caa a22 4500 475780655 CHVBK 20180406123643.0 cr unu---uuuuu 170329e20000401xx s 000 0 eng 10.1007/s004640020059 doi (NATIONALLICENCE)springer-10.1007/s004640020059 Microlaparoscopic cholecystectomy [Elektronische Daten] Less invasive gallbladder surgery [S. W. Unger, J. C. Paramo, M. Perez] Background: We set out to compare a prospective evaluation of microlaparoscopic cholesystectomy (MLC) using 5-mm ports for the scope and operating ports and two 2-mm ports for retracting to the historic results of standard laparoscopic cholecystectomy (SLC). Methods: Fifty-six consecutive patients were operated electively for symptomatic gallstones between June 1997 and July 1998. Demographics, history of prior abdominal surgery, operative time, resident level, need to convert, length of stay, and postoperative analgesia were recorded for each case. In all, 43 women and 13 men aged 21 to 89 (average, 51 years) underwent MLC. Average weight was 78 kg (range, 48-119) and average height was 163 cm. Results: Operative time for MLC was 72 ± 25 min (range, 35-140), somewhat less than the referenced standard of 79 ± 27 min (p= 0.1). The skin-to-trocar time (6 ± 2 vs 13 ± 77 min) and intraoperative cholangiogram time (9 ± 8 vs 11 ± 6 min) were significantly shorter (p < 0.01 and p < 0.05, respectively) for MLC. Other partial times were not significantly different. PGY2 residents averaged 74 ± 21 min (range, 44-118) compared to 75 ± 27 min (range, 35-140) for PGY3 and 53 ± 5 (range, 43-59) for PGY5. Patient weight influenced time. Patients <65 kg averaged 56 ± 12 min; 66-80 kg, 72 ± 24 min; 81-95 kg, 78 ± 26 min; and >95 kg, 85 ± 22 min. Previous abdominal surgery did not affect operative time. Nine patients (16%) required conversion from 2- to 5-mm ports because of adhesions, wall thickening, or need for better retraction. Time in these patients was 95 ± 26 min vs 68 ± 21 min in other patients (p < 0.01). No patient was converted to an open procedure. Three patients (5%) had a positive cholangiogram and common bile duct exploration that required placement of an extra 5-mm trocar. Five patients (9%) required insertion of an additional 2-mm port. All patients received patient-controlled analgesia (PCA). Morphine use was 0.21 ± 0.19 mg/kg (range, 0-0.8). Hospital stay was 1.31 days (range, 0.5-4). Subjective satisfaction was excellent because of smaller incisions. No additional morbidity was seen with MLC. Conclusion: MLC is a feasible and safe approach that provides similar times to SLC with better cosmesis, a less painful recovery, and possibly an earlier return to normal activity. Springer-Verlag New York Inc., 2000 Key words: Gallbladder — Laparoscopy — Microlaparoscopic cholecystectomy — Needlescopic surgery nationallicence Unger S. W. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut Paramo J. C. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut Perez M. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut Surgical Endoscopy Springer-Verlag 14/4(2000-04-01), 336-339 0930-2794 14:4<336 2000 14 464 https://doi.org/10.1007/s004640020059 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640020059 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Unger S. W. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut NATIONALLICENCE 700 1- Paramo J. C. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut NATIONALLICENCE 700 1- Perez M. Department of Surgery, Mount Sinai Medical Center of Greater Miami, 4302 Alton Road #820, Miami Beach, FL 33140, USA, US aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/4(2000-04-01), 336-339 0930-2794 14:4<336 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer