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Randomized clinical trial comparing radially expanding trocars with conventional cutting trocars for the effects on
T Bisgaard1, H L Jakobsen, B Jacobsen
1Department of Surgical Gastroenterology, University of Copenhagen, Gentofte Hospital, 2900, Gentofte, Denmark. thuebisgaard@tdcadsl.dk
Background:
Trocar incisions are important sources of pain the first days after laparoscopic cholecystectomy. Radially expanding trocars may cause less pain than conventional cutting trocars.
Methods:
In a patient- and observer-blinded trial, 80 patients were randomized to undergo laparoscopic cholecystectomy using either radially expanding trocars (radial group) or conventional cutting trocars (cutting group). Two 10-mm and two 5-mm trocars were used in both treatment groups. All the patients received standardized anesthetic and analgesic treatment. The primary outcome was incisional pain. Pain was registered during mobilization using a visual analog scale (VAS) and a verbal rating scale (VRS) before and 6 h after the operation, and at postoperative days 1 and 2. The needs for a fascial incision to retract the gallbladder, active surgical hemostasis, and supplementary requirements of opioids during the hospital stay were registered. In addition, 2 days after the operation, the incidence and severity of suggilations at the trocar incisions were measured.
Results:
Data from 77 patients were available for statistical analysis. In the radial group, 23 patients needed fascial incision for gallbladder retraction compared with 11 patients in the cutting group (p = 0.006). No significant intergroup differences in VAS or VRS pain scores or any other variable were found.
Conclusions:
The use of radially expanding trocars has no effect on incisional pain after laparoscopic cholecystectomy.
