Alhashemi Mohsen, Almahroos Mohammed, Fiore Julio F, Kaneva Pepa, Gutierrez Juan Mata, Neville Amy, Vassiliou Melina C, Fried Gerald M, Feldman Liane S
Department of Surgery, McGill University, Montreal, QC, Canada.
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, QC, Canada.
Surg Endosc. 2017 May;31(5):2299-2309. doi: 10.1007/s00464-016-5232-z. Epub 2016 Sep 21.
We conducted a randomized trial comparing minilaparoscopic cholecystectomy (MLC) to conventional laparoscopic cholecystectomy (CLC) to determine whether MLC accelerated recovery of physical activity after elective surgery (NCT01397565).
A total of 115 patients scheduled for elective cholecystectomy were randomized to either CLC or MLC. Both procedures used a 10-mm umbilical port, but the three upper abdominal ports were 5 mm in CLC and 3 mm in MLC. Primary outcome was self-reported physical activity 1 month after surgery as estimated by Community Health Activities Model Program for Seniors questionnaire (kcal/kg/week). Secondary outcomes were umbilical pain, abdominal pain, nausea and fatigue (VAS, 1-10), and cosmetic result at one and 3 months. Patients received identical surgical dressings for 1 week, and assessors were blinded to group allocation.
Forty-two patients randomized to CLC group and 33 patients randomized to MLC remained in the trial and were analyzed. Both groups were similar at baseline characteristics. In the MLC group, at least one 5-mm port was used in 17 (51.5 %) mainly due to unavailability of ML equipment. Median (IQR) physical activity for the CLC and MLC groups was similar at baseline (23.4 [13.1, 44.6] vs 23.6 [14.2, 66.9] kcal/kg/week, p = 0.35) and at 1 month (20 [7.9, 52.5] vs 16.8 [11.8, 28.6] kcal/kg/week, p = 0.90). One month post-op, umbilical pain and abdominal pain were similar, but the CLC group reported higher fatigue (4 [1-5] vs 1 [0-4], p = 0.05) and worse scar appearance scores (4 [3, 4] vs 4.5 [4, 5], p = 0.009). At 3 months, the CLC group had worse scar appearance (4 [3-5] vs 5 [4-5], p = 0.02) and lower scar satisfaction scores (4 [3, 4] vs 4 [3.5-4], p = 0.04).
Recovery of physical activity was similar after MLC and CLC. MLC resulted in less fatigue and better scar appearance and satisfaction. These benefits were seen despite the need to upsize one or more ports in more than half of patients related to availability of the miniature instruments.
我们进行了一项随机试验，比较迷你腹腔镜胆囊切除术（MLC）与传统腹腔镜胆囊切除术（CLC），以确定MLC是否能加速择期手术后身体活动的恢复（NCT01397565）。
总共115例计划进行择期胆囊切除术的患者被随机分为CLC组或MLC组。两种手术均使用10毫米脐部端口，但CLC组上腹部的三个端口为5毫米，MLC组为3毫米。主要结局是术后1个月通过老年人社区健康活动模型计划问卷估计的自我报告身体活动量（千卡/千克/周）。次要结局包括脐部疼痛、腹痛、恶心和疲劳（视觉模拟评分法，1 - 10分），以及术后1个月和3个月时的美容效果。患者接受相同的手术敷料包扎1周，评估者对分组情况不知情。
随机分配至CLC组的42例患者和随机分配至MLC组的33例患者留在试验中并接受分析。两组在基线特征方面相似。在MLC组中，17例（51.5%）至少使用了一个5毫米端口，主要原因是ML设备不可用。CLC组和MLC组在基线时的身体活动量中位数（四分位间距）相似（23.4 [13.1, 44.6] 千卡/千克/周 对 23.6 [14.2, 66.9] 千卡/千克/周，p = 0.35），在术后1个月时也相似（20 [7.9, 他也会说一些英语52.5] 千卡/千克/周 对 16.8 [11.8, 28.6] 千卡/千克/周，p = 0.90）。术后1个月，脐部疼痛和腹痛相似，但CLC组报告的疲劳程度更高（4 [1 - 5] 分 对 1 [0 - 4] 分，p = 0.05），瘢痕外观评分更差（4 [3, 4] 分 对 4.5 [4, 5] 分，p = 0.009）。在术后3个月，CLC组的瘢痕外观更差（4 [3 - 5] 分 对 5 [4 - 5] 分，p = 0.02），瘢痕满意度评分更低（4 [3, 4] 分 对 4 [3.5 - 4] 分，p = 0.04）。
MLC和CLC术后身体活动的恢复情况相似。MLC导致的疲劳更少，瘢痕外观和满意度更好。尽管超过一半的患者因微型器械可用性问题需要增大一个或多个端口，但仍能看到这些益处。
