Comparative Effectiveness of Novel Minimally Invasive Procedures

Trial Information

Comparative Effectiveness of Novel Minimally Invasive Procedures

To establish a pathway for comparative effectiveness using patient reported outcomes in
minimally invasive surgery, we propose to use a readily available and easily reproducible
model: cholecystectomy. Each year in the United States, approximately 750,000 patients
undergo a cholecystectomy. Patients clearly prefer the laparoscopic approach over the open
procedure to abdominal surgery. Initial survey data suggest that patients may also prefer
even less invasive approaches.

Currently, the standard operative procedure for a patient with symptomatic gallstone disease
is a laparoscopic cholecystectomy performed under general anesthesia with four small
abdominal incisions. Although postoperative pain and cardiopulmonary and wound
complications are much less compared to open cholecystectomy, considerable cost is generated
from lost productivity in days off of work after the surgical procedure related in part to
pain and the physiologic response to the stress of the operative procedure. Anecdotal data
suggest that fewer incisions, especially fewer transabdominal incisions, translate into less
pain, less need for narcotic pain medication and faster recovery, but randomized trial data
are needed. We propose to compare the effectiveness of the novel single-port
cholecystectomy with laparoscopic cholecystectomy, the current standard of care.