction. Time in these patients was 95+/-26 min vs. 68+/-21 min in other patients (p<0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21+/-0.19 mg/kg (range, 0-0.8). Hospital stay was 1.31 days (range, 0.5-4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity was seen with MLC.

MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and possibly an earlier return to normal activity.