Miniports versus standard ports for laparoscopic cholecystectomy

摘要: Background In conventional (standard) port laparoscopic cholecystectomy, four abdominal ports (two of 10 mm diameter and two 5 diameter) are used. Recently, use smaller ports, miniports, have been reported. Objectives To assess the benefits harms miniport (defined as than standard ports) cholecystectomy versus cholecystectomy. Search methods We searched Cochrane Central Register Controlled Trials (CENTRAL) in The Library, MEDLINE, EMBASE, Science Citation Index Expanded until February 2013 to identify randomised clinical trials relevance this review. Selection criteria Only (irrespective language, blinding, or publication status) comparing were considered for review. Data collection analysis Two review authors collected data independently. We analysed with both fixed-effect random-effects models using RevMan analysis. For each outcome we calculated risk ratio (RR), mean difference (MD), standardised (SMD) 95% confidence intervals (CI). Main results We included 12 734 patients (380 patients) (351 patients). Only one trial which 70 was low bias. Miniport could be completed successfully more 80% most trials. remaining mostly converted but some also open cholecystectomy. These conversion excluded from other outcomes. Accordingly, results outcomes on 343 group 351 group, therefore interpreted extreme caution. There no mortality seven that reported (0/194 0/203 cholecystectomy). There significant differences between proportion who developed serious adverse events (eight trials; 460 patients; RR 0.33; CI 0.04 3.08) (miniport cholecystectomy: 1/226 (adjusted 0.4%) 3/234 (1.3%); quality life at days after surgery (one trial; SMD -0.20; -0.68 0.27); whom operation had (11 670 1.23; 0.44 3.45) 8/351 2.3%) 6/319 (1.9%)). took five minutes longer complete (12 695 MD 4.91 minutes; 2.38 7.44). length hospital stay (six -0.00 days; -0.12 0.11); time taken return activity 52 0.00 -0.31 0.31); patient work 187 0.28 -0.44 0.99) groups. cosmesis scores six months groups 152 0.13; -0.19 0.46). Authors' conclusions Miniport can patients. appears advantage terms decreasing mortality, morbidity, stay, activity, work, improving cosmesis. On hand, there is a modest increase operating compared safety yet established. cannot recommended routinely outside well-designed Further risks bias random errors necessary.