Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons’ last five years experience over 932 cases

Abstract

Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth-5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.

Evaluation of pain scores after single‐incision and conventional laparoscopic cholecystectomy: A randomized control trial in a rural Indian population

“…Mini‐laparoscopic techniques are based on instruments that reduce the total length of trocar incisions to less than 2.5 cm. These are considered useful and reproducible alternatives to scarless surgery that offer easy adaptability . The recent progress in SILC is driven mainly by the cosmetic advantages if offers, without the risks and technical limitations of NOTES .…”

Minilaparoscopic ovariohysterectomy in healthy cats

“…Some divergences about the definition of the MINI technique exist among reports in the literature (MANAZZA et al, 2001;AGRESTA & BEDIN, 2012;KRPATA & PONSKY, 2013). However, this study was conducted based on the assertion of CARVALHO et al (2011) that the MINI technique uses one 5 or 10mm portal, which must be in the umbilical position, while the other portals must be 3mm or less.…”

“…In medicine, MINI has been evaluated since the 1990s, and it has been gradually introduced (AGRESTA & BEDIN, 2012). In veterinary medicine, studies of the applicability of this technique are still scarce.…”

Laparoscopic cholecystectomy: consensus conference-based guidelines

“…So, although morbidity and mortality are not significantly different in the two arms, its application is not recommended outside selected trials. In a large case series on 932 patients [195] (LE4), 45 women with a low BMI have undergone a 3-mm three-port-LC, with promising results, but the fragility of the instruments raises cost issues. Implications for future research hamper a comparison with LC regarding costs and learning curve such as to select patients who could certainly benefit from this approach.…”