Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial

Background: Needlescopic cholecystectomy (NC) utilises instruments and port s smaller than 3 mm in diameter compared with the 5 mm ones used in convent ional laparoscopic cholecystectomy (LC). Post-operative pain control and re covery has been thought to be superior in NC, when compared with historical controls with LC, but has not been proven in a prospective fashion. Patien ts and methods: A prospective randomised trial of NC versus LC for patients with symptomatic gallstone disease, with standardisation of pest-operative analgesia and daily assessment of post-operative pain, using a 5-point vis ual analogue scale. Results: There were 64 eligible patients randomised int o NC (28) and LC (36), Four patients who had NC were converted to LC due to technical problems. Another three and six patients from the NC and LC grou ps, respectively, had conversion to open surgery. Postoperative pain scores were low in both groups. Mean pain scores for those with successful NC and LC were: 1.24 versus 1.43 for the day of operation (P = 0.49), 0.86 versus 0.83 for the first day post-operatively (P = 0.92) and 0.75 versus 0.81 fo r the second post-operative day (P = 0.87), The mean number of intra-muscul ar analgesic injections required were 0.76 versus 0.83 after NC and LC, res pectively (P = 0.93), There were no significant differences between the two groups in the time taken to return to feeding, eating a normal diet and di scharge from hospital. Conclusion: There is no advantage of NC over LC in t erms of post-operative pain or recovery. Nevertheless, NC can be performed safely and expediently and has an excellent cosmetic outcome and high patie nt acceptability.