Impact of Minilaparoscopic versus Conventional Laparoscopic Cholecystectomy on recovery of physical activity: A Randomized Trial

Mohsen Alhashemi, MD, MSc, Mohammed Al Mahroos, MD, FRCSC, Pepa Kaneva, MSc, Amy Neville, MD, MSc, FRCS, Melina C Vassliou, MD, MED, FRCSC, FACS, Fried M Gerald, MD, FRCSC, FACS, Liane S Feldman, MD, FRCSC, FACS. Steinberg-Bernstein centre of Minimally Invasive Surgery and Innovation, Mcgill University Health Centre

Introduction: We conducted a randomized, double-blinded trial comparing minilaparoscopic cholecystectomy (ML-C) to conventional laparoscopic cholecystectomy (CL-C) to determine if ML-C is associated with better recovery of physical activity after elective surgery (NCT01397565).

Methods: 115 patients scheduled for elective cholecystectomy were randomized to either CL-C or ML-C. Both procedures used a 10mm umbilical port, but the 3 additional ports were 5mm in CL-C and 3mm for ML-C. Patients with upper abdominal surgery, acute cholecystitis, ASA >3 and morbid obesity were excluded. The primary outcome was self-reported physical activity one month postop as estimated by CHAMPS questionnaire (kcal/kg/week). Other outcomes were umbilical pain, abdominal pain and fatigue (VAS, 1-10), and cosmetic result (1= worst, 5= best) at one and three months.

Results: Forty-three patients randomized to CL-C group and 36 patients randomized to ML-C remained in the trial and were analyzed. In the ML-C group, 47% had at least one 5mm port mainly due to unavailability of ML equipment. The CL-C and ML-C groups were similar at baseline in terms of age, gender and indication for surgery.  Median (IQR) physical activity for the CL-C and ML-C groups was similar at baseline (24.3(13.1-58.8) vs 23.4(14.2-74.6 kcal/kg/wk, p=0.44) and at one month (20(7.9-52.5) vs 16.5(11.6-26.6) kcal/kg/wk, p=0.68). One month postop, while umbilical and abdominal pain were similar, the CL-C group reported higher fatigue (4(1-5) vs 1(0-4), p=0.04) and lower scar appearance scores (4(3-4) vs 4(4-5) vs p=0.02). At 3 months, the CL-C group had lower scar appearance (4(3-5) vs 5(4-5) p=0.05).

Conclusion: Recovery of physical activity was similar after ML-C and CL-C while ML-C resulted in less fatigue and better scar appearance. However, issues with instrument durability limits widespread applicability of minilaparoscopic cholecystectomy

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