No abstract

Single port laparoscopic cholecystectomy (SPLC) was introduced to minimize postoperative morbidity and improve cosmesis. We performed a comparative study to assess feasibility, safety and perceived benefits of SPLC. Two groups of patients (40 each) with comparable demographic characteristics were selected for SPLC and multiport laparoscopic cholecystectomy (MPLC) between November 2010 to October 2011. SPLC was performed using X-cone with 5 and 10 mm extra-long (50 cm) telescope and 3 ports for hand instruments. MPLC was performed with traditional 4 port technique. A large window was always created during dissection to obtain the critical view of safety. Data collection was prospective. The primary end points were postoperative pain and surgical complications. Secondary end points were patient assessed cosmesis and satisfaction with body image and operating time. The mean VAS scores for pain at rest in MPLC group were higher on day 0 (SPLC 3.38 versus MPLC 4.80, p0.0001). VAS on coughing/straining was also significantly higher in MPLC group on day 0(SPLC 3.98 versus MPLC 6.48, p0.0001).VAS on postoperative day 1 was significantly higher in MPLC group (SPLC 2.25 versus MPLC 3.80, p0.000). Number and nature of surgical complications was statistically insignificant. Post-operative resumption of normal activity was earlier in SPLC group (SPLC 7.08, MPLC 10.83, p0.0001). Patient assessed cosmesis and satisfaction with body image scores on likert index (SPLC 5 in 100% versus MPLC 3 in 82.5% and 3 in 7.50%) indicating better cosmesis and greater patient satisfaction in SPLC. SPLC took longer to perform (87.63min versus 58 min in MPLC). Additional laparoscopic device (Alligator, 2.3 mm grasper) was used for retraction of gall bladder in 6 patients and 5mm right subcostal port in SPLC. SPLC appears to be feasible and safe with cosmetic benefits in selected patients. However, challenges remain to improve operative ergonomics. SPLC needs to be proven efficacious with a high safety profile to be accepted as standard laparoscopic technique.