Abstracts
2002 Digestive Disease Week

# 104979 Abstract ID: 104979 Prospective Randomized Trial of Mini-Port vs Conventional Laparoscopic Cholecystectomy
Yuri W Novitsky, Donald R Czerniach, Richard A Perugini, Steven M Yood, Kent W Kercher, Karen A Gallagher, Mark P Callery, Demetrius E Litwin, John J Kelly, Worcester, MA

Benefits of laparoscopic cholecystectomy (LC) are well established. The use of smaller instruments has been proposed to further improve postoperative pain and cosmesis. We compared the safety, postoperative pain and cosmetic results of LC performed conventionally (C-LC) and utilizing the mini-ports (M-LC). Seventy eight patients agreed to be prospectively randomized to C-LC and M-LC groups. Experienced surgical attendings performed all operations. C-LC was performed utilizing two 10 and two 5-mm trocars. M-LC was performed with one 10, one 5 and two 2-mm lateral trocars. Postoperative follow up was conducted by blinded observers. Patients graded their pain according to the Visual Analog Scale (VAS) on postoperative days 1, 3, 7 and 28. Cosmetic results were scored between 1 and 10 both by patients and observers at 28 days. A two-sample t-test was used for the statistical analysis. The groups were similar in age, sex and preoperatively self-assessed pain tolerance. Eight out of 33 patients (24%) randomized to M-LC were intraoperatively converted to C-LC, commonly due to instrument failures. There was no significant difference in operative times between M-LC and C-LC groups (54.9 vs 50.5 min, respectively). There were no complications and no conversions to open procedure. Postoperative pain scores on days 1, 3, 7 and 28 were not statistically different between M-LC and C-LC groups (4.1 vs 4.8, 2.8 vs 2.9, 1.7 vs 1.9 and 0.1 vs 0.6, respectively). Cosmetic results were found to be statistically superior in M-LC when evaluated by both patients and blinded observers (32.0 vs 38.9, p=0.0002 and 28.7 vs 38.7, p<0.0001, respectively). Laparoscopic cholecystectomy can be safely performed using 2-mm lateral trocars. M-LC does not minimize postoperative pain. It appears to be superior in postoperative cosmetic results. However, high conversion rate to C-LC necessitates further improvement of the instruments before widespread implementation of M-LC.