Single-incision Laparoscopic Cholecystectomy Group Research Articles

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea.

The safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis (AC) has not yet been confirmed. This single-center retrospective study included patients who underwent laparoscopic cholecystectomy (LC) for AC between April 2010 and December 2020. Propensity scores were used to match patients who underwent SILC with those who underwent conventional multiport LC (CMLC) in the entire cohort and in the two subgroups. A total of 1,876 patients underwent LC for AC, and 427 (22.8%) underwent SILC. In the propensity score-matched analysis of the entire cohort (404 patients in each group), the length of hospital stay (2.9 days vs. 3.5 days, p = 0.029) was shorter in the SILC group than in the CMLC group. No significant differences were observed in other surgical outcomes. In grade I AC (336 patients in each group), the SILC group showed poorer surgical outcomes than the CMLC group, regarding operation time (57.6 minutes vs. 52.4 minutes, p = 0.001) and estimated blood loss (22.9 mL vs. 13.1 mL, p = 0.006). In grade II/III AC (58 patients in each group), there were no significant differences in surgical outcomes between the two groups. Postoperative pain outcomes were also not significantly different in the two groups, regardless of severity. This study demonstrated that SILC had similar surgical and pain outcomes to CMLC in patients with AC; however, subgroup analysis showed that SILC was associated with poor surgical outcomes than CMLC in grade I AC. Therefore, SILC should be carefully performed in patients with AC by experienced hepatobiliary surgeons.

Single-incision laparoscopic cholecystectomy using totally homemade glove port versus conventional laparoscopic approach: A cross-sectional study in a developing country

PurposeSeveral home made glove ports for single-incision laparoscopic cholecystectomy (SILC) has been proposed but no comparison in surgical outcomes with conventional laparoscopic cholecystectomy (CLC) was made. Therefore, we aimed to compare the outcomes of SILC using a totally homemade glove port versus CLC. MethodsThis cross-sectional study compared the surgical outcomes between 90 patients, who underwent SILC and 123 patients who underwent CLC. Patients with acute cholecystitis grade 3 according to the Tokyo Guidelines 2018, body mass index ≥30, and previous abdominal surgeries were excluded. Totally homemade glove port was made of a small and a big rubber ring and a surgical glove to creat the wound retractor. Trocars were inserted into the glove's fingers. ResultsThe proportion of patients with acute cholecystitis was lower in the SILC group (7.78%) than in CLC (21.79%). Intraoperative complication rate, the prevalence of additional trocar or conversion to open surgery, success rate, and postoperative complication rate were similar between the two groups. However, SILC showed a significantly longer operative time (62.9 ± 25.1 verus 50.4 ± 20.7 min) and lower postoperative pain than CLC. The discrepancy in operative time was more likely to be remarkable in acute cholecystitis (50.43 min) compared with symptomatic cholelithiasis (14.28 min). ConclusionsThe SILC using a totally homemade glove port is feasible and safe compared with the CLC. However, in the case of acute cholecystitis, SILC should be indicated with caution because of the longer operative time than CLC.

Single-Incision Laparoscopic Cholecystectomy Versus Standard Multiport Approach for Gallbladder Disease in Children: A Systematic Review and Meta-analysis.

Aim: To evaluate comparative outcomes of single-incision laparoscopic cholecystectomy (SILC) and standard multiport laparoscopic cholecystectomy (SLC) in the management of children with various hematological or biliary disorders. Methods: A comprehensive systematic review of literature studies with subsequent meta-analysis of outcomes was conducted in line with preferred reporting items for systematic reviews and meta-analyses statement standards. Operative time, length of hospital stay, and postoperation complications were extracted. Results: Seven researches reporting a total number of 479 patients who underwent SILC (n = 235) or SLC (n = 244) were included. There was no difference between SILC and SLC groups in operative time (mean difference (MD) 15.14, 95% confidence interval [CI] [10.50-19.79], P = .07) and length of hospital stay (MD 0.83, 95% CI [-2.41 to 4.06], P = .62). Postoperation complications and the cost also seemed similar. Conclusions: SILC and SLC seem to have comparable effect and safety in children. Future high-quality randomized controlled trials with adequate sample sizes and long-term follow-up are required to provide stronger evidence in favor of the intervention.

Robotic single-site cholecystectomy is better in reducing postoperative pain than single-incision and conventional multiport laparoscopic cholecystectomy.

To compare the short-term outcomes of robotic single-site cholecystectomy (RSSC) with single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC), focusing on postoperative pain outcomes. This single-center retrospective study included consecutive patients with benign gallbladder disease who underwent cholecystectomy by a single surgeon between June 2019 and December 2021. Exclusion criteria were acute cholecystitis (AC) and other combined surgeries. One-to-one propensity score matching was performed between the RSSC and SILC or CMLC. Of the 157 patients included, 39 (24.8%) underwent RSSC, 32 (20.4%) underwent SILC, and 86 (54.8%) underwent CMLC. In a propensity score-matched cohort between RSSC and SILC (32 patients in each group), the number of additional analgesic injections was significantly lower in the RSSC group than in the SILC group (0.7 vs. 1.3, p = 0.002), and postoperative pain scores were also significantly lower at 6h (2.8 vs. 3.6, p = 0.004) and 24h (2.6 vs. 3.3, p = 0.021) after surgery in the RSSC group than in the SILC group. In a propensity score-matched cohort between RSSC and CMLC (23 patients in each group), the number of additional analgesic injections was significantly lower in the RSSC group than in the CMLC group (0.7 vs. 1.3, p = 0.005), and postoperative pain scores were also significantly lower at 6h after surgery (2.9 vs. 3.7, p = 0.025) in the RSSC group than in the CMLC group. This study demonstrated that RSSC is helpful in reducing postoperative pain and the use of additional analgesics compared to both SILC and CMLC.

A Systematic Review and Meta-Analysis of Single-Incision Laparoscopic Cholecystectomy Versus Conventional Four-Port Laparoscopic Cholecystectomy.

The present systematic review compares single-incision laparoscopic cholecystectomy (SILC) with conventional laparoscopic cholecystectomy (CLC) with the aim of assessing early postoperative pain and morbidity. The secondary outcomes assessed were the duration of surgery, length of hospital stay, and conversion to open surgery. A systematic search for medical records was conducted on PubMed, Embase, Medline, and the Cochrane Library. Meta-analysis was conducted using Review Manager 5.4. A total of 14 randomized control trials met the eligibility criteria, involving a total of 1762 patients. Early postoperative pain (four to six hours) (mean difference (MD): -0.86; 95%; confidence interval (CI): -1.16 to -0.55) showed significantly better results in the SILC group but showed no difference on the first or second postoperative day. There were significantly fewer complications (relative risk (RR): 1.7; 95%; CI: 1.16-2.50)recorded in the CLC group as compared to the SILC group. Operative time (MD: 19.66; 95% CI: 13.21-26.11) was significantly longer in the SILC group, while the duration of hospital stay (MD: -0.01; 95% CI: -0.28-0.26) and conversion to open surgery (RR: 0.99; 95% CI: 0.20-4.82) showed no significant difference. SILC had a significantly longer operative time and more complications as compared to CLC. However, it was associated with significantly lower early post-operative pain.

RANDOMIZED CONTROL TRIAL OF CONVENTIONAL LAPAROSCOPIC VERSUS SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Background:From big incision to minimally invasive multiport classic laparoscopic cholecystectomy (CLC) and now to single incision laparoscopic cholecystectomy (SILC) surgeryhas travelled a long way. There are proposedadvantages and potential disadvantages of SILC compared to the gold standard CLC. However, debate still exists whether SILC has anything more to offer. We compared various parameters of patient satisfaction, quality of life and short term surgical outcomes between CLC and SILC. Method: RCT was conducted forduration of one year. Patients were assigned into SILC and CLC groups. Operative time, length of hospital stay, quality of life (SF 36 questionnaire), patients overall and cosmetic satisfaction and postoperative pain using 10-point visual analogue scale (VAS) were assessed.The data analysis was done using software SPSS version20.0. Results: A total of 36 patients (28 women and 8 men) with mean age 39.88±11.99 yearswere allocated into SILC (n=18) and CLC (n=18) groups.The mean operative time for SILC was significantly longer than CLC (66.33 vs 46.50 minutes, P=0.001). VAS recorded higher pain in first 24 hours postoperatively in SILC than CLC group (4.467 vs 2.667, P=0.06). However, at the time of discharge patients in CLC had greater pain than SILC group (0.22 vs 0.133, P>0.99).No significant variability was seen in length of hospital stay (SILC 3.60 vs CLC 3.38 days, P=0.47). The QOL on first follow up visit showed statistically significant difference in two of the domain of SF 36, namely vitality and bodily pain. Patients overall and cosmetic satisfaction showed no superiority of SILC over CLC. Conclusions:Although patient prefers SILC in wake of cosmetic reasons, still it is a long way off from replacing CLC. Larger operative time and lack of standardization makes SILC still an evolving procedure and judicious patient selection is must for better outcome.

COMPARATIVE EVALUATION OF COSMETIC OUTCOME BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY & SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Aim: Comparative analysis of cosmetic outcome between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy.
 Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included cosmetic outcome,
 Results: The body image score for SILC group ranged from 30 to 44 with mean score of 40.76 ± 2.773 while that for cLC group ranged from 33 to 42 with mean score of 38.28 ± 1.969. p-value for the comparison stands 0.001 which shows that patients undergoing SILC had better cosmetic perception of their body image compared to cLC group
 Conclusion: SILC is better cosmetic perception as compare to cLC
 Keywords: SILC, cLC, Cosmetic outcome

The Safety and Feasibility of Single Incision Laparoscopic Cholecystectomy for Acute Cholecystitis: Comparison with Conventional Laparoscopic Cholecystectomy

Introduction: Single incision laparoscopic cholecystectomy (SILC) is a considerable option in benign gallbladder surgery. However, the safety and feasibility of SILC in acute cholecystitis has not been confirmed. We report our surgical outcomes of SILC in acute cholecystitis compared with conventional laparoscopic cholecystectomy (CLC). Methods: 386 patients who underwent SILC and 592 patients who underwent CLC for acute cholecystitis between April 2010 and December 2018 in single institution were retrospectively reviewed the preoperative characteristics and surgical outcomes. Results: The patients in CLC group were older (55.1 vs 65.0 years, p< 0.001), higher ASA score (12.7 vs 35.5% in over III, p< 0.001), and higher incidence of preoperative percutaneous transhepatic gallbladder drainage (PTGBD) than the patients in SILC group. According to Tokyo guideline 18, the patients above grade 2 were more common in the CLC group (15.8 VS 24.3%, p=0.001). There is no statistical significance in operative time, Blood loss, intra-operative transfusion, adjacent organ injury, open conversion, postoperative complication, incisional hernia, and mortality. The length of postoperative hospital stay was significantly shorter in SILC group. On multivariable analysis, grade II or III acute cholecystitis according to Tokyo guideline 18 (TG18), was risk factor for major complication and prolonged operative time. Conclusion: In our experience, SILC can be a safe and feasible treatment for acute cholecystitis, if appropriate experience and when expertise is available. However, in case of grade II or III acute cholecystitis according to TG18, SILC should be selected carefully.

Robotic surgery enables safe and comfortable single-incision cholecystectomy: A comparison of robotic and laparoscopic approaches for single-incision surgery.

Background:Although single-incision robotic cholecystectomy (SIRC) overcomes various limitations of single-incision laparoscopic cholecystectomy (SILC), it is associated with high cost. In this study, we intended to investigate if SIRC is recommendable and advantageous to patients despite its high cost.Materials and Methods:We prospectively collected and analysed data of patients who had undergone either SILC (n = 25) or SIRC (n = 50) for benign gallbladder diseases, with identical inclusion criteria, between November 2017 and February 2019.Results:SILC and SIRC showed similar operative outcomes in terms of intra- and post-operative complications and verbal numerical rating scale (VNRS) for pain. However, the SIRC group exhibited significantly longer operation time than the SILC group (83.2 ± 32.6 vs. 66.4 ± 32.8, P = 0.002). The SIRC group also showed longer hospital stay (2.4 ± 0.7 vs. 2.2 ± 0.6, P = 0.053). Although the SILC and SIRC groups showed no significant difference in VNRS, the SIRC group required a higher amount (126.0 ± 88.8 mg vs. 87.5 ± 79.7 mg, P = 0.063) and frequency (3.0 ± 2.1 vs. 2.0 ± 1.8, P = 0.033) of intravenous opioid analgesic administration. During surgery, the critical view of safety (CVS), the prerequisite for safe cholecystectomy, was identified in only 24% (n = 6) of patients undergoing SILC and in 100% (n = 50) of patients undergoing SIRC (P < 0.05).Conclusion:We conclude that although SILC and SIRC have similar operative outcomes, SIRC is advantageous over SILC because of its potential to markedly enhance the safety of patients by proficiently acquiring CVS.

Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial.

Background:Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time.Methods:This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate.Results:In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures.Conclusions:SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.

Prospective Randomized Controlled Study to Compare the Outcome of Standard 4-Port Laparoscopic Cholecystectomy with Single-Incision Laparoscopic Cholecystectomy in Patients with Gallstone Disease

Four-port laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder disease. To reduce the invasiveness of standard four-port laparoscopic cholecystectomy, single-incision laparoscopic cholecystectomy (SILC) has come about an attractive option for the performance of laparoscopic cholecystectomy. There have been no studies on SILC from Indian subcontinent. The present study was designed to compare the outcomes of SILC with the standard four-port LC in a prospective randomized controlled trial. All patients with symptomatic gallstone disease were evaluated between May 2012 and April 2014. Patients were randomized to either standard four-port laparoscopic cholecystectomy (LC group) or single-incision laparoscopic cholecystectomy (SILC group). Demographic profile, preoperative and intraoperative variables, postoperative complications, hospital stay, and pain scores were recorded. WHO-QOL BREF was used for quality of life analysis. Patients were followed up at regular intervals, and satisfaction scores were recorded. Statistical analysis was done using STATA 12 and p value < 0.05 was considered significant. Out of 94 patients, 90 received the intended treatment, and four cases in SILC group were converted to standard four-port cholecystectomy. The demographic profile and preoperative WHO-QOL BREF scores were comparable between the two groups. Severity of adhesions, successful dissection of Calot’s triangle, ergonomics, and overall level of difficulty were also comparable. Operation time was significantly higher in SILC group, but the learning curve was seen to be achieved after 30–35 cases. There was no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 6 months except for pain score during normal activity in immediate postoperative period which was significantly higher in SILC group. Overall complication rate was significantly higher in SILC group, however the incidence of SSI was not found to be significant among the two groups. There was one case of transient bile leak and one case of intra-abdominal bleeding due to slippage of cystic artery clip. Postoperative quality of life outcomes were similar in the two groups. Although not significant, patients with SILC group had higher cosmetic score compared with the LC group. In conclusion, this study shows that SILC is a safe and feasible with a higher rate of complications but comparable cosmetic and QoL outcomes when compared with standard 4-port cholecystectomy.

The First Additional Port During Single-Incision Laparoscopic Cholecystectomy.

Background and Objectives:Single-incision laparoscopic cholecystectomy (SILC) has become increasingly popular. Regarding the difficulties of SILC in acute cholecystitis, additional port insertion is sometimes required. However, appropriate locations for additional port insertion have not been well studied. In the present study, the safety and effectiveness of the first additional port insertion in the epigastric region during SILC was assessed.Methods:Additional port insertions were needed in 52 of 113 patients who underwent SILC for acute cholecystitis. The first port was inserted in the epigastric region and the second (if required) was inserted in the right lateral subcostal area. A drainage catheter was positioned through the epigastric port.Results:One additional port was inserted in 43 patients and two additional ports were inserted in 9 patients. Mean operation time was 45.0 minutes in the Pure SILC group and 83.3 minutes in Additional Port group. Mean hospital stay was 3.7 days in the Pure SILC group and 5.9 days in Additional Port group. There was no open conversion. Intra-operative (n = 5) and postoperative bile leakages (n = 2) were identified in six patients. Timing of operation after onset of symptoms was significantly greater in the group with bile duct injury than in those without bile duct injury in patients who required additional ports.Conclusions:The first additional port in the epigastric area during SILC for acute cholecystitis helps to complete the operation without open conversion. However, the procedure can be performed safely in selective patients with relatively short duration of symptoms.

Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study.

Single-incision laparoscopic cholecystectomy (SILC) is a feasible technique that provides comparable results to standard laparoscopic cholecystectomy (LC). However, despite the theoretical advantages of minor wound complications and cosmetic results, SILC usuallyrequires a larger incision, which may increase the incidence of incisional hernias. This study evaluated SILC and standard multiport cholecystectomy with respect to perioperative outcomes, hospital stay, cosmetic results, and postoperative complications, including the 5-year incisional hernia rate. A cohort study was performed with patients who underwent elective laparoscopic surgery for noncomplicated cholelithiasis at our hospital between July 2009 and June 2011. During the study period, there were 45 nonselected patients who underwent SILC, and these patients were compared with a control group of 140 patients who underwent LC using the standard three-trocar technique during the same period. Both patient groups were comparable in age, gender, BMI and ASA classification. The mean follow-up was 58.7 ± 10.9 (range 3-80) months. There were no differences between groups in terms of hospital stay, rate and severity of complications, wound infection, and patient cosmetic satisfaction. However, the operating time (57.8 versus 35.2min) and long-term incisional hernia rate (13.3% versus 4.7%) were significantly higher in the SILC group. SILC is associated with a statistically significantly higher long-term incisional hernia rate at the umbilical port site than the standard multiport laparoscopic cholecystectomy. Our data show there was no relevant advantage regarding the postoperative course, hospital stay or cosmetic satisfaction. To date, widespread use of SILC cannot be recommended. Registration number: NCT03768661 (https://www.clinicaltrials.gov). This study has been registered at www.clinicaltrials.gov. The clinicaltrials.gov ID number is: NCT03768661.

Comparison of short-term outcomes between single incision laparoscopic cholecystectomy and conventional 4-port laparoscopic cholecystectomy

Background: Various numbers of case series, studies and randomized control trials conducted for comparison of Single port and Multi port cholecystectomy, however the benefit of Single Port cholecystectomy is still debatable.Methods: A prospective non-randomized comparative study was done to compare short term outcomes between SILS Cholecystectomy and Conventional 4-port Laparoscopic Cholecystectomy. Total of 85 patients underwent surgery out of which 5 cases were excluded (4 due to loss of follow up and 1 due conversion from SILS to LAP). There were 40 cases in each group, two group named as LAP (conventional 4-port laparoscopic cholecystectomy) group and SILS (single incision laparoscopic cholecystectomy) group.Results: On comparison of pain scores at 6 hours and 12 hours postoperatively and at the time of discharge between two groups there was significant difference at 12 hours postoperatively and at the time of discharge. The mean operative time in SILS group was similar to that of LAP group. The cosmesis score ranges from 2 to 10(1-5 for each questions) with 2 being best and 10 being worst appearance of scar. In LAP group, the mean cosmesis score was 4.65±0.9(SD) whereas, in SILS group it was 2.25±0.43(SD). On comparison between two groups there was significant difference (p= 0.0001). The quality of life total score on comparison between two groups there was significant difference in quality of life score (P=0.0001).Conclusions: It is concluded that SILS cholecystectomy is better than LAP and it should be preferred.

Comparison of single incision versus multiple incision laparoscopic cholecystectomy: a meta analysis

Introduction: Laparoscopic cholecystectomy is the gold standard in the management of symptomatic gallbladder stones. Single incision laparoscopic cholecystectomy (SILC) has emerged to achieve fewer complications and better cosmesis. This meta-analysis aims to find a reliable, risk-free, or at least of comparative risk versus the standard surgical procedure. This study aims to compare SILC with multiple incision laparoscopic cholecystectomy (MILC) in terms of mean operative time, various post-operative complications and aesthesis. Methodology: Articles included were obtained using PUBMED databases. The studies evaluated were restricted to only those with human subjects and those studies that are in English. All articles included in this study met the inclusion criteria: the study was an RCT, SILC was compared to MILC, features at least one year follow-up and the population were all adults. Exclusion criteria included: patients with cholecystitis, suspicion or proved persistence of a choledocholithiasis, necrotic pancreatitis, BMI higher than 30 or a history of liver disease or upper abdominal surgery, published more than 5 years, non-human trials and studies with incomplete data. Results: Mean operative time of surgery is significantly longer for the SILC group. In terms of cosmesis and patient satisfaction rates, SILC showed optimum results. Although most complications were equal with both techniques, presence of incisional hernia was higher in the SILC group. Conclusion: This study concludes that SILC is a feasible, safe and adaptable technique. The benefits of SILC in terms of cosmetic and patient satisfaction will spearhead the use of this technique in the future generations.

Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: results of a single-blinded randomized controlled trial

Background: Recent advances in robotic technology suggest that da Vinci Single-Site cholecystectomy (dVSSC) is safe, feasible and reduces the stress load of the surgeon compared to single-incision laparoscopic cholecystectomy (SILC). However, evidence needed to objectively assess differences based on high-quality comparative data is lacking to date. Methods: This single centre, single-blinded controlled trial included 60 patients with benign gallbladder disease randomly assigned to dVSSC (n=30) or SILC (n=30). The primary endpoint surgeon's physical and mental stress load was assessed using the validated Local Experienced Discomfort (LED) and Subjective Mental Effort Questionnaires (SMEQ). Secondary endpoints included operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, procedure costs, health-related quality of life, cosmesis and complications. Patients and ward staff were blinded until 12 months postoperatively. Results: The dVSSC-group showed a significant reduction of mental stress load of the surgeon compared to SILC (SMEQ: median 25.0 vs. 42.5 points; p=0.002) and a trend toward reduced physical stress load (LED: median 8 vs. 12 points; p=0.088). The rate of postoperative complications that required a re-intervention (Dindo-Clavien grade≥IIIa) was similar in both groups (SILC n=2 vs dVSSC n=0, p=0.492). The length of stay was longer in the SILC group (3.06 vs 1.9 days, p=0.034) but overall hospital costs were higher for dVSSC (9831 vs. 6900 CHF; p=0.001). Conclusions: dVSSC provides significant benefits over SILC in terms of surgeon's stress load, matches the standards of the laparoscopic single-incision approach with regard to patients' outcomes but increases overall expenses. Clinicaltrials.gov trial-no: NCT02485392.

Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials.

Over the last decade, single-incision laparoscopic cholecystectomy (SLC) has gained popularity, although it is not evident if benefits of this procedure overcome the potential increased risk. Aim of the study is to compare the outcome of SLC with conventional multi-incision laparoscopic cholecystectomy (MLC) in a meta-analysis of randomized controlled trials only. A systematic Medline, Embase, and Cochrane Central Register of Controlled Trials literature search of articles on SLC and MLC for any indication was performed in June 2017. The main outcomes measured were overall adverse events, pain score (VAS), cosmetic results, quality of life, and incisional hernias. Linear regression was used to model the effect of each procedure on the different outcomes. Forty-six trials were included and data from 5141 participants were analysed; 2444 underwent SLC and 2697 MLC, respectively. Mortality reported was nil in both treatment groups. Overall adverse events were higher in the SLC group (RR 1.41; p < 0.001) compared to MLC group, as well severe adverse events (RR 2.06; p < 0.001) and even mild adverse events (RR 1.23; p = 0.041). This was confirmed also when only trials including 4-port techniques (RR 1.37, p = 0.004) or 3-port techniques were considered (RR 1.89, p = 0.020). The pain score showed a standardized mean difference (SMD) of - 0.36 (p < 0.001) in favour of SLC. Cosmetic outcome by time point scored a SMD of 1.49 (p < 0.001) in favour of SLC. Incisional hernias occurred more frequently (RR 2.97, p = 0.005) in the SLC group. Despite SLC offers a better cosmetic outcome and reduction of pain, the consistent higher rate of adverse events, both severe and mild, together with the higher rate of incisional hernias, should suggest to reconsider the application of single incision techniques when performing cholecystectomy with the existing technology.

Laparoscopic cholecystolithotomy versus laparoscopic (single-port and four-port) cholecystectomy

The purpose of the study is a comparative analysis of laparoscopic cholecystolithotomy and (single-port and four-port) cholecystectomy in patients with cholecystolithiasis with isolated gallstones. Material and methods. 136 patients with cholecystolithiasis were involved in a one-center open prospective study, aged between 22 and 78 years, mean age was 48.9 ± 12.6 years, among them 79.41 % were women. Depending on the method of treatment, the patients were divided into three groups. The first group consisted of 53 patients who underwent laparoscopic four-port cholecystectomy (4-port laparoscopic cholecystectomy – 4PLC), the second – 50 patients who underwent single-incision laparoscopic cholecystectomy (SILC), the third group – 33 patients who underwent laparoscopic cholecystolithotomy (LCLT). Groups of patients were comparable in age. The operating time, the terms of activation after surgery, the hospital length of stay, the duration of hyperthermia, intraoperative and postoperative complications presence were analyzed. Results. The mean duration of laparoscopic four-port cholecystectomy was 42.83 ± 16.97 minutes, that was significantly greater than the mean duration of SILC (36.60 ± 14.37 minutes), (P = 0.039), but shorter than the mean duration of laparoscopic cholecystolythotomy (61.06 ± 13.27 minutes), (P = 0.001). The shortest hospital length of stay was in LCLT group. The hyperthermia duration after surgical interventions did not depend on the type of operation (P > 0.05) and did not exceed one day for all types of operations. In 42.6 % (58/126) of the total number of operated patients temperature rise was not observed at all, among them 23 patients in the 4PLC group, 21 patients in the SILC group and 14 patients in the LCLT group. Conclusions . Laparoscopic cholecystolithotomy allows gall bladder-preserving and postcholecystectomy syndrome development preventing in patients with cholecystolithiasis, reducing the number of postoperative complications and the hospital length of stay. Reduction of recurrent stones formation in the bile ducts after operations on the gall bladder is associated with organ-preserving interventions, namely cholecystolythotomy.

Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial

Background: Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. Methods: In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. Results: There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m²) was the only significant influential factor for operating time over 100 min (p = 0.031). Conclusion: NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.

A large-cohort comparison between single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy from a single center; 2080 cases.

Backgrounds/AimsThis study was conducted to verify and compare the safety and feasibility of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC).MethodsA total of 2,080 patients underwent laparoscopic cholecystectomy in a single center, Konyang University Hospital, between 2010 and 2016. We retrospectively compared the demographics, perioperative outcome, and postoperative complication results between the CLC and SILC groups.ResultsAmong the 2,080 patients who underwent laparoscopic cholecystectomy, 1,080 had CLC and 1,000 had SILC. When retrospectively reviewed, the SILC group had significantly higher percentages of patients who were aged under 80 years, who were women, and had the American Society of Anesthesiologist score of lower than 3 points compared to those of the CLC group. Furthermore, the CLC group had a higher percentage of patients with acute cholecystitis or empyema, whereas the SILC group had a higher percentage of patients with chronic cholecystitis. Preoperative percutaneous transhepatic gallbladder drainage insertion or H-vac insertion was more frequently conducted, bleeding loss was more common, and hospital stay was longer in the CLC group. Postoperative complications such as wound infection, biloma, bile duct injury, and duodenal perforation were not significantly different between the two groups.ConclusionsIn conclusion, if performed after preoperative patient selection such as in younger and female patients with no abdominal operation history at the time of benign gallbladder surgery, SILC can be considered feasible and safe without additional complications when compared with CLC.