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Randomized Controlled Trial
. 2015 Dec 20;128(24):3310-6.
doi: 10.4103/0366-6999.171422.

Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy

Wei Guo, Yang Liu, Wei Han, Jun Liu, Lan Jin, Jian-She Li, Zhong-Tao Zhang  1
Affiliations
Randomized Controlled Trial

Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy

Wei Guo et al. Chin Med J (Engl). .

Abstract

Background: We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed.

Methods: A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle.

Results: Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015).

Conclusions: The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.

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Figures

Figure 1
Figure 1
Incision and placement of instruments in single-incision laparoscopic cholecystectomy (a) shows the mark of the incision site (b and c) that show a curved scar present 7 days and 30 days after surgery, respectively (d) shows the triangular placement of three conventional trocars in a semicircular incision (≤ 2.5 cm in all patients) on the slope of the umbilicus.
Figure 2
Figure 2
Patient selection and procedure allocation.
Figure 3
Figure 3
Postoperative pain associated with single-incision laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy. (a) “Radar” chart of postoperative visual analgesia scores. A significant inter-group difference was seen only at the earliest postoperative time recorded (6 h after surgery). (b) “Dot plot” of subgroup analyses to compare operative time of single-incision laparoscopic cholecystectomy with earliest recorded postoperative pain (6 h after surgery).
See this image and copyright information in PMC

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