Comparison of Cosmetic Outcome Between Single-Incision Laparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy in Rural Indian Population: A Randomized Clinical Trial

Abstract

Persistent efforts are being made to reduce operative trauma and morbidity and to improve cosmesis following laparoscopic cholecystectomy. The trend is to reduce the number of incisions, and thus single-incision laparoscopic cholecystectomy (SILC) and natural orifice endoscopic surgery (NOTES) are becoming popular. There is a paucity of studies pertaining to cosmetic outcome after SILC and conventional laparoscopic cholecystectomy in rural Indian population. In the present study, the cosmetic outcome of SILC versus conventional laparoscopic cholecystectomy (CLC) in rural Indian population was evaluated. Sixty patients with gallstone disease were randomly assigned to two groups. In group A (n=30), CLC was performed, while group B (n=30) was subjected to SILC. The cosmetic outcome was evaluated using a body image questionnaire on the 7th and 30th postoperative days. On the 7th postoperative day, the body image score for SILC was 6.23±0.89 and for CLC, 8.26±1.08 (p<0.0001), while the cosmetic score for SILC was 19.56±1.07 and for CLC, 15±1.20 (p<0.0001). On the 30th postoperative day, the body image score for SILC was 5.50±0.68 and for CLC, 8±1.31 (p<0.0001), while the cosmetic score for SILC was 21.13±0.57 and for CLC, 15.63±1.06 (p<0.0001), which favored SILC over CLC. The patient perception and acceptance of SILC was better than that of CLC in terms of cosmetic outcome.

Long-term follow up of single-incision laparoscopic cholecystectomy compared to conventional laparoscopic cholecystectomy

“…More recently, more SILC-specifi c instrumentation has been developed. However, we report a higher mean surgery duration for SILC of 52 ± 2 mins, compared to the experiences reported from several studies [4,14,[23][24][25][26]. Postoperative pain, use of an additional port, complication rates, operation time and the costs of SILC were similar to or greater than those of CLC [27].…”

Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis

“…Only seven trials did not report postoperative pain at least at one time point. Pain scores measured on a VAS were obtained at ten time points (3, 4, 8, 12, 24, 48 and 72 h, 7 and 14 days, and 1 month).…”

Deep neuromuscular blockade improves surgical conditions during low-pressure pneumoperitoneum laparoscopic donor nephrectomy

“…However, till date no evidence exists that the hand-assisted and/or retroperitoneoscopic approach improve the clinical outcome after LDN as compared to the standard transperitoneal procedure [ 4 ]. Less invasive technique modifications such as laparoendoscopic single site (LESS) or natural orifice transluminal (NOTES) improve the cosmetic result, but are associated with a longer learning curve and higher costs [ 5 – 8 ]. An alternative, simple, and therefore attractive method to refine the standard transperitoneal technique is the use of low-pressure PNP.…”