Comparative Study of Effectiveness of Single Incision Laparoscopic Cholecystectomy versus Conventional 3-Port Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial
Keywords:
Laparoscopic cholecystectomy, single incision laparoscopic cholecystectomyAbstract
Background: The conventional 3-4 port laparoscopic cholecystectomy is the standard surgery. The singleincision laparoscopic cholecystectomy had been developed to reduce pain for a better recovery and improve
cosmesis of surgical wounds. However, previous study showed mixed results leading to ambiguous conclusion.
Objectives: To study and compare the effectiveness of short-term single incision laparoscopic cholecystectomy
versus conventional 3-port laparoscopic cholecystectomy
Materials and Methods: One hundred and ninety eight patients, who had laparoscopic cholecystectomy from
January 2012 to December 2014, were randomized to the single incision laparoscopic cholecystectomy (SILC) and
the conventional 3-port laparoscopic cholecystectomy (CLC). The operative time, postoperative complication,
postoperative pain, length of hospital stay, time to resume to work, and cosmesis outcome were compared between
two groups.
Results: One hundred and ninety eight patients were divided into 99 patients each group. After processing,
there were 92 patients in the SILC group and 94 patients in the CLC. Patients’ characteristics including gender, age,
body mass index, and ASA conditions showed no significant difference. Mean operative time for SILC was
significantly longer than that of CLC (35 minutes vs. 30 minutes; p < 0.01). The length of hospital stay for both groups
was similar (3 days; p > 0.01). The time back to work for SILC patients was 14 days and 10 days for the CLC which
was not significantly different (p > 0.01). There was no postoperative complication in both groups. The mean of
postoperative pain level after the surgery in the first 24 hours in SILC was significantly higher than CLC (2.53 ± 1.51,
1.79 ± 0.98 respectively; p < 0.01). The cosmesis outcome of SILC was greater than CLC (23.19 ± 1.31 vs.
22.42 ± 1.45; p < 0.01).
Conclusion: The SILC had the same length of hospital stay and time to resume to work as the CLC, but took
more operative time with more postoperative pain within the first 24 hours. However, the cosmesis outcome of the
SILC was better than the CLC.
References
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2. Majeed AW, Troy G, Nicholl JP, et al. Randomised, prospective,
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Single-incision laparoscopic cholecystectomy: a comparison
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Comparison between single-incision and conventional
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Comparison of cosmesis outcome between single-incision
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versus conventional laparoscopic cholecystectomy: A
systematic review and meta-analysis. Open Science Journal
of Clinical Medicine 2014;2(5):103-18.
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standard 4-port laparoscopic cholecystectomy: a prospective
randomized trial. J Pediatr Surg 2013;48(1):209-14.
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G, et al. Intermediate results of a prospective randomized
controlled trial of traditional four-port laparoscopic
cholecystectomy versus single-incision laparoscopic
cholecystectomy. Surg Endosc 2012;26:1296-303.
16. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L,
Kinross J, Paraskeva P. Single incision laparoscopic surgery
(SILS) vs. conventional multiport cholecystectomy: systematic
review and meta-analysis. Surg Endosc 2012;26:1205-13.
17. Ramon V, Omut B, Aziz S, et al. Single-port transumbilical
laparoscopic cholecystectomy: A prospective randomised
comparison of clinical results of 140 cases. J Minim Access
Surg 2012;8(3):74-8.
18. Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of
laparoendoscopic single-site versus conventional
laparoscopic cholecystectomy. Br J Surg 2011; 98(12):1695-
702.
19. Yoen TK van der Linden, Koop Bosscha, Hubert A Prins, et al.
Single-port laparoscopic cholecystectomy vs standard
laparoscopic cholecystectomy: A non-randomized, agematched
single center trial. World J Gastrointest Surg 2015;
27;7(8):145-51.
20. Brittney L, MD, Veronica E, David T. Arnold. Single-incision
laparoscopic cholecystectomy versus traditional four-port
cholecystectomy. Proc (Bayl Univ Med Cent) 2012;25(4): 319-
23.
21. Kapischke M, Caliebe A, Tepel J, Schulz T, Hedderich J. Open
versus laparoscopic appendectomy: a critical review. Surg
Endosc 2006;20:1060-8.
22. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L,
Kinross J, Paraskeva P. Single-incision laparoscopic surgery
(SILS) vs. conventional multiport cholecystectomy: systematic
review and meta-analysis. Surg Endosc 2012;26(5):1205-13.
23. Hey J, Roberts KJ, Morris-Stiff GJ, et al. Patient views through
the keyhole: new perspectives on single-incision vs. multiport
laparoscopic cholecystectomy. HPB (Oxford) 2012;14:242.
24. Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, et al. Randomized
clinical trial of single-incision laparoscopic cholecystectomy
versus minilaparoscopic cholecystectomy. Br J Surg 2010;97:
1007-12.
2001;5(1):89-94.
2. Majeed AW, Troy G, Nicholl JP, et al. Randomised, prospective,
single-blind comparison of laparoscopic versus small-incision
cholecystectomy. Lancet 1996;347:989-94.
3. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I.
One-wound laparoscopic cholecystectomy. Br J Surg 1997;
84(5):695.
4. Philipp SR, Miedema BW, Thaler K. Single-incision laparoscopic
cholecystectomy using conventional instruments: early
experience in comparison with the gold standard. J Am Coll
Surg 2009;209(5):632-7.
5. Joseph S, Moore BT, Sorensen GB, Earley JW, Tang F, et al.
Single-incision laparoscopic cholecystectomy: a comparison
with the gold standard. Surg Endosc 2011;25:3008-15.
6. Hauters P, Auvray S, Cardin JL, Papillon M, Delaby J, et al.
Comparison between single-incision and conventional
laparoscopic cholecystectomy: a prospective trial of the
Club Coelio. Surg Endosc 2013;27:1689-94.
7. Garg P, Thakur JD, Raina NC, Mittal G, Garg M, et al.
Comparison of cosmesis outcome between single-incision
laparoscopic cholecystectomy and conventional laparoscopic
cholecystectomy: an objective study. J Laparoendosc
Adv Surg Tech A 2012;22:127-30.
8. Waraporn Suksuchano. Sample size determination, web
research http://teacher.aru.ac.th/waraporn/images/stories/
pdf/sample-size.pdf. 14 March 2013.
9. Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J,
Griffioen G, Bemelman WA. Cosmesis and body image after
laparoscopic-assisted and open ileocolic resection for Crohn’s
disease. Surg Endosc 1998;12:1334-40.
10. Park SK, Olweny EO, Best SI, Tracy CR, Mir SA, Cadeddu JA.
Patient-reported body image and cosmesis outcomes
following kidney surgery: comparison of laparoendoscopic
single-site, laparoscopic, and open surgery. Eur Urol 2011;
60:1097-104.
11. Pugliese R, Forgione A, Sansonna F, Ferrari GC, Di Lernia S,
Magistro C. Hybrid NOTES transvaginal cholecystectomy:
Operative and long-term results after cases. Langenbecks
Arch Surg 2010;395:241-5.
12. Tacchino R, Greco F, Matera D. Single-incision laparoscopic
cholecystectomy: Surgery without a visible scar. Surg Endosc
2009;23:896-9.
13. Jie Hua1, Jian Gong, Le Yao1, Zhenshun Song. Single-incision
versus conventional laparoscopic cholecystectomy: A
systematic review and meta-analysis. Open Science Journal
of Clinical Medicine 2014;2(5):103-18.
14. Ostlie DJ, Juang OO, Iqbal CW, et al. Single incision versus
standard 4-port laparoscopic cholecystectomy: a prospective
randomized trial. J Pediatr Surg 2013;48(1):209-14.
15. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto
G, et al. Intermediate results of a prospective randomized
controlled trial of traditional four-port laparoscopic
cholecystectomy versus single-incision laparoscopic
cholecystectomy. Surg Endosc 2012;26:1296-303.
16. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L,
Kinross J, Paraskeva P. Single incision laparoscopic surgery
(SILS) vs. conventional multiport cholecystectomy: systematic
review and meta-analysis. Surg Endosc 2012;26:1205-13.
17. Ramon V, Omut B, Aziz S, et al. Single-port transumbilical
laparoscopic cholecystectomy: A prospective randomised
comparison of clinical results of 140 cases. J Minim Access
Surg 2012;8(3):74-8.
18. Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of
laparoendoscopic single-site versus conventional
laparoscopic cholecystectomy. Br J Surg 2011; 98(12):1695-
702.
19. Yoen TK van der Linden, Koop Bosscha, Hubert A Prins, et al.
Single-port laparoscopic cholecystectomy vs standard
laparoscopic cholecystectomy: A non-randomized, agematched
single center trial. World J Gastrointest Surg 2015;
27;7(8):145-51.
20. Brittney L, MD, Veronica E, David T. Arnold. Single-incision
laparoscopic cholecystectomy versus traditional four-port
cholecystectomy. Proc (Bayl Univ Med Cent) 2012;25(4): 319-
23.
21. Kapischke M, Caliebe A, Tepel J, Schulz T, Hedderich J. Open
versus laparoscopic appendectomy: a critical review. Surg
Endosc 2006;20:1060-8.
22. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L,
Kinross J, Paraskeva P. Single-incision laparoscopic surgery
(SILS) vs. conventional multiport cholecystectomy: systematic
review and meta-analysis. Surg Endosc 2012;26(5):1205-13.
23. Hey J, Roberts KJ, Morris-Stiff GJ, et al. Patient views through
the keyhole: new perspectives on single-incision vs. multiport
laparoscopic cholecystectomy. HPB (Oxford) 2012;14:242.
24. Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, et al. Randomized
clinical trial of single-incision laparoscopic cholecystectomy
versus minilaparoscopic cholecystectomy. Br J Surg 2010;97:
1007-12.
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Published
2016-10-01
How to Cite
1.
Promnoy W. Comparative Study of Effectiveness of Single Incision Laparoscopic Cholecystectomy versus Conventional 3-Port Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial. Thai J Surg [Internet]. 2016 Oct. 1 [cited 2024 Nov. 22];37(4). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/225987
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