Table 7. Total size of trocar incision: Study Details and Qualitative Outcomes

Table 7: Total size of trocar incision: Study Details and Qualitative Outcomes






















































































































Study


 


n treatment/


control


Comparison


Supplemental analgesia


Pain scores and type of pain, where specified


Use of supplemental analgesic


Other important outcomes


Ainslie 2003


(LoE 1)


21/19


 


Total 19.9 mm (3 × 3.3 mm cannulas and one 10 mm cannula) vs.  total 30 mm (2 × 10 mm ports + 2 × 5 mm ports)


Postop: oral co-codamol 30/500 (30 mg codeine + 500 mg paracetamol), as required and rescue IM morphine (10 mg)


VAS


NS (recorded at 8, 12 and 24 h after induction and then daily, until the 7th postop day)


Total opiate consumption: NS; number of patients requiring parenteral opiate: total 19.9 mm superior (p=0.04); quantity of parenteral opiate used: total 19.9 mm superior (p=0.04); oral analgesics: NS


PONV


Nausea and vomiting: NS


Pulmonary function


NS


Operating time


NS


Hospital stay


Length of hospital stay: NS


Conversion rates


Total 19.9 mm partially converted to LC: n=7 (out of 21; in 5 out of the 7 patients, an extra cannula was used)


Total 30 mm converted to open surgery: n=0 (out of 19) (although in 5 patients, an extra cannula was used)


Alponat 2002


(LoE 2)


17/22


Total 16 mm (one 10 mm port + 3 × 2 mm ports) vs. total 30 mm (2 × 10 mm ports + 2 × 5 mm ports)


IM piroxicam (20 mg) in recovery room; additional 20 mg on request


VAS


NS (recorded at arrival in recovery and at 4, 16 and 24 h; average pain score on day 0 was compared with 24 h pain score)


NS


Pulmonary function


NS


Operating time


NS


Hospital stay


Length of hospital stay: NS


Cosmetic outcome


Total 16 mm superior (p<0.005; patient-rated 2 months after the operation)


Conversion rates


Total 16 mm converted to total 30 mm: n=5 (out of 22)


Total 30 mm converted to open surgery: n=0


(out of 22)


Bisgaard 2000


(LoE 1)


8/13


Total 16 mm (one 10 mm trocar + 3 × 2 mm trocars) vs. total 30 mm (2 × 10 mm trocars + 2 × 5 mm trocars)


Postop: rectal paracetamol (2 g) in recovery room, ibuprofen from 3 h after surgery (600 mg every 8 h); supplemental opioids (morphine) if required: 5 mg IV in PACU or 30 mg orally on the ward or 5–10 mg IV on the ward


VAS


NS (overall and incisional pain, at rest and on mobilisation; recorded at 0–3 h and then once, in the evening, for 7 days)


VRS


Total 16 mm superior at 0–3 h for overall pain on movement (p=0.039) and incisional pain at rest (p=0.044) and on movement (p=0.031)


 


Morphine requirement: NS


Operating time


Total 16 mm significantly longer (p=0.016)


Hospital stay


Length of hospital stay: NS


Conversion rates


Total 16 mm converted to total 30 mm: n=5 (out of 13)


Total 30 mm converted to open surgery: n=0


(out of 13)


Bisgaard 2002


(LoE 1)


25/27


Total 20.5 mm (one 10 mm trocar + 3 × 3.5 mm trocars) vs. total 30 mm (2 × 10 mm trocars + 2 × 5 mm trocars)


Postop: rectal paracetamol (2 g) in recovery room, ibuprofen from 3 h after surgery (600 mg every 8 h); supplemental opioids (morphine) if required: 5–10 mg IV in PACU or 20–30 mg orally on the ward


VAS


Cumulative incisional pain scores (at rest and on mobilisation) from day 0 and day 1: Total 20.5 mm superior (p<0.05); cumulative incisional pain scores (at rest and on mobilisation) from day 0 to day 7: NS; cumulative overall pain scores (at rest and on mobilisation) from day 0 and day 1: NS; cumulative overall pain scores (at rest and on mobilisation) from day 0 to day 7: NS; incisional pain (cumulated from 4 ports): Total 20.5 mm superior during 1st week postop (p<0.01); overall pain during 1st week postop: NS; incisional pain during 1st 6 h postop: NS (at rest and on mobilisation); overall pain during 1st 6 h postop: NS (at rest and on mobilisation)


NS


PONV


Nausea and vomiting: NS at 0–6 h and 6–24 h


Pulmonary function


NS during 1st 6 h


Operating time


Numerically similar, but p value not reported


Hospital stay


Length of hospital stay: NS


Cosmetic outcome


Total 20.5 mm superior (p<0.01; patient-rated)


Conversion rates


Total 20.5 mm converted to total 30 mm then converted to open surgery: n=1 (out of 30)


Patients requiring one extra trocar with total 20.5 mm: n=1 (out of 30)


Total 30 mm converted to open surgery: n=1 (out of 30)


Return to normal activities


Duration of convalescence time away from work and recreational activities:


NS


Bresadola 1999


(LoE 2)


28/37


Total 15 mm (one 10 mm port  + one 5 mm port) vs. total 30 mm (2 × 10 mm ports + 2 × 5 mm ports)


Postop: IV ketorolac (30 mg), as needed


VAS


Total 15 mm superior at 8 and 12 h (p<0.01, in both cases), but NS at 0, 4, 24 or 48 h


VRS


(at rest, on breathing, on coughing): Total 15 mm superior at 8 h (p<0.01), and at 12 and 24 h (p<0.05, in both cases), but NS at 48 h


 


Ketorolac use (mg): Total 15 mm superior during 1st 24 h postop (p<0.05, in all cases), but NS between 24–48 h


PONV


Nausea and vomiting incidence: Total 15 mm superior, but p values not given


Operating time


NS


Hospital stay 


Length of hospital stay: NS


Conversion rates


Patients requiring one extra trocar with total 15 mm: n=4 (out of 45)


Patients requiring two extra trocars with total 15 mm: n=9 (out of 45)


Total 30 mm converted to open surgery: n=0 (out of 45)


Cheah 2001


(LoE 1)


37/38


Total 17 mm (one 10 mm + 2 × 2 mm + one 3 mm ports) vs. total 25 mm (one 10 mm + 3 × 5 mm ports)


Postop: oral naproxen (375 mg) twice daily and IM pethidine (1 mg/kg) every 6 h if needed


VAS


Total 17 mm superior the morning after surgery (p<0.003)


Pethidine requirement: Total 17 mm superior (p=0.05)


Hospital stay


Length of hospital stay: NS


Operating time


NS


Cosmetic outcome


Total 17 mm superior (p<0.001)


Conversion rates


Total 17 mm converted to total 25 mm: n=3 (out of 37)


Total 17 mm converted to open surgery: n=1 (out of 37)


Total 25 mm converted to open surgery: n=1 (out of 38)


Huang 2003


(LoE 1)


25/29/30


Total 16 mm (3 × 2 mm trocars + one 10 mm port) vs. total 24 mm  (2 × 5 mm + 2 × 2 mm + one 10 mm ports) vs. total 30 mm (2 × 10 mm trocars + 2 × 5 mm trocars)


Postop: IM pethidine (1 mg/kg), on request; acetaminophen (500 mg every 6 h, commenced 24 h following surgery)


VAS


Subxyphoid port: Total 16 mm superior to total 30 mm at 24 h (p=0.03), but NS at 48 h and at umbilicus, upper quadrant and flank ports; Umbilicus port: total 30 mm superior to total 24 mm at 24 (p=0.01) and 48 h (p=0.003); total 16 mm vs. total 24 mm: NS for all ports


Pethidine use (mg): total 16 mm vs. total 30 mm: NS; total 16 mm vs. total 24 mm: total 16 mm superior (p=0.03); total 24 mm vs. total 30 mm: total 30 mm superior (p=0.01)


Hospital stay


Length of hospital stay: NS for all comparisons


Operating time


Total 16 mm significantly longer (compared with total 24 mm  and total 30 mm; p=0.03, in both cases)


Cosmetic outcome


NS (at 1 week, 1 month and 6 months; patient-rated)


Conversion rates


Total 24 mm converted to total 30 mm: n=1 (out of 30)


Total 16 mm converted to total 30 mm: n=5 (out of 30)


Total 30 mm converted to open surgery: n=0 (out of 30)


Leggett 2000


(LoE 2)


20/21


Total 15 mm (3 × 5 mm ports) vs. total 25 mm (2 × 10 mm + one 5 mm port)


Postop: 0.5% bupivacaine (5 ml) hydrochloride into each trocar site; at discharge: propoxyphene napsylate (100 mg tablets) – 1 or 2 tablets every 3–4 h, as needed


VAS


Incisional: NS


Propoxyphene napsylate tablets taken: NS; total days of medication: NS


Operating time


NS


Conversion rates


No conversion to other techniques


Return to normal activities


Return to going out:


NS


Return to work:


NS


Look 2001


(LoE 2)


21/30


Total 19 mm (one 10 mm + 3 × 3 mm ports) vs. total 25 mm (10 + 3 × 5 mm ports)


Postop: oral naproxen (500 mg bd) or suitable alternative; additional analgesia: IM pethidine (1 mg/kg/8 h) if required


VAS


Mean pain scores on days 0–2: NS


 


Number of parenteral analgesic requirements: NS


Hospital stay


Time to discharge: NS


Operating time


NS


Conversion rates


Total 19 mm partially converted to total 25 mm: n=4 (out of 28)


Total 19 mm converted to open surgery: n=3 (out of 28)


Total 25 mm converted to open surgery: n=6 (out of 36)


Return to normal activities


Return to solid diet:


NS


Poon 2003


(LoE 1)


58/57


Total 16 mm (one 11 mm supraumbilical port  + one 5 mm subxyphoid port) vs. total 26 mm (one 11 mm supraumbilical port  + one 5 mm subxyphoid port  + 2 × 5 mm subcostal ports)


Postop: IM pethidine (1 mg/kg every 4 h, as requested)


VAS


Subcostal port sites: total 16 mm superior (mid, p=0.01; lateral, p=0.02) (specific times not recorded); mean overall pain: NS


Pethidine dose: NS


Hospital stay


Length of hospital stay: NS


Operating time


Total 16 mm significantly shorter (p=0.04)


Cosmetic outcome


NS (on day 7; observer-rated)


Conversion rates


Total 16 mm converted to open surgery: n=3 (out of 58)


Total 16 mm partially converted to LC: n=5 (out of 58)


Total 26 mm converted to open surgery: n=2 (out of 58)


Return to normal activities


Time to resume feeding:


NS


Sarli 2003


(LoE 1)


67/68


Total 21 mm (3 × 3 mm ports + one 12 mm port) vs. total 32 mm (one 10 mm port + one 12 mm port + 2 × 5 mm)


Postop: IV ketoprofen, on demand


VAS


Total 21 mm superior at 1, 3, 6 and 24 h (p<0.05), but not at 12 h


 


Mean analgesic requirement during 24 h postop: total 21 mm superior (p=0.005)


Hospital stay


Length of hospital stay: NS


Bowel function


Time taken to resume stool passage: NS


Operating time


NS


Cosmetic outcome


Total 21 mm superior (p=0.001; patient-rated)


Conversion rates


Total 21 mm converted to open surgery: n=4 (out of 67)


Total 32 mm converted to open surgery: n=3 (out of 68)


Return to normal activities


Time to return to normal activities:


NS


Time to resume walking and eating:


NS


Schwenk 2000


(LoE 1)


25/25


Total 14 mm (2 × 5 mm ports + 2 × 2 mm ports) vs. total 30 mm (2 × 10 mm ports + 2 × 5 mm ports)


Postop: PCA-morphine sulphate IV (0.02 mg/kg boluses)


VAS


Pain at rest and when sitting up: NS (recorded 3 times/day, day 0–day 3; pain at rest also recorded on day 7); pain on coughing (cumulative until day 3): total 14 mm superior (p=0.02); pain on coughing on day 7: NS; all pain scores at 8 pm on day 0: NS


Cumulative morphine dose up to day 3: NS; PCA morphine boluses (requested, rejected and given): NS


Pulmonary function


NS


Operating time


NS


Cosmetic outcome


Total 14 mm superior (p=0.004) (patients contacted at home for self-assessment of cosmetic result)


Conversion rates


Total 14 mm converted to total 30 mm: n=1 (out of 25)


Total 30 mm converted to open surgery: n=1 (out of 25)


Trichak 2003


(LoE 1)


100/100


Total 20 mm (one 10 mm + 2 × 5 mm ports) vs. total 30 mm (2 × 10 mm ports + 2 × 5 mm ports)


Postop analgesia: IV nalbuphine, oral paracetamol


VAS


NS


Oral paracetamol: NS; number of nalbuphine injections: total 20 mm superior (p=0.02)


Hospital stay


Length of hospital stay: NS


Operating time


NS