Combined use of mini-laparoscope and conventional laparoscope in laparoscopic cholecystectomy: preservation of minimal invasiveness.

摘要

Mini-laparoscopic cholecystectomy using a 2-mm mini-laparoscope has been reported to be beneficial but technically difficult. This study attempted to evaluate the relative efficacy of a new method, which provides the benefits of both conventional and mini-laparoscopic cholecystectomy. From March 1997 to December 1997, 143 patients (49 men, 94 women, mean age 52.6 years, range 20-79), American Society of Anesthesiology (ASA) class I-II, underwent elective cholecystectomy by a combination of a 2-mm mini-laparoscope and 10-mm conventional laparoscope (combined lap-aroscopic cholecystectomy, C group) in National Taiwan University Hospital, Taipei, Taiwan. The entire procedure was done through four ports (one 11-mm port and three 2-mm ports). For comparison, records from 46 patients receiving mini-laparoscopic cholecystectomy (M group, 17 men, 29 women, mean age 49.0 years, range 26-76) and 139 patients receiving conventional laparoscopic cholecystectomy (L group, 47 men, 92 women, mean age 51.2 years, range 28-82) by the same operative team were included retrospectively. Mean operation time, time until first postoperative oral intake, dosage of analgesic, and postoperative hospital stay as well as possible complications were compared. No significant differences concerning the age, sex, and ASA classification were identified between all groups. The operative time of the C group (59.9 +/- 17.3 min, p = 0.420) but was significantly shorter than that of the M group (72.8 +/- 26.5 min, p < 0.001). No differences concerning the analgesic usage (0.5 +/- 0.8 unit vs. 0.4 +/- 0.7 unit, p = 0.372), postoperative oral intake (4.4 +/- 1.9 h vs. 3.3 +/- 2.3 h, p = 0.067), and postoperative hospital stay (1.7 +/- 0.7 days vs. 1.7 +/- 0.7 days, p = 0.941) were found between the C group and the M group. However, compared with the L group, analgesic usage (0.5 +/- 0.8 unit vs. 0.8 +/- 1.0 unit, p = 0.003) and time until first postoperative oral intake (4.4 +/- 1.9 h vs. 6.2 +/- 3.0 h, p < 0.001) were less, and the postoperative hospital stay (1.7 +/- 0.7 days vs. 2.0 +/- 0.9 days, p = 0.002) was significantly shorter in the C group. Combined use of the mini-laparoscope and the conventional laparoscope in cholecystectomy provides the benefits of both conventional laparoscopic and mini-laparoscopic cholecystectomy. It is easier to perform than cholecystectomy that uses the mini-laparoscope alone and results in a much smaller wound with less pain than conventional laparoscopic cholecystectomy. It is a feasible, safe procedure, and the minimal invasiveness of mini-laparoscopic cholecystectomy is preserved. It is an alternative way to deal with gallstone disease, especially for younger women, who tend to be more concerned about cosmetic outcome.