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Three-port microlaparoscopic cholecystectomy in 159 patients
P L Leggett1, C D Bissell, R Churchman-Winn
1Houston Health Science Center (Houston Northwest Medical Center), University of Texas, 800 Peakwood, Suite 8B, Houston, TX 77090, USA. drleggett@drleggett.com
Background:
Laparoscopic cholecystectomy has undergone many refinements including reductions in port size and number. This study attempts to determine whether further reduction in port size from that previously reported by us can reduce postoperative pain without compromising the efficacy of the surgery.
Methods:
In this study, 159 patients underwent laparoscopic cholecystectomy with three ports: one 5-mm umbilical port, one 3-mm subxiphoid port, and one 3-mm port in the right subcostal position. Data were collected prospectively for each patient on the duration of analgesic use, quantity of analgesic tablets consumed, postoperative pain, most painful incision, and days of recovery required before return to activity and work. These measures were compared with those collected from a group of 100 patients who had undergone laparoscopic cholecystectomy with three 5-mm ports in a previous study.
Results:
Patients in the current study group required analgesics for a longer duration (4 vs 2.9 days; p = 0.001), used more analgesic tablets (10.7 vs 8.1; p = 0.007), and reported greater postoperative discomfort (5 vs 4.1; p = 0.016) as compared with all in the 5-mm port group. The 3-mm port group needed more days for recovery before leaving the house (2.9 vs 2.7; p = 0.504), but they returned to work earlier (5.1 vs 5.9; p = 0.065) than the group that had undergone cholecystectomy with three 5-mm ports, although there was not a significant difference between the groups. Operative time increased from 18.5 to 20.9 min (p = 0.054) in the group with two 3-mm ports. Five patients (3.1%) in the current group required enlargement of a port to complete the procedure, as compared with none in the comparison group. There was one complication (0.6%), as compared with two complications (2.0%) in the previous group.
Conclusions:
This study did not demonstrate a reduction in postoperative pain or a consistent improvement in recovery when the port size was reduced at the subcostal and subxiphoid positions. It did, however, show that ports could safely be reduced in size without a negative impact on the surgeon's ability to perform a cholecystectomy. Reducing port size can be a tool in the surgeon's armamentarium for use in the attempt to optimize cosmetic results.
Insights
Reducing port size in laparoscopic cholecystectomy did not decrease postoperative pain or improve recovery. However, smaller ports were safely used without compromising surgical efficacy, offering potential cosmetic benefits.
Area of Science:
- Minimally Invasive Surgery
- Surgical Techniques
- Gastrointestinal Surgery
Background:
- Laparoscopic cholecystectomy has evolved with port size and number reductions.
- Previous studies suggested benefits from smaller ports.
- This study investigated further port size reduction.
Purpose of the Study:
- To evaluate if reducing port size in laparoscopic cholecystectomy decreases postoperative pain.
- To assess if smaller ports compromise surgical efficacy.
- To compare outcomes with standard 5-mm ports.
Main Methods:
- 159 patients underwent laparoscopic cholecystectomy using one 5-mm and two 3-mm ports.
- Data collected prospectively included analgesic use, pain, and recovery time.
- Compared outcomes with a historical group of 100 patients using three 5-mm ports.
Main Results:
- The 3-mm port group reported increased pain, longer analgesic duration, and more tablets used.
- Recovery to leave the house was similar, but return to work was faster (not significant).
- Operative time increased slightly, and 3.1% of patients required port enlargement.
Conclusions:
- Reducing port size to 3-mm did not reduce postoperative pain or consistently improve recovery.
- Smaller ports were safely used without compromising the ability to perform cholecystectomy.
- Port size reduction may be a useful option for optimizing cosmetic outcomes.