Pain after microlaparoscopic cholecystectomy - A randomized double-blind controlled study

Background: Laparoscopic cholecystectomy (LC) is traditionally performed wi th two 10-mm and two 5-mm trocars. The effect of smaller port incisions on pain has not been established in controlled studies. Methods: In a double-blind controlled study, patients were randomized to LC or cholecystectomy with three 2-mm trocars and one 10-mm trocar (micro-LC) . All patients received a multimodal analgesic regimen, including incisiona l local anesthetics at the beginning of surgery, NSAID, and paracetamol. Pa in was registered preoperatively, for the first 3 h postoperatively, and da ily for the 1st week. Results: The study was discontinued after inclusion of 26 patients because five of the 13 patients (38%) randomized to micro-LC were converted to LC. In the remaining 21 patients, overall pain and incisional pain intensity du ring the first 3 h postoperatively increased in the LC group (n = 13) compa red with preoperative pain levels (p < 0.01), whereas pain did not increase in the micro-LC group (n = 8). Conclusions: Micro-LC in combination with a prophylactic multimodal analges ic regimen reduced postoperative pain for the first 3 h postoperatively. Ho wever, the micro-LC led to an unacceptable rate of conversion to LC (38%). The micro-LC instruments therefore need further technical development befor e this surgical technique can be used on a routine basis for laparoscopic c holecystectomy.