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Pain after microlaparoscopic cholecystectomy. A randomized double-blind controlled study
T Bisgaard1, B Klarskov, R Trap
1Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, DK-2650, Hvidovre, Denmark.
Surgical Endoscopy
|May 3, 2000
Summary
Micro-laparoscopic cholecystectomy (micro-LC) with smaller incisions reduced early postoperative pain. However, a high conversion rate to standard laparoscopic cholecystectomy (LC) indicates a need for instrument development.
Area of Science:
- Minimally Invasive Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Laparoscopic cholecystectomy (LC) traditionally uses 10-mm and 5-mm trocars.
- The impact of smaller port incisions on postoperative pain remains understudied.
Purpose of the Study:
- To evaluate the effect of smaller port incisions on pain after laparoscopic cholecystectomy.
- To compare micro-laparoscopic cholecystectomy (micro-LC) with standard LC regarding postoperative pain.
Main Methods:
- A double-blind, controlled study randomized patients to LC or micro-LC (three 2-mm, one 10-mm trocar).
- All patients received multimodal analgesia, including local anesthetics, NSAIDs, and paracetamol.
- Pain was assessed preoperatively, during the first 3 hours postoperatively, and daily for a week.
Main Results:
- The study was halted due to a 38% conversion rate from micro-LC to LC.
- In the first 3 hours postoperatively, pain increased significantly in the LC group (n=13) compared to preoperative levels (p<0.01).
- No significant pain increase was observed in the micro-LC group (n=8) during the same period.
Conclusions:
- Micro-LC, combined with multimodal analgesia, effectively reduced early postoperative pain.
- The high conversion rate necessitates further technical development of micro-LC instruments for routine use.