Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting

Abstract

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.

Evidence-based surgery for laparoscopic cholecystectomy

“…Twelve RCTs and 3 systematic reviews compared SILC with greater port number LC [ [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] ]. Of the 6 RCTs comparing SILC against 4-LC ( Table 4 ), 4 concluded that SILC was associated with less postoperative pain [ 25 , 26 , 28 , 30 ].…”

“…Although Subirana et al did not find a difference in operative time, they noted that surgeon-rated subjective difficulty was higher for SILC [ 29 ]. Sulu et al specifically sought to determine whether operative duration for SILC could be reduced by adding a sub-xiphoid port for gallbladder retraction and noticed that operative time was halved for 2-LC compared with regular SILC (35.0 ± 12.3 vs 79.1 ± 7.7 min, P < .05) [ 36 ] ( Table 5 ).…”

Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy

“…When compared with multiport laparoscopic surgery, SILC shows better cosmetic outcomes, post-operative pain control, and patient satisfaction, as well as shorter hospital stays. [7][8][9] However, SILC is not widely performed because the narrow working space limits the movement of instruments and causes crowding between instruments. [10][11][12] In 2011, the da Vinci Single-Site Instrumentation and Accessories (Intuitive Surgical, Inc., Sunnyvale, CA, USA) system was developed to overcome these limitations.…”