5 mm versus 10 mm umbilical port during laparoscopic cholecystectomy: do outcomes justify broader use in obese patients? A randomized controlled trial

Mini-laparoscopic cholecystectomy (MLC) is proposed as a modification for standard laparoscopic cholecystectomy to improve patient experience and postoperative outcomes. The aim of this study is to assess the feasibility and outcomes of performing laparoscopic cholecystectomy using 5 mm umbilical port and telescope in obese patients who are at higher risk for developing port-site complications while factoring in surgeon's satisfaction. 240 obese patients with chronic calcular cholecystitis were randomly allocated to two groups, standard laparoscopic cholecystectomy (SLC) group using 10 mm umbilical port, and MLC group using 5 mm one. The groups were analyzed for umbilical port-site hernia (PSH), postoperative pain, total operative time, and patient and surgeon satisfaction. There were no conversions from MLC to SLC. None of the patients in the MLC group experienced port-site hernia compared to 6 patients in the SLC group (P = 0.03). MLC group had shorter total operative time (46 vs 52 min, P = 0.005), less pain during the first 24 h postoperative (P < 0.001), and fewer in-hospital analgesic requirements (P < 0.001). Duration of postoperative analgesia at home was shorter in MLC group (P < 0.001) with earlier return of patients to normal daily activities compared to SLC group (P < 0.001). Patient satisfaction and cosmesis were significantly higher among the MLC group (P < 0.001), however, surgeon satisfaction was inferior with the use of 5 mm telescopes compared to 10 mm ones (P = 0.06). Mini-laparoscopic cholecystectomy using 5 mm umbilical port and 5 mm telescope is safe and feasible among obese patients with uncomplicated gallstone disease. It offers shorter operative time, less postoperative pain and analgesic requirement, earlier return to normal daily activities, lower incidence of port-site hernia, and higher degree of patient satisfaction.