SJLA_2024_A13: Utilized Ports in Laparoscopic Cholecystectomy: Is it a Matter of Numbers? A Systematic

Abstract

Introduction and Background: The past decade has witnessed a paradigm shift in surgical interventions, with minimally invasive surgery is superior to the traditional open approach for several conditions, including the management of benign gallbladder diseases. The widespread acceptance and popularity of laparoscopic cholecystectomy, in fact, can be explained by the significant reduction in associated morbidity and faster recovery to daily activities, in comparison to the classic open approach. The current systematic review is the first to provide comparative outcomes by summarizing the previously published systematic reviews in a comprehensive and objective pattern. It aims to illustrate evidence regarding the intra- and postoperative outcomes of each laparoscopic cholecystectomy approach, as most of the previous publications have only briefly touched upon one or two of them. Methods: The current systematic review is the first to provide comparative outcomes by summarizing the previously published systematic reviews in a comprehensive and objective pattern. It aims to illustrate evidence regarding the intra- and postoperative outcomes of each laparoscopic cholecystectomy approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. Results: The analysis of our primary and secondary outcomes revealed a statistically significant improvement in esthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Discussion: Since the introduction of SILC by Navarra et al. in 1997, extensive efforts have been made to prove its safety and feasibility to replace the conventional method of laparoscopic cholecystectomy. Previous surgeries involving the abdomen and signs of acute cholecystitis were identified as factors predicting failure of SILC, with success rate limited to 59% in association with acute cholecystitis, as suggested by Antoniou et al. in his systematic review addressing the limitations of the single-incision approach. The associated increase in the length of operative time can be partly explained by the surgeon learning curve as applied to any surgical procedure. Conclusion: Careful selection of candidates undergoing SILC should be present to minimize technical difficulties and prevent related complications both intraoperatively and shortly after the procedure.