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Smaller Instruments Lead to Better Outcomes After Surgery

Advantages for those undergoing elective laparoscopic cholecystectomy include less postop pain and superior cosmetic results

WEDNESDAY, Dec. 28 (HealthDay News) -- In laparoscopic cholecystectomy (LC), the use of 10-mm umbilical, 5-mm epigastric, 2-mm subcostal and 2-mm lateral ports is safe and can result in decreased postoperative pain, do away with late incisional discomfort and yield better cosmetic results, according to a study in the December issue of the Archives of Surgery.

Yuri W. Novitsky, M.D., of the University of Massachusetts Medical School in Worcester, Mass., and colleagues conducted a clinical trial of 79 patients scheduled for an elective LC, randomized to receive surgery using either conventional (C-LC) or miniaturized instruments (M-LC). The study measured operative time, operative blood loss, intraoperative complications, early and late postoperative incisional pain and cosmetic results.

On the first postoperative day, those who underwent M-LC had an average incisional pain score of 3.9 versus 4.9 for the C-LC group. At 28 days after surgery, 90% of patients in the M-LC group had no pain, compared with 74% in the C-LC group. Both the nurse and patient assessment of cosmetic results was higher for the M-LC group.

"Although improved instrument durability and better optics are needed for widespread use of miniport techniques, this approach can be routinely offered to many properly selected patients undergoing elective LC," the authors conclude.

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