Clinical experience of transumbilical single-port laparoscopic cholecystectomy using a modified glove-port device and...

The use of single-port laparoscopic cholecystectomy (SPLC) with disposable multichannel ports is constrained in resource-limited primary hospitals under China's diagnosis-related groups (DRGs) payment model, where consumable expenditures are systematically controlled. This study reports a practical modification of the glove-port technique using conventional instruments for transumbilical single-port laparoscopic cholecystectomy (TUSPLC) and compares its single-center clinical outcomes with those of conventional three-port LC.

A retrospective, non-randomized, comparative cohort analysis was performed on consecutive eligible patients who underwent TUSPLC (study group) or traditional three-port LC (control group) between October 2023 and December 2024 at a single center. Baseline demographics, perioperative outcomes, hospitalization costs, and short-term patient-reported cosmetic satisfaction were compared. Propensity score matching (PSM) was performed to adjust for selection bias on age, sex, BMI, ASA classification, and disease type.

A total of 173 patients underwent TUSPLC and 242 patients underwent three-port LC. After nearest-neighbor 1:1 PSM on age, sex, BMI, ASA grade, and gallbladder disease type, 162 pairs were retained for analysis. Matching yielded well-balanced groups (all standardized mean differences below 0.1). Three TUSPLC cases required conversion to multi-port surgery (1.7%) - two because of difficult Calot's triangle dissection and one for severe gallbladder atrophy. No bile duct injury, postoperative hemorrhage, or surgical site infection was recorded in either group. Operative time (42.0 ± 5.1 vs. 41.2 ± 4.6 min, mean difference 0.80 min, 95% CI -0.3 to 1.9, p = 0.140), blood loss (5.9 ± 1.5 vs. 5.7 ± 1.4 mL, mean difference 0.20 mL, 95% CI -0.1 to 0.5, p = 0.220), and total cost (14,376.2 ± 982.5 vs. 14,437.3 ± 856.7 CNY, mean difference - 61.1 CNY, 95% CI - 262.6 to 140.4, p = 0.551) did not differ significantly between the two approaches (all p > 0.05). Postoperative hospital stay was statistically shorter in the TUSPLC group (2.0 ± 0.5 vs. 2.1 ± 0.4 days, mean difference - 0.10 day, 95% CI -0.2 to 0.0, p = 0.048), although the absolute difference was small and of uncertain clinical significance. Visual analogue scale (VAS) scores at 1 month favored TUSPLC (9.23 ± 0.45 vs. 8.52 ± 0.68, mean difference 0.71, 95% CI 0.6 to 0.8, p < 0.001), although the assessment was unblinded and patient-reported.

TUSPLC using a modified glove-port device and conventional instruments appears technically feasible within the short-term (1-month) follow-up period in selected patients, with no statistically significant differences in operative time, blood loss, or total hospitalization costs compared with conventional three-port LC. Postoperative hospital stay was statistically shorter by 0.10 day, a difference of uncertain clinical significance. This modified technique may serve as a practical option for performing single-port LC in resource-limited primary-level hospitals under China's DRGs payment model. However, because of the retrospective, single-center design and short (1-month) follow-up, long-term safety data for port-site hernia and other delayed complications are lacking, and the cosmetic benefit requires validation with objective assessments; therefore, these findings should be interpreted as preliminary. Further prospective, multicenter studies with extended follow-up are essential.