Maria Altieri, MD, Dana A Telem, MD, Lily Wang, George Zhou, Sumit Kapoor, MD, Aurora Pryor, MD. Stony Brook University Hospital
In recent years, the use of microlaparoscopic procedures (trocar incisions less than 3mm) has been gaining popularity. It is thought that the smaller incision will lead to decreased postoperative pain, better cosmetic results, decreased hospital length of stay (HLOS). We examined our experience with microlaparoscopy with two common procedures: cholecystectomy and Heller myotomy.
Following Institutional Review Board (IRB) approval, a retrospective chart review of all patients who presented for cholecystectomy and heller myotomy was performed. Patients with incomplete records were excluded. Three hundred fifty-four patients who underwent microlaparoscopic versus conventional laparoscopic cholecystectomy from September 2011 to January 2014 were identified from surgical reports. Statistical comparison between patient demographics, ASA classification, perioperative parameters, hospital length of stay (HLOS), 30-day readmissions and returns to the emergency department (ED) was performed via univariate analysis.
From the 354 patients identified, 338 (95.5%) underwent cholecystectomy and 16 (4.5%) underwent heller myotomy. In the cholecystectomy group, 18/338 (5.3%) had microlaparoscopy; in the Heller myotomy group 1/16 (6.3%) had microlaparoscopy. There was no statistical significance between these groups in terms of age, sex, or race (Table 1). Patients undergoing microlaparoscopic cholecystectomy had significantly lower body mass index (P<0.01). Pre-operatively, the patients who underwent microlaparoscopy had lower length of stay prior to surgery, compared to those that underwent conventional laparoscopic cholecystectomy. Majority of patients undergoing Heller myotomy came as scheduled procedures. There was no statistical significance in term of operative time and estimated blood loss (EBL) for both surgeries. Following surgery, patients with microscopic cholecystectomy had decreased hospital length of stay compared to those who underwent conventional laparoscopy (P=0.03). There was no difference between the two groups when comparing 30-day returns to emergency department and readmissions for both types of surgeries.
Although we concluded that microlaparoscopy is a safe alternative to conventional laparoscopy, in our series there was no statistical significance noted in 30-day readmission or ED return. Patients undergoing microlaparoscopic cholecystectomy had significantly lower BMI, less hospital stay prior to surgery, and HLOS following surgery. Due to the small number of Heller myotomies, no statistical significance was seen.