Comparison between single incision laparoscopic cholecystectomy using conventional laparoscopic instruments vs. four port laparoscopic cholecystectomy in patients of symptomatic cholelithiasis: a prospective randomised study
Keywords:Single incision laparoscopic surgery, Conventional laparoscopic instruments, Four port laparoscopic cholecystectomy
Background: The desire to reduce invasiveness, pain, discomfort and improve cosmesis and early return of patient to normal activities is the basis for single incision laparoscopic surgery. The primary aim was to compare post-operative pain and the secondary aim to compare duration of surgery, intraoperative bile spill or stone spill, duration of hospital stay, any postoperative complications and cosmetic outcome between SILC and the gold standard for symptomatic gall stone disease, FPLC (Four port laparoscopic cholecystectomy).
Methods: A total of 150 patients were randomized into two groups, A (SILC) and B (FPLC). Post-operative pain and other intra-operative and post -operative parameters were compared.
Results: The age ranged between 20 years to 76 years most of them being females with body mass index ranging between 19 and 35 kg/m2. Comparison of pain score was done using MEWS scale; which was found to be statistically significantly SILC at 6 hours, mean difference (MD)-0.833 while at 24 hours the difference was not significant (MD- 0.234). Duration of surgery was significantly more (MD-12.17 minutes) in SILC. No addition of port or conversion to open cholecystectomy was required. There were no significant difference between post-operative complications between the two groups. Cosmesis was significantly better in terms of look of the scar (MD-0.867) and recommending it to their relatives (MD-0.700) in SILC group.
Conclusions: SILC is a safe and easily learnable procedure which can be safely be done using conventional laparoscopic instruments in low risk patients. Duration of surgery even after expertise is gained remains to be more than FPLC.
Gollan JL, Kalser SC, Pitt HA, Strasberg SM. National Institutes of Health (NIH) consensus development conference statement on gallstones and laparoscopic cholecystectomy. Am J Surg. 1993;165:388-9.
Navarra G, Pozze E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84:695.
Bhandarkar DG. Shah MR, Katara A. Single-incision laparoscopic cholecystectomy: How I do it?. J Minim Access Surg. 2011;7(1):17-23.
Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD. Single port access adrenalectomy. J Endourol. 2008;22:1573-6.
Rao PP, Rao PP, Bhagwat S. Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg. 2011;7:6-16.
Khiangte E, Newme I, Phukan P, Medhi S. Improvised Transumbilical Glove Port: A Cost Effective Method for Single Port Laparoscopic Surgery. Indian J Surg. 2011;73:142-5.
Kumar CVP. Different types of single incision surgery ports. WJ Lap Surg. 2001;4:47-51.
Chaudhary S, Bhullar JS, Subhas G, Mittal VK, Kolachalam R. Single-Incision Laparoscopic Cholecystectomy (SILC) Using Non-articulating Instruments and Conventional Trocars. Surg J. 2013; 17:809-13.
Singh V, Gupta V, Verma SK. Single-incision laparoscopic cholecystectomy: a novice technique. Int Surg J. 2016;3:533-6.
Hajong R, Hajong D, Natung T, Anand M, Sharma G. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy. J Clin Diag Res. 2016;10:6-9.
Evers L, Bouvy N, Branje D, Peeters A. Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis. Surg Endosc. 2017;31:3437-48.
Tyagi S, Sinha R, Tyagi A. Single incision laparoscopic cholecystectomy: Less scar, less pain. J Minim Access Surg. 2017;13:118-23.
Prasad A, Mukherjee KA, Kaul S, Kaur M. Postoperative pain after cholecystectomy: Conventional laparoscopic versus single-incision laparoscopic surgery. J Min Access Surg. 2011;7:24-7.
Arezzo A, Passera1 R, Forcignanò E, Rapetti1 L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc. 2018;73:464.
Guanxiong Ye, Yong Q, Shengqian X, Chengjun Wu, Wang S, Debiao P, et al. Comparison of transumbilical single-port laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy. Int J Clin Exp Med. 2015;8:7746-53.
Sharma A, Soni V, Baijal M, Khullar R, Najma K, Chowbey PK. Single port versus multiple port laparoscopic cholecystectomy: a comparative study. Ind J Surg. 2013;75:115-22.
Gupta P, Agarwal NK, Gupta P, Singh SP. To compare single incision laparoscopic cholecystectomy with standard laparoscopic cholecystectomy for treatment of symptomatic cholelithiasis: a prospective randomized study. Int Surg J. 2016;3:900-4.
Karim MA, Ahmed J, Mansour M, Ali AM. Single incision vs. conventional multiport laparoscopic cholecystectomy: A comparison of two approaches. Int J Surg. 2012;10:368-72.
Cinar H, Topgul K, Malazgirt Z, Yuruker S, Buyukakincak S, Kesicioglu T, et al. Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life? Ann Med Surg. 2018;32:1-5.
Borle FR, Mehra B, Singh AR. Comparison of cosmetic outcome between single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy in rural indian population: a randomized clinical trial. Indian J Surg. 2015;77:877-80.
Sinha R, Yadav AS. Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study. J Minim Access Surg. 2014;10(4):175-9.
Park HJ, Kim DH, Jeong J, Lee HS, Cho J, Heo JS. The real-world application of single incision laparoscopic cholecystectomy. Int J Surg. 2014;12: 1254-7.
Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, de Noto G, et al. Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg. 2013;216:1037-47.
Joseph M, Phillips MR, Farrell TM, Rupp CC. Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate A Review and a Word of Caution. Ann Surg. 2012;256:1-6.
Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc. 2011;25:367-77.