Surgical Endoscopy

, Volume 31, Issue 5, pp 2299–2309 | Cite as

Impact of miniport laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy on recovery of physical activity: a randomized trial

  • Mohsen Alhashemi
  • Mohammed Almahroos
  • Julio F. FioreJr.
  • Pepa Kaneva
  • Juan Mata Gutierrez
  • Amy Neville
  • Melina C. Vassiliou
  • Gerald M. Fried
  • Liane S. Feldman
Article
First Online:
Received:
Accepted:

Abstract

Introduction

We conducted a randomized trial comparing minilaparoscopic cholecystectomy (MLC) to conventional laparoscopic cholecystectomy (CLC) to determine whether MLC accelerated recovery of physical activity after elective surgery (NCT01397565).

Methods

A total of 115 patients scheduled for elective cholecystectomy were randomized to either CLC or MLC. Both procedures used a 10-mm umbilical port, but the three upper abdominal ports were 5 mm in CLC and 3 mm in MLC. Primary outcome was self-reported physical activity 1 month after surgery as estimated by Community Health Activities Model Program for Seniors questionnaire (kcal/kg/week). Secondary outcomes were umbilical pain, abdominal pain, nausea and fatigue (VAS, 1–10), and cosmetic result at one and 3 months. Patients received identical surgical dressings for 1 week, and assessors were blinded to group allocation.

Results

Forty-two patients randomized to CLC group and 33 patients randomized to MLC remained in the trial and were analyzed. Both groups were similar at baseline characteristics. In the MLC group, at least one 5-mm port was used in 17 (51.5 %) mainly due to unavailability of ML equipment. Median (IQR) physical activity for the CLC and MLC groups was similar at baseline (23.4 [13.1, 44.6] vs 23.6 [14.2, 66.9] kcal/kg/week, p = 0.35) and at 1 month (20 [7.9, 52.5] vs 16.8 [11.8, 28.6] kcal/kg/week, p = 0.90). One month post-op, umbilical pain and abdominal pain were similar, but the CLC group reported higher fatigue (4 [1–5] vs 1 [0–4], p = 0.05) and worse scar appearance scores (4 [3, 4] vs 4.5 [4, 5], p = 0.009). At 3 months, the CLC group had worse scar appearance (4 [3–5] vs 5 [4–5], p = 0.02) and lower scar satisfaction scores (4 [3, 4] vs 4 [3.5–4], p = 0.04).

Conclusion

Recovery of physical activity was similar after MLC and CLC. MLC resulted in less fatigue and better scar appearance and satisfaction. These benefits were seen despite the need to upsize one or more ports in more than half of patients related to availability of the miniature instruments.

Keywords

Minilaparoscopic Needlescopic Cholecystectomy Randomized trial Laparoscopy Miniport 
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Notes

Acknowledgments

The minilap instruments were donated by Storz. The Steinberg-Bernstein Centre receives an unrestricted educational Grant from Medtronic.

Compliance with ethical standards

Disclosures

Drs. Mohsen Alhashemi, Mohammed Almahroos, Julio F. Fiore Jr., Juan Mata Gutierrez, Amy Neville, Melina Vassiliou, Gerald M. Fried, Liane S. Feldman and Ms. Pepa Kaneva have no conflict of interest or financial ties to disclose.

Supplementary material

464_2016_5232_MOESM1_ESM.docx (106 kb)
Supplementary material 1 (DOCX 106 kb)

References

  1. 1.
    Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 161(3):385–387. doi: 10.1016/0002-9610(91)90603-B CrossRefPubMedGoogle Scholar
  2. 2.
    Visser BC, Parks RW, Garden OJ (2008) Open cholecystectomy in the laparoendoscopic era. Am J Surg 195(1):108–114. doi: 10.1016/j.amjsurg.2007.04.008 CrossRefPubMedGoogle Scholar
  3. 3.
    Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. doi: 10.1002/14651858.cd006231 Google Scholar
  4. 4.
    McCormack D, Saldinger P, Cocieru A, House S, Zuccala K (2011) Micro-laparoscopic cholecystectomy: an Alternative to single-port surgery. J Gastrointest Surg 15(5):758–761. doi: 10.1007/s11605-011-1438-5 CrossRefPubMedGoogle Scholar
  5. 5.
    Thakur V, Schlachta CM, Jayaraman S (2011) Minilaparoscopic versus conventional laparoscopic cholecystectomy a systematic review and meta-analysis. Ann Surg 253(2):244–258. doi: 10.1097/SLA.0b013e318207bf52 CrossRefPubMedGoogle Scholar
  6. 6.
    Carvalho GL, Loureiro MP, Bonin EA (2011) Renaissance of minilaparoscopy in the NOTES and single port era. J Soc Laparoendosc Surg 15(4):585–588. doi: 10.4293/108680811X13176785204832 CrossRefGoogle Scholar
  7. 7.
    Gurusamy KS, Vaughan J, Rossi M, Davidson BR (2014) Fewer-than-four ports versus four ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2:Cd007109. doi: 10.1002/14651858.CD007109.pub2 Google Scholar
  8. 8.
    Lee L, Dumitra T, Fiore JF Jr, Mayo NE, Feldman LS (2015) How well are we measuring postoperative “recovery” after abdominal surgery? Qual Life Res Int J Qual Life Asp Treat Care Rehabil 24(11):2583–2590. doi: 10.1007/s11136-015-1008-5 CrossRefGoogle Scholar
  9. 9.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8:18. doi: 10.1186/1741-7015-8-18 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    McGill University Health Center: a guide to gallblader surgery. http://www.muhcpatienteducation.ca/DATA/GUIDE/231_en~v~gallbladder-surgery.pdf
  11. 11.
    Feldman LS, Kaneva P, Demyttenaere S, Carli F, Fried GM, Mayo NE (2009) Validation of a physical activity questionnaire (CHAMPS) as an indicator of postoperative recovery after laparoscopic cholecystectomy. Surgery 146(1):31–39. doi: 10.1016/j.surg.2009.02.019 CrossRefPubMedGoogle Scholar
  12. 12.
    Durani P, McGrouther DA, Ferguson MW (2009) The Patient Scar Assessment Questionnaire: a reliable and valid patient-reported outcomes measure for linear scars. Plast Reconstr Surg 123(5):1481–1489. doi: 10.1097/PRS.0b013e3181a205de CrossRefPubMedGoogle Scholar
  13. 13.
    Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR (2009) Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ (Clin Res ed) 338:b2393. doi: 10.1136/bmj.b2393 CrossRefGoogle Scholar
  14. 14.
    Novitsky YW, Kercher KW, Czerniach DR et al (2005) Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial. Arch Surg 140(12):1178–1183. doi: 10.1001/archsurg.140.12.1178 CrossRefPubMedGoogle Scholar
  15. 15.
    Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L (2003) Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg 90(11):1345–1348. doi: 10.1002/bjs.4315 CrossRefPubMedGoogle Scholar
  16. 16.
    Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J (2002) Microlaparoscopic vs conventional laparoscopic cholecystectomy. Surg Endosc 16(3):458–464. doi: 10.1007/s00464-001-9026-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Huang M, Wang W, Wei P, Chen RJ, Lee W (2003) Minilaparoscopic and laparoscopic cholecystectomy: a comparative study. Arch Surg 138(9):1017–1023. doi: 10.1001/archsurg.138.9.1017 CrossRefPubMedGoogle Scholar
  18. 18.
    Saad S, Strassel V, Sauerland S (2013) Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 100(3):339–349. doi: 10.1002/bjs.9003 CrossRefPubMedGoogle Scholar
  19. 19.
    Tran TT, Kaneva P, Mayo NE, Fried GM, Feldman LS (2014) Short-stay surgery: what really happens after discharge? Surgery 156(1):20–27. doi: 10.1016/j.surg.2014.03.024 CrossRefPubMedGoogle Scholar
  20. 20.
    Carli F, Mayo N (2001) Measuring the outcome of surgical procedures: what are the challenges? Br J Anaesth 87(4):531–533CrossRefPubMedGoogle Scholar
  21. 21.
    Lee L, Tran T, Mayo NE, Carli F, Feldman LS (2014) What does it really mean to “recover” from an operation? Surgery 155(2):211–216. doi: 10.1016/j.surg.2013.10.002 CrossRefPubMedGoogle Scholar
  22. 22.
    Antonescu I, Scott S, Tran TT, Mayo NE, Feldman LS (2014) Measuring postoperative recovery: what are clinically meaningful differences? Surgery 156(2):319–327. doi: 10.1016/j.surg.2014.03.005 CrossRefPubMedGoogle Scholar
  23. 23.
    Gkegkes ID, Mavros MN, Alexiou VG, Peppas G, Athanasiou S, Falagas ME (2012) Adhesive strips for the closure of surgical incisional sites: a systematic review and meta-analysis. Surg Innov 19(2):145–155. doi: 10.1177/1553350611418989 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Mohsen Alhashemi
    • 1
    • 2
    • 4
  • Mohammed Almahroos
    • 1
    • 2
    • 4
  • Julio F. FioreJr.
    • 2
    • 4
  • Pepa Kaneva
    • 2
    • 4
  • Juan Mata Gutierrez
    • 1
    • 2
    • 4
  • Amy Neville
    • 3
  • Melina C. Vassiliou
    • 1
    • 2
    • 4
  • Gerald M. Fried
    • 1
    • 2
    • 4
  • Liane S. Feldman
    • 1
    • 2
    • 4
  1. 1.Department of SurgeryMcGill UniversityMontrealCanada
  2. 2.Steinberg-Bernstein Centre for Minimally Invasive SurgeryMcGill University Health CentreMontrealCanada
  3. 3.Department of SurgeryUniversity of OttawaOttawaCanada
  4. 4.McGill University Health CentreMontrealCanada

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