Carvalho Gustavo L, Paquentin Eduardo Moreno, Redan Jay A, Shadduck Phillip P
University of Pernambuco, Attending Surgeon, Department of Surgery, Hospital Universitário Oswaldo Cruz, Recife, Brazil.
Centro Medico ABC Santa Fe, Mexico City, Mexico.
Surg Technol Int. 2016 Oct 26;29:93-98.
Mini-laparoscopy (Mini) was pioneered more than 20 years ago. Newer generation mini instruments have recently become available with improved effector tips, a choice of shaft diameters and lengths, better shaft insulation and electrosurgery capability, improved shaft strength and rotation, more ergonomic handles, low-friction trocar options, and improved instrument durability. Whether the use of mini instruments, particularly newer generation instruments, offers advantages for laparoscopic cholecystectomy is the subject of this review.
The literature was searched for level I data comparing mini-laparoscopic cholecystectomy (Mini LC) to standard laparoscopic cholecystectomy (Std LC). Three systematic reviews and 19 randomized clinical trials were identified and these were studied to evaluate the science behind Mini LC.
Mini LC requires conversion to Std LC in 12.3% of patients. Mini LC and Std LC require conversion to open cholecystectomy at the same rate (2-3%). As compared to Std LC, Mini LC: (1) takes 3.4-4.9 minutes longer to perform; (2) has the same rate of intraoperative and postoperative complications; (3) may result in slightly less pain in the first 24 hours after surgery; (4) has the same duration of hospital stay, pain scores 1-28 days after surgery, time to return to activity, time to return to work, and postoperative quality of life 10 days after surgery; (5) provides a better early cosmetic result (as graded by patients and by blinded observers); and (6) provides no apparent difference in late cosmesis (as evaluated 6-12 months postop). There are minimal level I data published on the effects of newer mini instruments for laparoscopic cholecystectomy.
When applied to elective laparoscopic cholecystectomy, the use of mini-laparoscopic instruments results in a slightly longer operative procedure (3-5 minutes), slightly less immediate postoperative pain (in the first 24 hours), and a better early cosmetic result, with no other apparent significant differences. Additional data are needed from large, well-conducted studies of Mini LC to resolve several unanswered questions, including the role of newer mini instruments.
微型腹腔镜检查（Mini）开创于20多年前。新一代微型器械最近已面市，其操作端有所改进，有多种不同直径和长度的杆身可供选择，杆身绝缘性和电外科功能更佳，杆身强度和旋转性能有所提高，手柄更符合人体工程学，有低摩擦套管针可供选择，器械耐用性也有所提升。微型器械尤其是新一代器械的使用对于腹腔镜胆囊切除术是否具有优势，是本综述的主题。
检索文献以获取将微型腹腔镜胆囊切除术（Mini LC）与标准腹腔镜胆囊切除术（Std LC）进行比较的I级数据。共识别出三项系统评价和19项随机临床试验，并对这些研究进行分析，以评估Mini LC背后的科学依据。
12.3%的患者需要将Mini LC转换为Std LC。Mini LC和Std LC转换为开腹胆囊切除术的比例相同（2%-3%）。与Std LC相比，Mini LC：（1）手术时间长3.4 - 4.9分钟；（2）术中及术后并发症发生率相同；（3）术后24小时内疼痛可能略轻；（4）住院时间、术后1 - 28天的疼痛评分、恢复活动时间、恢复工作时间以及术后10天的生活质量相同；（5）早期美容效果更好（由患者和不知情观察者评定）；（6）后期美容效果无明显差异（术后6 - 12个月评估）。关于新一代微型器械用于腹腔镜胆囊切除术的效果，发表的I级数据极少。
应用于择期腹腔镜胆囊切除术时，使用微型腹腔镜器械会使手术时间略长（3 - 5分钟），术后即刻疼痛略轻（术后24小时内），早期美容效果更好，无其他明显显著差异。需要来自大型、实施良好的Mini LC研究的更多数据来解决几个未解答的问题，包括新一代微型器械的作用。
