Randomized trial of needlescopic versus laparoscopic cholecystectomy. 
Several studies have reported the feasibility of using 'needlescopic' instruments with a diameter less than 3 mm in minimally invasive surgery.  This study reports a comparison of needlescopic cholecystectomy and laparoscopic cholecystectomy.  Seventy-five patients with symptomatic chronic cholelithiasis were randomized to needlescopic (n = 37) or laparoscopic (n = 38) cholecystectomy.  The duration of surgery in the two groups was similar.  Patients in the needlescopic group had less pain (mean visual analogue score 2.2 versus 3.6; P < 0.003) and had smaller scars (median length 17.0 versus 25.0 mm; P < 0.001).  In addition, patients in the needlescopic group tended to require fewer intramuscular pethidine injections (P = 0.05).  However, oral analgesic requirements in the two groups were similar.  There were no complications in either group.  Needlescopic cholecystectomy resulted in less postoperative pain and a smaller surgical scar than laparoscopic cholecystectomy in patients with chronic cholecystitis.