Single-incision laparoscopic surgery--hype or reality: a historical control study

Single-incision laparoscopic surgery (SILS) is a "new" method to perform "old" operations. Though SILS has been referred to by many names, for the sake of this paper, any procedure done laparoscopically through one incision (regardless of the number of ports or working channels) will be considered a SILS procedure. This brief review will discuss the history of SILS, current applications, and potential pitfalls.

To explore the outcomes of SILS cholestectomy in a community setting, we conducted a historical control study comparing, through retrospective review, 50 laparoscopic cholecystectomies to 50 SILS cholecystectomies, all performed by one of the authors (DT).

Of the 50 patients selected, 12 patients had cholangiograms performed at the same time. The mean operative time for all cases was 50.4 minutes (range 31 minutes to 108 minutes). For the noncholangiogram group, the mean operative time was 48 minutes whereas it was 57.7 minutes for patients requiring a cholangiogram. Mean estimated blood loss was 28 mL. There was a 20% "conversion" rate (n = 10): 4 with an additional trocar, 5 with a 4-port technique, 1 with an open procedure.

We conclude that, although SILS is a relatively new procedure for general surgery, we feel it is here to stay. Although the only documented benefit is cosmetic, SILS is equivalent to conventional laparoscopy in all other respects.