Randomized comparison of pulmonary function after the 'French' and 'American' techniques of laparoscopic...

The 'French' and 'American' techniques of laparoscopic cholecystectomy, which differ in the position of the surgeon and ports, have not been compared directly. The authors' hypothesis was that the 'French' technique results in better postoperative pulmonary function than the 'American' technique. Patients undergoing elective cholecystectomy were randomized, 25 patients to have the 'French' method and 24 the 'American' method. Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were measured before operation, and 6, 24 and 48 h after surgery. Postoperative pain and fatigue were also measured. Both FVC and FEV1 at 6 h, 24 h and 48 h after operation were significantly less in the 'American' group (FVC at 24 h: 71 versus 86 per cent of preoperative value; P = 0.001, Student's t test; 95 per cent confidence interval 7-24). Two cases of atelectasis occurred in the 'American' group and none in the 'French' group. Differences in access to Calot's triangle were also noted. One patient in the 'French' group sustained a diathermy injury of the duodenum, related to defective equipment. It is concluded that the 'French' method leads to less impairment of pulmonary function.