Advantages of minilaparoscopic access in comparison with standard laparoscopic access during cholecystectomy

Objective. The aim of the study was to evaluate the advantages of access and the use of needlescopic instruments with a diameter of 3 mm in comparison with traditional laparoscopic access during cholecystectomy. Material and methods. The study was performed at the Department of Faculty Surgery of the RUDN Medical Institute on the basis of the V.V. Vinogradov Clinical Hospital. The prospective follow-up included 46 patients hospitalized at the V.V. Vinogradov Clinical Hospital as planned with a diagnosis of cholelithiasis. The average age of the study group was 57.4 ±15.3 years, 65% of women, 5 patients previously had biliary tract surgery. During the first five months of the study, 23 patients underwent mini-laparoscopic cholecystectomy (MLC) and were considered the main study group. Over the next five months, a control group was collected, it included 23 patients with cholelithiasis, who underwent cholecystectomy with traditional laparoscopic access. Results. The average duration of the operation in the main group was 52.8±14.8 minutes, in the control group 45.4±14.5 minutes, but this difference did not reach statistical significance (p>0.05). There were no intraoperative complications of surgical intervention in any of the groups. There was a tendency to reduce the length of hospital stay in the main group: the average bed-day in the main group was 3.3±0.8 bed-days, in the control group 3.8±1.2 bed-days (p>0.05). In the main group, the pain syndrome (assessed on a visual analog scale (VAS) from 0 to 10 points) in the early postoperative period was less pronounced than in the control group, while every fourth patient in the MLC group had no pain syndrome. Conclusion. Minilaparoscopic cholecystectomy is associated with less pronounced pain syndrome in the early postoperative period. Early activation of patients became feasible. Further, MLC reduced need for nonsteroidal anti-inflammatory drugs, shorter hospital stays, and hence the duration of temporary disability. Moreover, MLC showed better cosmetic results in the long term. Thus, if technically possible, preference should be given to minimally invasive interventions, especially in patients of working age.