Pain after microlaparoscopic cholecystectomy

Abstract

Micro-LC in combination with a prophylactic multimodal analgesic regimen reduced postoperative pain for the first 3 h postoperatively. However, the micro-LC led to an unacceptable rate of conversion to LC (38%). The micro-LC instruments therefore need further technical development before this surgical technique can be used on a routine basis for laparoscopic cholecystectomy.

Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy

“…This result compares favorably with the randomized trials reported in the literature, in which the conversion rate to CLC or open cholecystectomy ranges from 3% to 38% [3,4,6,11,15]. In one randomized study, the duration of the operation was a median of 30 min longer when performed with 2-mm instruments and was associated with a 38% conversion rate to CLC [4]. In the present study and the other four trials, there were no significant increases in the overall times for cholecystectomy and conversion rates were lower [3,6,11,15].…”

“…If a 3.3-mm argon diathermy probe had been available, this could have been avoided. This result compares favorably with the randomized trials reported in the literature, in which the conversion rate to CLC or open cholecystectomy ranges from 3% to 38% [3,4,6,11,15]. In one randomized study, the duration of the operation was a median of 30 min longer when performed with 2-mm instruments and was associated with a 38% conversion rate to CLC [4].…”

“…Smaller instruments may result in reduced pain [8,20,21], a faster recovery [21], and virtually invisible wounds [8,10,20,21]. Although two studies recorded a 70% reduction in analgesic requirements [7,8], recent randomized controlled trials have not confirmed this finding [3,4,6,11,15]. Four trials reported a reduction in postoperative pain [3,4,6,15], but only one recorded a lower consumption of analgesia [6].…”

“…There may also be a learning curve for fine-caliber instruments [21]. Due to these difficulties, one randomized trial had to be abandoned prematurely because 38% of procedures were converted to CLC [4].…”

Laparoscopic sigmoidectomy in Germany—a standardised procedure?

“…Although evidence-based guidelines on colon and rectal cancer surgery exist [11,12], and surgical procedures have been described in detail [7][8][9][10][13][14][15], there obviously is no standardised pathway concerning the technical issues of laparoscopic sigmoid resection in Germany. This is important because it has been shown that details of laparoscopic surgery, like trocar position [24] or size of incisions [25,26], have a clinically relevant impact on postoperative recovery after minimal invasive surgery.…”