Single-Incision Laparoscopic Cholecystectomy: Is It a Plausible Alternative to the Traditional Four-Port Laparoscopic Approach?

Table 2

Comparison of clinical trials comparing SILC versus 4PLC—SILC/LESSC (single-incision laparoscopic cholecystectomy/laparoendoscopic single-site cholecystectomy), 4PLC (four port laparoscopic cholecystectomy).

Study	Study type	Year	No. of patients	Inclusion criteria	Exclusion criteria	Primary outcomes	Secondary outcomes	Mean operative
								time (min)
								SILC/LESSC	LC
Tsimoyiannis et al. [12]	Prospective, randomized	2010	40	BMI < 30, pain from cholelithiasis, ASA class I or II	BMI > 30, acute cholecystitis, choledocholithiasis or acute pancreatitis	Postoperative pain* (less pain in SILSC group)	NR	49.65±9.02 *	37.3±9.16
Marks et al. and Phillips et al. (same cohort of patients) [13, 14]	Prospective, randomized,	2011	200	BMI < 45, diagnosis of biliary colic, with gallstones or polyps, biliary dyskinesia EF < 30%.	Pregnancy, acute cholecystitis, preoperative indication for cholangiogram, ASA class III or IV, peritoneal dialysis, umbilical hernia	Intraoperative, postoperative complications (up to 1 yr)*, operative time*, and estimated blood loss.	Pain evaluation* (less pain in 4PLC group), cosmesis*, quality of life, time required for insertion of SILS/LESSC port versus LC ports	57.2*	45.2
Lai et al. [15]	Prospective, randomized,	2011	51	Age 18–80 yrs, diagnosis of symptomatic gallstones or polyps scheduled for elective cholecystectomy	ASA class IV or V, contraindication to laparoscopy, the Mirizzi syndrome, suspected common duct stones, suspected malignancy, previous upper abdominal surgery, long-term anticoagulation, previous history of cholangitis/cholecystitis, gallstones >3 cm, contracted gallbladder or chronic cholecystitis	Postoperative pain* (less pain in LC group)	Open conversion rate, surgical complications, hospital stay, resumption of normal life, cosmesis	43.5±15.4	46.5±20.1
Lee et al. [16]^+	Prospective, randomized	2010	70	Symptomatic colelithiasis, ASA class I or II	Acute cholecystitis, common bile duct stones, severe obesity and previous upper abdominal surgery	Postoperative pain	Duration of surgery, complications, analgesic requirements, length of hospital stay*, cosmesis*, wound length*, time to return to work	71.7±11.6 *	48.4±10.5
Bucher et al. [17]	Prospective, randomized	2011	150	Elective patients with symptomatic gallbladder stones, history of cholecystitis, history of common bile duct stone migration and/or biliary pancreatitis, age > 18 yrs	Acute gallbladder disease, contraindications to pneumoperitoneum, cirrhosis, mental impairment	Cosmesis*	Postoperative pain* (less in SILC/LESSC group), analgesia requirement*, satisfaction*, morbidity, duration of operation, need for main port expansion for specimen retraction*, hospital stay, return to work* and operative costs*	66 (no SD reported)	64 (no SD reported)
Ma et al. [18]	Prospective, randomized	2011	43	Indications for LC with no evidence of choledocholithiasis, age 18–85 yrs, BMI < 40, creatinine < 2 mg/dL, AST/ALT <5x upper limit of lab normal, normal total bilirubin	Acute cholecystitis, gallstones >2.5 cm	Postoperative pain	Operative time, length of hospital stay, postoperative morbidity, QOL, cosmesis	88.5*	44.8
Lirici et al. [19]	Prospective, randomized	2011	40	age 18–75, BMI < 30, no previous abdominal surgery, gallstones on US exam. ASA class I–III, Nassar grade I–III	BMI > 30, previous abdominal surgery, acute cholecystitis, bile duct stones, pancreatitis, ASA class > III, Nassar grade IV	Length of stay, postoperative pain* (higher with SILC/LESSC on the day of surgery, rest NS), cosmetic results*, SF-36 questionnaire scores* (Role Emotional only, rest NS)	Operative time*, conversion to LC, difficulty of exposure*, difficulty to dissect, complication rate	76.75*	48.25
Gang et al. [20]	Prospective, matched pair analysis	2011	134	SILC/LESSC patients matched to LC controls		Completion rate, operating time, postoperative complications, length of stay, postoperative pain		77±26 *	68±31

⁺SILC versus mini laparoscopic procedure.
*Statistically significant difference.