Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs microlaparoscopic cholecystectomy

Background: The size of laparoscopic instruments has been reduced for use i n abdominal video endoscopic surgery. However, it has yet to be proven that microlaparoscopic surgery will actually result in clinically relevant bene fits for patients. Methods: Fifty patients were randomized in a blinded fashion to receive eit her elective laparoscopic (MINI), (n = 25) or microlaparoscopic (MICRO) (n = 25) cholecystectomy. Pulmonary function (FVC, FEV1), analgesic consumptio n during patient-controlled analgesia (PCA), pain perception by visual anal ogue score (VAS), and the cosmetic result (by the patient's self-assessment ) were evaluated postoperatively as clinically relevant end points. Results: Age, sex, body mass index (BMI), preoperative pulmonary function, pain perception, and operative time were similar for the two groups. At 8:0 0 PM on the day of surgery, FVC (MINI: 1.96 L [range, 1.48-2.48]; MICRO: 2. 13 L) [(range, 1.61.-2.50)] and FEV, (MINI: 1.17 L/sec) [range, 0.87-1.48]; MICRO: 1.34 L/sec [range, 1.05.-2.14] were also similar (each p = 0.5). Fr om surgery to the 3rd postoperative day, cumulative PCA morphine doses were comparable (MINI: 0.15 mg/kg bw [range, 0.09-0.23]; MICRO: 0.21 mg/kg bw [ range, 0.10-0.42]; p = 0.4), but overall VAS scores for pain while coughing were higher in the laparoscopic group (406 [range, 358-514]) than in the m icrolaparoscopic group (365 [range, 215-427];p = 0.02). The cosmetic result was judged to be slightly superior by the microlaparoscopic patients (10 [ range, 9-10]), as compared to those in the laparoscopic (9 [range, 8-10]) g roup (p = 0.04). Conclusion: Because microlaparoscopic cholecystectomy has some minor advant ages over laparoscopic surgery, it should be considered for use in selected patients.