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 |
(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) | 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) | |
(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) |
(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) |
(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 |
(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) |
(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) |
(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) |
(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 |
(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 |
(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 |
(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 |
(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) |
(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 |