Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. [Surgical trauma induced by laparoscopic cholecystectomy]. Minilaparoscopic versus laparoscopic cholecystectomy: a randomised controlled trial. Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response. Evidence‐based management of pain after laparoscopic cholecystectomy: a PROSPECT review update Laparoscopic single site (LESS) and classic video-laparoscopic cholecystectomy in the elderly: A single centre experience. Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomised trial. Mini-laparoscopic versus conventional laparoscopic cholecystectomy: a randomized controlled trial. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial Randomized comparison of conventional and gasless laparoscopic cholecystectomy: Operative technique, postoperative course, and recovery Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study Single‐incision versus 3‐port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses Laparoendoscopic single-site cholecystectomy: A randomized controlled study [Gasless versus conventional laparoscopic cholecystectomy. A randomized trial with regard to technical problems, postoperative course and convalescence]. 
Two-port versus four-port laparoscopic cholecystectomy

BACKGROUND In recent years , new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier . The potential benefits of laparoendoscopic single-site ( LESS ) cholecystectomy may include scarless surgery , reduced postoperative pain , reduced postoperative length of stay , and improved postoperative quality of life . There are no comparative data between LESS cholecystectomy and st and ard laparoscopic cholecystectomy ( LC ) available at present with which to quantify these benefits . METHODS This study was a prospect i ve , r and omized , dual-institutional pilot trial comparing LESS cholecystectomy with st and ard LC . The primary end point was postoperative quality of life , measured as length of hospital stay , postoperative pain , cosmetic results , and SF-36 question naire scores . Secondary end points included operative time , conversion to st and ard LC , difficulty of exposure , difficulty of dissection , and complication rate . RESULTS No significant differences in postoperative lengths of stay were found in the two groups . Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the st and ard LC arm on the same day of surgery ( P = .041 ) . No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications . Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up ( mean , 94.5 ± 9.4 % vs 86 ± 22.3 % ; median , 100 % vs 90 % ; P = .025 ) . Among the 8 scales of the SF-36 assessing patients ' physical and mental health , scores on the Role Emotional scale were significantly better in the LESS group ( mean , 80.05 ± 29.42 vs 68.33 ± 25.31 ; median , 100 vs 66.67 ; P < .0001 ) . CONCLUSIONS In this pilot trial , LESS cholecystectomy result ed in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery . A larger multicenter trial is needed to confirm and further investigate these results The objective demonstration of improved postoperative recovery suggests that surgical injury induced by the laparoscopic approach is less intense than that after open surgery .  Forty-two patients diagnosed as having noncomplicated gallstones were studied prospect ively . They were operated on by laparoscopy ( LC , n = 21 ) or open surgery ( OC , n = 21 ) . Both surgical procedures induced significant changes of investigated parameters ( acute-phase response , free radical mediated reactions , neutrophil functions ) . Comparison of the results of the two cholecystectomy techniques showed that laparoscopic cholecystectomy induced a significantly less intense acute-phase response , a more attenuated oxidative stress characterising by free radical mediated reactions and that is less disruptive to neutrophil function . The results and the data from the literature suggest that surgical injury causing by the laparoscopic cholecystectomy is less intense than that after open cholecystectomy , which can explain partially the better clinical outcome following laparoscopic versus open procedure Since its introduction in 1987 , the technique of cholecystectomy has continued to undergo evolution . Surgeons have reduced the port size and number or both to achieve improvement in postoperative pain control , rapid return to activity and better cosmetic results . Therefore , this study was done to compare the st and ard 4 port laparoscopic cholecystectomy ( LC ) with the 3 port laparoscopic cholecystectomy using a 5 mm telescope instead of 10 mm telescope ( mini laparoscopic cholecystectomy - MLC ) .  Forty patients were r and omised to each group .  Mean operating time , intraoperative and postoperative complications , mean period to resume walking , eating and return to normal activities and mean hospital stay were similar in the two groups . The level of postoperative pain was significantly lower in the MLC group . Patients who underwent MLC required a significantly lower dose of analgesics . In conclusion mini laparoscopic cholecystectomy is a feasible and safe procedure with less postoperative pain and better cosmesis and without increased complications OBJECTIVE Open cholecystectomy ( OC ) has been superseded by laparoscopic cholecystectomy ( LC ) for the treatment of cholelithiasis , although this fashion has not been vali date d by prospect i ve studies . Our aim was to compare the two techniques . DESIGN Prospect i ve , r and omised , open study . SETTING University hospital , Finl and . PATIENTS 49 patients who required cholecystectomy for cholelithiasis confirmed by ultrasound . INTERVENTIONS 49 patients were r and omly allocated to LC ( n = 27 ) or OC ( n = 22 ) : 25 and 22 , respectively , eventually had the operation . LC was done using a four-trocar technique , and OC through a transverse right subcostal incision , as short as possible . MAIN OUTCOME MEASURES Length of hospital stay and the duration of the sick leave were the primary outcome measures . Secondary outcome measures were : postoperative pain evaluated by visual analogue scale ( VAS ) and the need for opioids ; pulmonary function measured by forced vital capacity ( FVC ) , forced expiratory volume in one second ( FEV1 ) , peak flow velocity ( PEFV ) , and arterial oxygen tension ( PaO2 ) , and endocrine stress measured by plasma catecholamines , cortisol and glucose concentrations . RESULTS The median ( range ) hospital stay was significantly shorter after LC than OC , being 2.0 ( 1 - 15 ) compared with 4.5 ( 2 - 19 ) days p < 0.01 . The duration of sick leave was also significantly shorter after LC than OC , being 14 ( 7 - 17 ) compared with 29 ( 4 - 34 ) , p < 0.01 . Patients had significantly less postoperative pain after LC than OC as reflected by the need for opioids . Pulmonary function and arterial oxygen tension deteriorated significantly less after LC than OC . The stress response was equal . There were three documented complications , one pneumonia after LC and two wound infections after OC . CONCLUSIONS LC gives significantly better results in terms of less postoperative pain , better pulmonary function , better arterial oxygenation , and shorter hospital stay and duration of sick leave Background : Significant pain can be experienced after laparoscopic cholecystectomy . This systematic review aims to formulate PROSPECT ( PROcedure SPECific Postoperative Pain ManagemenT ) recommendations to reduce postoperative pain after laparoscopic cholecystectomy . Methods : R and omised controlled trials published in the English language from January 2006 ( date of last PROSPECT review ) to December 2017 , assessing analgesic , anaesthetic , or operative interventions for laparoscopic cholecystectomy in adults , and reporting pain scores , were retrieved from MEDLINE and Cochrane data bases using PRISMA ( Preferred Reporting Items for Systematic Review s and Meta‐Analyses ) search protocol s. PROSPECT methodology was used , and recommendations were formulated after review and discussion by the PROSPECT group ( an international group of leading pain specialists and surgeons ) . Results : Of 1988 r and omised controlled trials identified , 258 met the inclusion criteria and were included in this review . The studies were of mixed method ological quality , and quantitative analysis was not performed because of heterogeneous study design and how outcomes were reported . Conclusions : We recommend basic analgesic techniques : paracetamol + NSAID or cyclooxygenase‐2 specific inhibitor + surgical site local anaesthetic infiltration . Paracetamol and NSAID should be started before or during operation with dexamethasone ( GRADE A ) . Opioid should be reserved for rescue analgesia only ( GRADE B ) . Gabapentanoids , intraperitoneal local anaesthetic  , and  transversus abdominis plane blocks  are not recommended ( GRADE D ) unless basic analgesia is not possible . Surgically , we recommend low‐pressure pneumoperitoneum , postprocedure saline lavage , and aspiration of pneumoperitoneum ( GRADE A ) . Single‐port incision techniques are not recommended to reduce pain ( GRADE A ) Laparoscopic cholecystectomy ( LC ) is the gold-st and ard surgical method used to treat gallbladder diseases . Recently Laparoendoscopic single site surgery ( LESS ) has gained greater interest and diffusion for the surgical treatment of several pathologies . In elderly patients , just few r and omized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures . We present in this paper the preliminary results of this r and omized prospect i ve study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique . We demonstrated that LESS technique compared with traditional technique show some advantages like : acceptable operative times , lower post-operative discomfort and sometimes reduction added complications . In addition we also demonstrate that fewer incisions and less scarring which mean less pain , and fewer parietal complications are related to this surgical procedure . In conclusion in the elderly  LESS cholecystectomy technique is to be considered a suitable alternative to traditional three-port cholecystectomy BACKGROUND Needlescopic cholecystectomy ( NC ) utilises instruments and ports smaller than 3 mm in diameter compared with the 5 mm ones used in conventional laparoscopic cholecystectomy ( LC ) . Post-operative pain control and recovery has been thought to be superior in NC , when compared with historical controls with LC , but has not been proven in a prospect i ve fashion . PATIENTS AND METHODS A prospect i ve r and omised trial of NC versus LC for patients with symptomatic gallstone disease , with st and ardisation of post-operative analgesia and daily assessment of post-operative pain , using a 5-point visual analogue scale . RESULTS There were 64 eligible patients r and omised into NC ( 28 ) and LC ( 36 ) . Four patients who had NC were converted to LC due to technical problems . Another three and six patients from the NC and LC groups , respectively , had conversion to open surgery . Post-operative pain scores were low in both groups . Mean pain scores for those with successful NC and LC were : 1.24 versus 1.43 for the day of operation ( P = 0.49 ) , 0.86 versus 0.83 for the first day post-operatively ( P = 0.92 ) and 0.75 versus 0.81 for the second post-operative day ( P = 0.87 ) . The mean number of intra-muscular analgesic injections required were 0.76 versus 0.83 after NC and LC , respectively ( P = 0.93 ) . There were no significant differences between the two groups in the time taken to return to feeding , eating a normal diet and discharge from hospital . CONCLUSION There is no advantage of NC over LC in terms of post-operative pain or recovery . Nevertheless , NC can be performed safely and expediently and has an excellent cosmetic outcome and high patient acceptability BACKGROUND Several studies have reported faster recoveries , lower pain scores , and superior cosmetic results after mini-laparoscopic cholecystectomy ( MLC ) . The purpose of this study was to perform a r and omized controlled trial , comparing MLC with conventional laparoscopic cholecystectomy ( LC ) . SUBJECTS AND METHODS Forty-one patients with symptomatic cholecystolithiasis were r and omized between the two groups : 23 having undergone LC and 18 MLC .  The primary end point was postoperative pain , which was evaluated during the first 24 hours postoperatively , using the numerical rating scale . Patient satisfaction with the cosmetic result was evaluated after 1 month . RESULTS The two groups were comparable concerning age , sex , and body mass index . The median operating time ( 42 minutes versus 45 minutes ; P=.386 ) , complication rate , and duration of hospital stay ( 2 days ; P=.611 ) were similar in both groups . The level of postoperative pain was analogous at every time . There was no difference in the analgesic requirements or cosmesis . CONCLUSIONS MLC showed similar results concerning postoperative pain and did not lead to a greater patient satisfaction with the cosmetic result , compared with LC . MLC did not take longer to perform , nor was it associated with major complications or a high conversion rate . MLC is a safe and feasible technique for the treatment of gallbladder disease in elective patients Background The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery ( NOTES ) and single-incision laparoscopic surgery ( SILS ) . These new techniques are considered to be painless procedures , but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy . In this r and omized control study , we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy . Patients and methods Forty patients ( 34 women and 6 men ) were r and omly assigned to two groups . In group A ( n = 20 ) four-port classic laparoscopic cholecystectomy was performed . Patients in group B ( n = 20 ) underwent SILS cholecystectomy .  In all patients , preincisional local infiltration of ropivacaine around the trocar wounds was performed . Infusion of ropivacaine solution in the right subdiaphragmatic area at the beginning of the procedure plus normal saline infusion in the same area at the end of the procedure was performed in all patients as well . Shoulder tip and abdominal pain were registered at 2 , 6 , 12 , 24 , 48 , and 72 h postoperatively using visual analog scale ( VAS ) . Results Significantly lower pain scores were observed in the SILS group versus the classic laparoscopic cholecystectomy group after the first 12 h for abdominal pain , and after the first 6 h for shoulder pain . Total pain after the first 24 h was nonexistent in the SILS group . Also , requests for analgesics were significantly less in the SILS group , while no difference was observed in incidence of nausea and vomiting between the two groups . ConclusionS ILS cholecystectomy , as well as the invisible scar , has significantly lower abdominal and shoulder pain scores , especially after the first 24 h postoperatively , when this pain is nonexistent . ( Registration Clinical Trial number : NTC00872287 , www . clinical trials.gov ) The positive CO2 pneumoperitoneum needed to create the working space for laparoscopic surgery induces cardiovascular , neuroendocrine , and renal changes . Concern about these pathophysiologic changes has led to the introduction of a gasless technique .  Fifty consecutive patients with symptomatic gallstones were r and omized to conventional ( CLC ) or gasless laparoscopic cholecystectomy ( GLC ) , with special reference to overall patient satisfaction , technical difficulties , duration of surgery , postoperative pain , and recovery . The overall exposure of the operative field was extremely poor in the GLC group , whereas the duration of surgery , steps involved in the cholecystectomy technique , length of hospital stay , and postoperative pain score did not differ significantly . After discharge , the median time to complete relief of pain tended to be shorter in the gasless group ( 5 days [ range 1 to 15 ] ) vs. the conventional group ( 8 days [ range 1 to 15 ] ) . The period to return to normal activity was shorter in the GLC group ( 6 days [ range 1 to 1.5 ] ) compared to the CLC group ( 8.5 days [ range 1 to 15 ] ) ( P = 0.031 ) . No differences were found in terms of fatigue , dizziness and nausea , and overall satisfaction with the outcome . This study demonstrates a significantly shorter convalescence after laparoscopic cholecystectomy by means of the gasless technique compared to the conventional CO2 technique . Exposure of the operative field was less than optimal using the gasless technique BACKGROUND Laparoscopic cholecystectomy ( LC ) is the gold-st and ard for the treatment of gallbladder stone disease . In recent years laparoendoscopic single site surgery ( LESS ) has gained greater interest and diffusion for the treatment of gallstones and also in bariatric and colonic surgery . However , no r and omized controlled trials are present in the literature that confirm the clinical advantages of LESS compared with the classic laparoscopic procedures . For this reason , we present the preliminary results of this r and omized prospect i ve study regarding the feasibility and safety of LESS cholecystectomy versus classic laparoscopic technique . METHODS Between October 2009 and April 2010 , 50 patients were r and omly assigned to three-port classic laparoscopic cholecystectomy ( n = 25 ) or LESS procedure ( n = 25 ) . Exclusion criteria were : ( 1 ) previous abdominal surgery , ( 2 ) signs of acute cholecystitis , choledocholithiasis , or acute pancreatitis , ( 3 ) ASA grade III or more , ( 4 ) lack of written informed consent , and ( 5 ) BMI ≥ 30 Kg/m(2).All the patients ' details were recorded : age , weight , height , body mass index , operative time , length of hospital stay , patients ' pain and wound satisfaction score . Abdominal pain was registered at 6 , 12 , and 24 h postoperatively . Wound satisfaction score ( very unsatisfied = 1 , unsatisfied = 2 , acceptable = 3 , satisfied = 4 , very satisfied = 5 ) was registered for each patient at the seventh postoperative day . RESULTS No differences were registered between the two groups about gender , age , weight , height , and BMI . Also postoperative hospital stay was similar ( P = 0.71 ) . In three patients ( 1 in group A and 2 in group B ) a 5-mm trocar was added . Intraoperative cholangiography was performed in five patients ( 2 in group A and 3 in group B ) . Mean operative time was significantly longer in LESS procedures ( 41.3 ± 12.0 versus 35.6 ± 5.8 ; P = 0.04 ) . Abdominal postoperative pain was similar in LC and LESS cholecystectomy . Wound satisfaction score showed statistically significant differences between the two groups : in LESS group , patients were more satisfied with the presence of a small umbilical medication ( P < 0.05 ) . CONCLUSION In this r and omized prospect i ve study , we conclude that LESS cholecystectomy is an excellent alternative to traditional three-port cholecystectomy for patients with uncomplicated disease , and no previous abdominal surgery . Although no differences are present about hospital stay and postoperative pain compared with classic laparoscopic cholecystectomy , in our experience LESS has had a significant impact on patients ' wound satisfaction Background This study aim ed to compare the short-term outcomes of single-access laparoscopic cholecystectomy ( SALC ) and conventional laparoscopic cholecystectomy ( CLC ) . Methods In a prospect i ve study , patients with symptomatic cholelithiasis were r and omized to SALC or CLC with follow-up at 1 week , 1 and 6 months . The primary end point of this study was to assess the total outcomes of quality of life using the EuroQoL EQ-5D question naire . The secondary end points were postoperative pain , analgesia requirement and duration of use , operative time , perioperative complications , estimated blood loss , hospital stay , cosmesis outcome , and number of days required to return to normal activities . Results A total of 269 patients were prospect ively r and omized into two groups ( 125 in each group after excluding 19 patients for various reasons ) . The SALC procedure was done safely without intraoperative or major postoperative complications . In four SALC patients , an extra epigastric port was inserted to enhance exposure . There was no open conversion in either group . SALC patients reported better results among four of the EuroQoL EQ-5D dimensions ( mobility , self-care , activity , and pain/discomfort ) at 1 week after surgery , an improved pain profile at 4 , 12 , and 24 h , better cosmetic outcome at 1 and 6 months ( P ≤ 0.01 ) , shorter duration of need for analgesia ( P ≤ 0.02 ) , and earlier return to normal activities ( P ≤ 0.026 ) . Operative times , hospital stay , QOL at 1 and 6 months postoperatively , and estimated blood loss were similar for both procedures . Conclusion This study supports other studies that show that SALC is a feasible and promising alternative to traditional laparoscopic cholecystectomy in selected patients with better cosmesis , QOL , and improved postoperative pain results , and it can be performed with the existing laparoscopic instruments Background . Laparoscopic cholecystectomy is the st and ard treatment for symptomatic gallbladder disease .  Single‐incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy . The aim of this study was to compare the clinical outcome of single‐incision laparoscopic cholecystectomy with 3‐port laparoscopic cholecystectomy . Methods . From February 2014 to September 2016 , 187 patients with symptomatic cholecystolithiasis were r and omized to a single‐incision laparoscopic cholecystectomy group ( 89 patients ) or a 3‐port laparoscopic cholecystectomy group ( 98 patients ) . The primary outcomes were a postoperative pain score ( at 6 hours and 1 day ) and patients of complications , while the secondary outcomes were operative time , estimated blood loss , opioid requirements , duration of hospital stay , and patient satisfaction with aesthetic effects . Results . When comparing 3‐port laparoscopic cholecystectomy and single‐incision laparoscopic cholecystectomy , there were differences in the ( mean ± st and ard deviation ) operative time ( 58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes ; P < .001 ) , success rate ( 93 % vs 99 % ; P < .01 ) , conversion rate ( 7 % vs 1 % ; P < .001 ) , and aesthetic score ( 7.9 ± 1.6 vs 6.7 ± 1.4 ; P = .008 ) . There were no statistically significant differences in estimated blood loss , postoperative pain , opioid requirement , complications , and hospital stay between both groups . Conclusion . Single‐incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients . The main advantage is the superior aesthetic results , while the main disadvantage is a greater operative time with some technical difficulties Laparoscopic cholecystectomy has rapidly become established as the treatment of choice for cholecystolithiasis . There is very little evidence , however , to support the cl aim ed benefit to patients . In the present study 30 consecutive patients below the age of 65 years without acute cholecystitis and with no signs of common bile duct stones were r and omized to laparoscopic or conventional open eholecystectomy .  Median ( interquartile range ) intravenous consumption of pethidine with a patientcontrolled injection device between 13 and 24 h after surgery was 125 ( 62–175 ) mg in patients who underwent the laparoscopic procedure and 200 ( 150–250 ) mg in those who had open operation . Urinary adrenaline and cortisol levels as well as those of plasma glucose , C‐reactive protein and interleukin 6 were increased after surgery in both groups of patients , but without any significant difference between them . The mean(s.d . ) duration of postoperative hospital stay ( 2·8(0·8 ) versus 1·8(0·6 ) days ) and sick leave ( 24·0(4·4 ) versus 11·7(4·1 ) days ) was significantly longer with open than laparoscopic cholecystectomy . The findings demonstrate obvious advantages of laparoscopic surgery  as regards postoperative pain and convalescence , although factors reflecting the magnitude of trauma did not differ Abstract This study reports the initial experience with laparoendoscopic single-site ( LESS ) cholecystectomy and compares it with laparoscopic cholecystectomy ( LC ) through a r and omized controlled trial . Sixty selective patients diagnosed with cholelithiasis or polyp lesion of the gallbladder ( PLG ) were r and omly divided into two groups undergoing either LESS cholecystectomy or LC separately . The clinical data about operations and recovery of the two groups were compared . In the LESS group 28 of 30 patients underwent LESS cholecystectomy successfully and the remaining two ( 6.7 % ) were converted to st and ard laparoscopic surgery . LC was successfully performed in all patients in the control group . Mean operative time of LESS cholecystectomy group and LC group was 55.6 ± 25.7 versus 42.7 ± 18.6 ( p < 0.05 ) . Mean postoperative hospital stay was 3.7 ± 1.3 versus 3.8 ± 0.8 days ( p < 0.05 ) . Mean pain index was 2.8 ± 0.6 versus 3.7 ± 1.1 ( p < 0.05 ) . A question naire revealed that the mean scores of satisfaction with the operation were 8.9 ± 0.7 versus 8.1 ± 1.5 ( p < 0.05 ) . LESS cholecystectomy is safe , feasible , minimally invasive , and cosmetic . It is a reasonable alternative to selective patients with uncomplicated cholelithiasis and PLG . But larger controlled studies are still needed INTRODUCTION The positive CO2 pneumoperitoneum needed to create the working space for laparoscopic surgery may induce pathophysiological changes . Concern about these changes has led to the introduction of a gasless technique . The aim of the present study was to compare the gasless CLC and GLC with regard to exposure , technical problems , operation time , postoperative pain , clinical course , and convalescence . MATERIAL AND METHODS Fifty consecutive patients with symptomatic gallstones were r and omised to  conventional ( CLC ) or gasless laparoscopic cholecystectomy ( GLC ) , with special reference to overall patient satisfaction , technical difficulties , duration of surgery , postoperative pain , and recovery . RESULTS The overall exposure of the operative field was poorer in the GLC group , whereas the duration of surgery , steps involved in the cholecystectomy technique , length of hospital stay , and postoperative pain score did not differ significantly . The period to return to normal activity was significantly shorter in the GLC group , six days compared to 8.5 days in the CLC group ( p < 0.05 ) . No differences were found in terms of fatigue , dizziness and nausea , and overall satisfaction with the outcome . DISCUSSION This study shows that convalescence is significantly shorter after laparoscopic cholecystectomy by the gasless technique than by the conventional CO2 technique . However , exposure of the operative field was less than optimal with the gasless technique Background : Two-port laparoscopic cholecystectomy has been reported to be safe and feasible . However , whether it offers any additional advantages remains controversial . This study reports a r and omized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy . Methods : One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were r and omized to receive either the two-port or the four-port technique . All patients were blinded to the type of operation they underwent . Four surgical tapes were applied to st and ard four-port sites in both groups at the end of the operation . All dressings were kept intact until the first follow-up 1 week after surgery . Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale ( VAS ) . Other outcome measures included analgesia requirements , length and difficulty of the operation , postoperative stay , and patient satisfaction score on surgery and scars . Results : Demographic data were comparable for both groups . Patients in the two-port group had shorter mean operative time ( 54.6 ± 24.7 min vs 66.9 ± 33.1 min for the four-post group ; p = 0.03 ) and less pain at individual subcostal port sites [ mean score using 10-cm unscaled VAS : 1.5 vs 2.8 ( p = 0.01 ) at the midsubcostal port site and 1.3 vs 2.3 ( p = 0.02 ) at the lateral subcostal port site ] . Overall pain score , analgesia requirements , hospital stay , and patient satisfaction score on surgery and scars were similar between the two groups . Conclusion : Two-port laparoscopic cholecystectomy result ed in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy . Thus , it can be recommended as a routine procedure in elective laparoscopic cholecystectomy
This approach has been design ed to provide adequate analgesia while minimizing exposure to adverse events
Background : Laparoscopic cholecystectomy has advantages over the open procedure for postoperative pain .
However , a systematic review of postoperative pain management in this procedure has not been conducted .