J Korean Surg Soc.  2013 Dec;85(6):275-282. 10.4174/jkss.2013.85.6.275.

The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study

• Deveci U
• Barbaros U
• Kapakli MS
• Manukyan M
• Simsek S
• Kebudi A
• Mercan S

• KMID: 2212550
• DOI: http://doi.org/10.4174/jkss.2013.85.6.275

Abstract

PURPOSE
Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma. Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of conventional laparoscopy. In this study we aimed to compare results of SILS cholecystectomy and three port conventional laparoscopic (TPCL) cholecystectomy prospectively.
METHODS
In this prospective study, 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were randomly allocated to SILS cholecystectomy (group 1) or TPCL cholecystectomy (group 2). Demographics, pathologic diagnosis, operating time, blood loss, length of hospital stay, complications, pain score, conversion rate, and satisfaction of cosmetic outcome were recorded.
RESULTS
Forty-four SILS cholesystectomies (88%) and 42 TPCL cholecystectomies (84%) were completed successfully. Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2. Operating time was significantly longer in group 1 compared with group 2 (73 minutes vs. 48 minutes; P < 0.05). Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 (P < 0.05). There was higher cosmetic satisfaction in group 1 (P < 0.05).
CONCLUSION
SILS cholecystectomy performed by experienced surgeons is at least as successful, feasible, effective and safe as a TPCL cholecystectomy. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempt the various procedures. Prospective randomized studies comparing single access versus conventional multiport laparoscopic cholecystectomy, with large volumes and long-term follow-up, are needed to confirm our initial experience. (ClinicalTrials.gov Identifier: NCT01772745.)

Keyword

Surgery; Laparoscopy; Cholecystectomy

MeSH Terms

Cholecystectomy
Cholecystectomy, Laparoscopic*
Conversion to Open Surgery
Demography
Diagnosis
Follow-Up Studies
Gallbladder Diseases
Humans
Laparoscopy
Length of Stay
Prospective Studies*

Figure

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  Fig. 1 Flow diagram of the study.

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  Fig. 2 Intraumbilical incision and gelport insertion.

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  Fig. 3 Gallbladder dissection with articulated instruments in group 1.

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  Fig. 4 Instruments in the gelport.

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  Fig. 5 Postoperative view of patient in group 1.

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  Fig. 6 Operating time. SILS group, single incision laparoscopic surgery cholecystectomy group; TPCL group, three port conventional laparoscopic cholecystectomy group.

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