Single-Incision Laparoscopic Cholecystectomy Safe, Feasible, and Comparable to CLC: Study Shows
China: A new study has revealed that single-incision laparoscopic cholecystectomy (SILC) using conventional instruments is safe and non-inferior to conventional laparoscopic cholecystectomy (CLC), offering advantages in patient satisfaction with pain and cosmetic outcomes while maintaining similar surgical results, hospital stay, and complication rates.
The research, published in BMC Surgery by Dr. Zhiquan Chen and colleagues from the Department of Hepatobiliary Pancreatic Surgery at The Second Affiliated Hospital of Zhejiang University, evaluated the outcomes of SILC performed with standard, inflexible laparoscopic tools. While SILC has been proposed as a less invasive option than the traditional multi-port approach, its benefits when performed with conventional instruments have remained uncertain.
In this retrospective analysis, the investigators reviewed records of 958 patients who underwent gallbladder removal between January 2023 and March 2024. Among them, 533 patients received SILC through a single transumbilical incision using straight laparoscopic instruments, while 425 underwent the standard three-port CLC technique. Researchers compared demographic factors, pathological findings, and a range of clinical outcomes, including operative time, blood loss, hospital costs, pain scores, quality-of-life measures, and complication rates.
The study revealed the following findings:
- Both groups showed similar baseline characteristics and pathology.
- Surgical duration, estimated blood loss, and overall costs were comparable between SILC and CLC.
- Sixteen SILC cases required the placement of an additional trocar due to technical challenges.
- SILC patients reported greater satisfaction with scar appearance.
- Follow-up revealed lower rates of chronic pain and diarrhea in the SILC group.
- Six-month quality-of-life assessments showed significant improvements in bodily pain, vitality, and emotional well-being among SILC patients.
- Rates of wound infection, postoperative pain, and hospital stay duration were similar in both groups.
The authors noted that the procedure is not without limitations. Being a single-center, retrospective study, the findings could be influenced by selection bias. Moreover, follow-up lasted only six months, leaving questions about long-term complications such as incisional hernias. In certain cases, particularly those with acute inflammation or challenging anatomy, extra ports or drainage tubes are used. When liver segments blocked the surgical view, additional retraction techniques were needed, which could increase surgical trauma.
Despite these challenges, the team concluded that SILC performed with conventional, inflexible instruments is a safe and practical alternative to the standard multi-port technique. The approach provides clear cosmetic benefits and enhanced patient-reported outcomes without increasing surgical risks or healthcare costs. The use of a hand-crafted glove port also helps keep expenses comparable to traditional laparoscopy, potentially widening access to this method.
The researchers recommend larger, randomized trials with extended follow-up to confirm these results and better understand the long-term safety profile. For now, their experience supports SILC as a viable option for gallbladder disease when performed by skilled surgeons, offering patients improved comfort and appearance without sacrificing effectiveness.
Reference:
Chen, Z., Zha, L., Wu, J. et al. Single-incision laparoscopic cholecystectomy with inflexible laparoscopic instruments and laparoscopy: a single-center experience of 533 cases. BMC Surg 25, 396 (2025). https://doi.org/10.1186/s12893-025-03124-z
Next Story