Surgical Endoscopy

, Volume 22, Issue 12, pp 2541-2553

First online:

Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

  • Rory McCloyAffiliated withNorth of England Wolfson Centre for Minimally Invasive Therapies, Lancashire Teaching Hospitals NHS Foundation Trust
  • , Delia RandallAffiliated withChoice Pharma
  • , Stephan A. SchugAffiliated withSchool of Medicine and Pharmacology, University of Western Australia
  • , Henrik KehletAffiliated withSection for Surgical Pathophysiology, The Juliane Marie Centre
  • , Christian SimanskiAffiliated withDepartment of Trauma and Orthopaedic Surgery Cologne-Merheim, University of Witten/Herdecke
  • , Francis BonnetAffiliated withDepartement d’Anesthésie-Réanimation, Hôpital Tenon Assistance Publique Hôpitaux de Paris and Université Pierre & Marie Curie
  • , Frederic CamuAffiliated withDepartment of Anesthesiology, Flemish Free University of Brussels Medical Center
  • , Barrie FischerAffiliated withDepartment of Anaesthesia, Alexandra Hospital
  • , Girish JoshiAffiliated withDepartment of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center
    • , Narinder RawalAffiliated withDepartment of Anaesthesiology and Intensive Care, Örebro Medical Center Hospital
    • , Edmund A. M. NeugebauerAffiliated withInstitute for Research in Operative Medicine, University of Witten/Herdecke Email author 

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In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision <25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC).


The literature was systematically reviewed using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision ≥25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques.


Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared with conventional LC, without reduction in opioid use. Patients in the MLC group had slightly reduced length of hospital stay, but there were no significant differences for return to activity. The two interventions were also similar in terms of operating times and adverse events, but MLC was associated with better cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67–8.31), p < 0.00001].


The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.


Laparoscopic cholecystectomy Minilaparoscopic cholecystectomy Systematic review