Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study

Laparoscopic cholecystectomy is the standard treatment for symptomatic gallbladder disease. Single-incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy. The aim of this study was to compare the clinical outcome of single-incision laparoscopic cholecystectomy with 3-port laparoscopic cholecystectomy.

From February 2014 to September 2016, 187 patients with symptomatic cholecystolithiasis were randomized to a single-incision laparoscopic cholecystectomy group (89 patients) or a 3-port laparoscopic cholecystectomy group (98 patients). The primary outcomes were a postoperative pain score (at 6 hours and 1 day) and patients of complications, while the secondary outcomes were operative time, estimated blood loss, opioid requirements, duration of hospital stay, and patient satisfaction with aesthetic effects.

When comparing 3-port laparoscopic cholecystectomy and single-incision laparoscopic cholecystectomy, there were differences in the (mean ± standard deviation) operative time (58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes; P < .001), success rate (93% vs 99%; P < .01), conversion rate (7% vs 1%; P < .001), and aesthetic score (7.9 ± 1.6 vs 6.7 ± 1.4; P = .008). There were no statistically significant differences in estimated blood loss, postoperative pain, opioid requirement, complications, and hospital stay between both groups.

Single-incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients. The main advantage is the superior aesthetic results, while the main disadvantage is a greater operative time with some technical difficulties.