Study compares Single-Incision with standard 4-port Laparoscopic cholecystectomy

Four-port laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder disease. To reduce the invasiveness of standard four-port laparoscopic cholecystectomy, a single umbilical incision laparoscopic cholecystectomy has come about an attractive option for the performance of laparoscopic cholecystectomy. Laparoscopy through a single umbilical incision is an emerging technique supported by case series, but prospective comparative data are lacking on SILC especially in the Indian subcontinent. For the same purpose, researchers in AIMS conducted a prospective study to compare the outcomes of SILC with the standard four-port LC.

It was a randomized-controlled prospective comparative study in 94 patients with symptomatic cholelithiasis between May 2012 and April 2014. Patients were randomized to either standard four-port laparoscopic cholecystectomy (LC group) or single-incision laparoscopic cholecystectomy (SILC group). Demographic profile, preoperative and intraoperative variables, postoperative complications, hospital stay, and pain scores were recorded. Patients were followed up at regular intervals, and satisfaction scores were recorded. Researchers used WHO-QoL BREF to assess the quality of life.

Key findings of the study were:

♦Upon analysis, the researchers found demographic profile and preoperative WHO-QoL BREF scores were comparable between the two groups. The severity of adhesions, successful dissection of Calot's triangle, ergonomics, and overall level of difficulty were also found to be comparable.

♦They noted that the operation time was significantly higher in the SILC group. However, the learning curve was seen to be achieved after 30–35 cases.

♦They found no significant difference in the incidence of immediate postoperative and chronic pain over a mean follow-up of 6 months.

♦They also found pain score during normal activity in the immediate postoperative period was significantly higher in the SILC group than in 4 port LC group.

♦They observed that the complication rate was significantly higher in the SILC group, but the incidence of SSI (Surgical Site Infection) was not found to be significant among the two groups.

♦Postoperative quality of life outcomes was similar in the two groups.

♦They noted patients in the SILC group had higher cosmetic score compared with the LC group but it was not found to be significant.

The authors concluded, "this study shows that SILC is safe and feasible with a higher rate of complications but comparable cosmetic and QoL outcomes when compared with standard 4-port cholecystectomy".

For further information:

https://link.springer.com/article/10.1007/s12262-020-02081-6