Minilaparoscopic Versus Conventional Laparoscopic Cholecystectomy A Systematic Review and Meta-analysis

Objective: This review broadly examines the impact of minilaparoscopic versus conventional laparoscopic cholecystectomy. The primary outcome was failure of surgical technique. The secondary outcomes were to examine adverse events, cosmesis, length of time to return to activity, quality of life, and length of operation. Methods: Five databases, 2 conference proceedings, reference lists of retrieved articles, and a Web-based trial registry were searched to identify eligible studies. Experts in the field of laparoscopic surgery were also contacted to provide information for the review. This systematic review and meta-analysis were conducted in accordance with the QUORUM guidelines. Results: Eighteen studies met eligibility criteria. Methodologic quality was unclear in most trials. Patients having a minilaparoscopic technique had higher conversion rates than patients having a conventional laparoscopic technique [OR 2.25 (1.18-4.30)]. Although minilaparoscopic surgeries were converted, more often there was not a trend toward increased conversion to an open technique. There was a trend toward fewer adverse events using a minilaparoscopic technique [0.57 (0.31-1.04)], however it was not significant. Cosmesis was improved in minilaparoscopic patients at 1 month [mean difference -0.74 (-1.09 to -0.38)]. Patients receiving minilaparoscopic procedures returned to activity quicker [mean difference -0.74 (-1.23-0.25)]. Conclusions: Further randomized trials are needed to determine whether minilaparoscopic techniques truly offer any advantages. Important patient outcomes such as failure of technique, adverse events, cosmesis, and quality of life should be emphasized to determine whether there is any benefit over conventional laparoscopic cholecystectomy.