Joseph Shaw, Fatima Haggar, Mehar-Un-Nisa Rashid, Reilly Musselman, MD, Husein Moloo, MD, MSc, Joseph Mamazza, MD. Ottawa Hospital Research Institute.
Needlescopic surgery may be an alternative to conventional laparoscopic surgery as it uses smaller instruments, thereby potentially reducing postoperative pain, hospital stay and improving cosmesis. We performed a systematic review of published randomised controlled trials (RCTs) and nonrandomised comparative studies (non-RCTs) to assess the efficacy of needlescopic surgery in comparison with conventional laparoscopic surgery in patients undergoing intra-abdominal surgeries. We searched The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE until June 2013. Reference lists of included citations were screened for potentially relevant articles. Continuous variables were compared as weighted mean differences (WMD) and pooled odds ratios (OR) were calculated for categorical variables using a fixed effects model. We identified 36 studies (16 RCTs and 20 non-RCTs), with a total of 2980 participants. Our review included cholecystectomy procedures (14 RCTs and 10 non-RCTs), appendectomy procedures (2 RCTs and 2 non-RCTs), Nissen Fundoplication procedures (2 non-RCTs), Heller Myotomy procedures (2 non-RCTs), inguinal hernioplasty procedures (3 non-RCTs), adrenalectomies (2 non-RCTs) and 1 non-RCT reported on both splenectomy and sympathectomy procedures. Meta-analysis of the cholecystectomy RCT and non-RCT data demonstrated a significant reduction in postoperative length of stay: WMD = -0.15 days, 95% CI = [-0.22 days, -0.07 days]. Rates of overall complications and conversion to open procedure for needlescopic cholecystectomy were not significantly different from the laparoscopic cholecystectomy group. The overall complication rate seems to favour the laparoscopic cholecystectomy group, with higher complication rates associated with needlescopic procedures, although this result was not statistically significant: OR = 1.38, 95% CI = [0.92, 2.05], p = 0.1079. Meta-analysis of pain and cosmesis outcomes was not possible for any of the studies due to the heterogeneity in reported outcomes. However, results from individual studies seem to suggest that needlescopic cholecystectomy and appendectomy procedures are associated with less postoperative pain and improved cosmesis. The only trade-off appears to be a longer operative time for needlescopic surgery procedures. Meta-analysis of the cholecystectomy studies revealed a significantly longer operative time for needlescopic procedures versus laparoscopic procedures: WMD = 8.52 min, [6.81 min, 10.24 min]. Meta-analysis of the appendectomy studies revealed a significantly longer operative time for needlescopic procedures as well: WMD = 7.24 min, [3.96 min, 10.51 min]. Needlescopic surgery appears to offer some benefits to patients requiring intra-abdominal surgery as compared to the laparoscopic approach, particularly with regard to postoperative pain and cosmetic outcomes. However, larger studies using standardised assessment tools are necessary to confirm or refute these findings.
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