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A Randomised, Single Blind Study of Miniports (3mm) Versus Conventional Ports in Laparoscopic Cholecystectomy
Mark Bignell*, Edward Cheong, Michael P. Lewis, Michael Rhodes
General Surgery, Norfolk and Norwich university Hospital, Norwich, United Kingdom
Introduction
Single incision laparoscopic cholecystectomy (SILC) is said to provide improved cosmesis with a reduction in postoperative pain, but involves a change in operative technique. We have conducted a single-blind, randomised controlled trial study of cosmetic outcome and post-operative pain comparing laparoscopic cholecystectomy (LC) using either 3mm or 5 mm ports.
Methods
80 patients with symptomatic gallstones were recruited from a single centre and randomised to a LC using either a 10mm and three 5mm ports (control) or a 5mm port and three 3mm ports. The 5mm port was extended as necessary at the end of the operation to facilitate removal of the gallbladder. Operative details, time and pain scores at 1h, 6h, and 1 week and analgesia required in the 1st week were collected.
Statistical analysis was undertaken using a paired t-test or fisher’s exact test as appropriate.
Results
40 patients were recruited to each group. The mean age of the 3mm group was 53 (+/-14) compared to 52 (+/- 12) in the control group (p=0.89). There were 11 males in the 3mm group vs. 4 in the control group. One patient in the control group was converted to open whilst 2 patients in the 3mm group had a 3mm port converted to a 5mm port and 4 patients required the insertion of a 10mm and 5mm ports. The mean operative time was 49 minutes (+/- 12, range 24-120 mins) in the 3mm group versus 46 minutes (+/- 19, range 21-124 mins) in the control group (p=0.40). There was no statistical difference in the day case rate between the 2 groups. The pain scores in the 3mm group at 1h, 6h, and 1 week were 2.5 +/- 2.1 , 3.2+/- 2.2, and 0.8 +/- 2.2 versus 4.2+/-2.9, 3.3+/- 2.4, and 2.1 +/-2.4 in the control group (p Value = 0.003, 0.63, and 0.002). The mean daily analgesia score, calculated using the WHO pain ladder to attribute each class of analgesia a value, was 3.47 (+/- 3.2) in the 3mm group Vs 5.21 (+/- 4.8) in the control group (p=0.008).
Conclusion
The use of 3mm ports is technically feasible in patients undergoing LC for gallstones with comparable operating times to conventional LC with reduced pain scores and need for analgesia.
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