Single-incision laparoscopic surgery for biliary tract disease

Area of Science:

• Minimally invasive surgery
• Gastrointestinal surgery
• Surgical innovation

Background:

• Single-incision laparoscopic surgery (SILS) aims to reduce surgical trauma.
• Single-incision laparoscopic cholecystectomy (SILC) is the most studied SILS, yet results are inconclusive, especially in complex scenarios.
• Advanced procedures like common bile duct exploration (CBDE) and biliary-enteric anastomosis are challenging with traditional laparoscopy and rarely performed with SILS.

Purpose of the Study:

• To provide a comprehensive analysis of SILC.
• To review operative techniques, training, safety, efficacy, recovery, and costs of SILC.
• To describe the rare application of SILS in CBDE and laparoscopic hepaticojejunostomy.

Main Methods:

• Review of randomized controlled trials (RCTs) on SILC from the past three years.
• Analysis of two recent meta-analyses on SILC.
• Systematic literature review of single-incision common bile duct exploration (SICBDE) and single-incision laparoscopic hepaticojejunostomy.

Main Results:

• Hundreds of studies on SILC have not yielded conclusive results.
• Most RCTs on SILC are small-scale and performed under ideal conditions.
• The application of SILS for CBDE and biliary-enteric anastomosis is extremely rare and limited to specialized centers.

Conclusions:

• The efficacy and safety of SILC in complicated biliary scenarios require further investigation.
• Advanced single-incision laparoscopic biliary procedures are technically demanding and infrequently reported.
• Specialized expertise is crucial for the successful application of SILS in complex biliary surgery.