Comparison of short-term outcomes between single incision laparoscopic cholecystectomy and conventional 4-port laparoscopic cholecystectomy


  • Vishwanath . Associate Consultant, HCG Cancer Centre, Kalaburgi, Karnataka, India
  • Rajkumar Palaniappan Consultant General and Minimal Access Surgeon, Apollo Hospital, Chennai, Tamil Nadu, India
  • Balachandran Premkumar Consultant General and Minimal Access Surgeon, Apollo Hospital, Chennai, Tamil Nadu, India



Cholecystectomy, Comparison, Incision, Outcomes


Background: Various numbers of case series, studies and randomized control trials conducted for comparison of Single port and Multi port cholecystectomy, however the benefit of Single Port cholecystectomy is still debatable.

Methods: A prospective non-randomized comparative study was done to compare short term outcomes between SILS Cholecystectomy and Conventional 4-port Laparoscopic Cholecystectomy. Total of 85 patients underwent surgery out of which 5 cases were excluded (4 due to loss of follow up and 1 due conversion from SILS to LAP). There were 40 cases in each group, two group named as LAP (conventional 4-port laparoscopic cholecystectomy) group and SILS (single incision laparoscopic cholecystectomy) group.

Results: On comparison of pain scores at 6 hours and 12 hours postoperatively and at the time of discharge between two groups there was significant difference at 12 hours postoperatively and at the time of discharge. The mean operative time in SILS group was similar to that of LAP group. The cosmesis score ranges from 2 to 10(1-5 for each questions) with 2 being best and 10 being worst appearance of scar. In LAP group, the mean cosmesis score was 4.65±0.9(SD) whereas, in SILS group it was 2.25±0.43(SD). On comparison between two groups there was significant difference (p= 0.0001). The quality of life total score on comparison between two groups there was significant difference in quality of life score (P=0.0001).

Conclusions: It is concluded that SILS cholecystectomy is better than LAP and it should be preferred.


Morgenstern L. Carl Langenbuch and the first cholecystectomy. Surg Endosc. 1992;6(3):113-4.

Beal JM. Historical perspective of gallstone disease. Surg Gynecol Obstet. 1984;158(2):181-9.

Sheffield KM, Ramos KE, Djukom CD, Jimenez CJ, Mileski WJ, Kimbrough TD, et al. Implementation of a critical pathway for complicated gallstone disease: translation of population-based data into clinical practice. J Am Coll Surg. 2011 May 1;212(5):835-43.

Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic Cholecystectomy The New'Gold Standard'?. Arch Surgy. 1992 Aug 1;127(8):917-23.

Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med. 1994;330(6):409-19.

National Institute of Health. Gallstones and laparoscopic cholecystectomy. NIH Consensus Statement. 1992 Sep 14-16;10(3):1-28. Available at: Accessed January 15, 2014

Arulampalam T, Paterson-Brown S, Morris AJ, Parker MC. Natural orifice transluminal endoscopic surgery. Ann Roy Coll f Surg Eng. 2009 Sep;91(6):456-9.

Dunkin BJ. Natural orifice transluminal endoscopic surgery: Educational challenge. World J Gastrointest Surg. 201027;2(6):224-30.

Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK,Kim DG. Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech. 2009 Aug 1;19(4):495-9.

Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, et al. Impact of single‐port cholecystectomy on postoperative pain. Br J Surg. 2011 Jul;98(7):991-5.

Prasad A, Mukherjee KA, Kaul S, Kaur M. Postoperative pain after cholecystectomy: conventional laparoscopy versus single-incision laparoscopic surgery. J Minimal Access Surg. 2011 Jan;7(1):24-7.

Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endoscopy. 2010 Aug 1;24(8):1842-8.

Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single‐site versus conventional laparoscopic cholecystectomy. Br J Surg. 2011 Dec 1;98(12):1695-702.

Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS. Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointestinal Surg. 2009 Feb 1;13(2):188-92.

Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg. 2011 Sep 1;202(3):254-8.

Cao ZG, Cai W, Qin MF, Zhao HZ, Yue P, Li Y. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutaneous Tech. 2011 Oct 1;21(5):311-3.

Deveci U, Barbaros U, Kapakli MS, Manukyan MN, Şimşek S, Kebudi A, et al. The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study. Journal of the Korean Surgical Society. 2013 Dec 1;85(6):275-82.

Ellatif ME, Askar WA, Abbas AE, Noaman N, Negm A, El-Morsy G, et al. Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2013 Jun 1;27(6):1896-906.

Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, et al. Systematic review and meta‐analysis of randomized clinical trials comparing single‐incision versus conventional laparoscopic cholecystectomy. Br J Surg. 2013 Jan 1;100(2):191-208.






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