Top

Surgical Endoscopy

Published in:

01-07-2013 | Review

Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis

Authors: Alberto Arezzo, Gitana Scozzari, Federico Famiglietti, Roberto Passera, Mario Morino

Published in: Surgical Endoscopy | Issue 7/2013

Abstract

Background

Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity. It is not evident whether the benefits of this procedure overcome the potential increased risk. We performed a systematic review and meta-analysis to compare SILC with conventional multi-incision laparoscopic cholecystectomy (MILC).

Methods

Data from randomized, controlled trials published up to December 2011 and comparing SILC versus MILC were extracted. The primary end point was overall morbidity. A fixed-effect model was applied to summarize the study outcomes in the meta-analysis, and a random-effect model was used in the sensitivity analysis. The outcome measures were relative risk (RR) and mean difference (MD); a RR of <1.0 or a negative MD indicated a more favorable outcome after SILC. Publication bias was assessed by a funnel plot, and heterogeneity was tested by the I ² measure and subgroup analyses.

Results

A total of 12 trials (996 patients) were included. Mortality was nil in both treatment groups; the overall RR for morbidity was 1.36 (p = 0.098). The mean operating time was 47.2 min for MILC and 58.1 min for SILC (MD 9.47 min; p < 0.001). The visual analog scale pain score at 24 h after surgery was 2.96 in MILC and 2.34 in SILC (MD −0.64; p = 0.058), but sensitivity analysis of the four studies deemed at low risk of bias for pain assessment, according to blinding and postoperative analgesic protocols, showed significance at −0.43 points (95 % confidence interval −0.87 to 0.00; p = 0.049). Cosmetic outcome scored better in the SILC group, with its standardized MD being equal to 1.16 (95 % confidence interval 0.57 to 1.75; p < 0.001).

Conclusions

In selected patients, SILC has similar overall morbidity compared with MILC; further, it results in better cosmetic satisfaction and reduced postoperative pain despite longer operative time.

Navarra G, Pozza E, Occhionorelli S (1997) Short note: one wound laparoscopic cholecystectomy. Br J Surg 84:695–697PubMedCrossRef

Allemann P, Schafer M, Demartines N (2010) Critical appraisal of single port access cholecystectomy. Br J Surg 97:1476–1480PubMedCrossRef

Joseph M, Phillips MR, Farrell TM, Rupp CC (2012) Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate. A review and a word of caution. Ann Surg 256:1195–1200CrossRef

Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:e109–e112PubMedCrossRef

Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98:991–995PubMedCrossRef

Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254:22–27PubMedCrossRef

Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, Lee PH (2010) Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 97:1007–1012PubMedCrossRef

Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52PubMedCrossRef

Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201:369–372PubMedCrossRef

10.

Edwards C, Bradshaw A, Ahearne P, Dematos P, Humble T, Johnson R, Mauterer D, Soosaar P (2010) Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases. Surg Endosc 24:2241–2247PubMedCrossRef

11.

Vettoretto N, Arezzo A (2010) Human natural orifice translumenal endoscopic surgery: on the way to two different philosophies? Surg Endosc 24:490–492PubMedCrossRef

12.

Lirici MM, Arezzo A (2006) Surgery without scars: the new frontier of minimally invasive surgery? Controversies, concerns and expectations in advanced operative endoscopy. Minim Invasive Ther Allied Technol 15:323–324PubMedCrossRef

13.

Rocchietto S, Scozzari G, Arezzo A, Morino M (2012) Obese women’s perception of bariatric trans-vaginal NOTES. Obes Surg 22:452–459PubMedCrossRef

14.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:65–94CrossRef

15.

Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions, version 5.1.0. Available at: http://www.cochrane-handbook.org. Accessed January 1, 2012

16.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedCrossRef

17.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef

18.

Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G, Rivas H, Islam A, Soper N, Gecelter G, Rubach E, Paraskeva P, Shah S (2012) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 26(5):1296–1303PubMedCrossRef

19.

Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702PubMedCrossRef

20.

Cao ZG, Cai W, Qin MF, Zhao HZ, Yue P, Li Y (2011) Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech 21:311–313PubMedCrossRef

21.

Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK (2011) Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg 202:254–258PubMedCrossRef

22.

Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848PubMedCrossRef

23.

Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol 21(2):113–117PubMedCrossRef

24.

Vilallonga R, Barbaros U, Sümer A, Demirel T, Fort JM, González O, Rodriguez N, Carrasco MA (2011) Laparoscopic single-site surgery for cholecystectomy. Initial experience. Surg Endosc 25(suppl 1, S35)

25.

Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S (2009) Early experience with single port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 19:551–553PubMedCrossRef

26.

Saber AA, El-Ghazaly TH, Dewoolkar AV (2010) Single-incision laparoscopic bariatric surgery: a comprehensive review. Surg Obes Relat Dis 6:575–582PubMedCrossRef

27.

Targarona EM, Balague C, Martinez C, Pallares L, Estalella L, Trias M (2009) Single-port access: a feasible alternative to conventional laparoscopic splenectomy. Surg Innov 16:348–352PubMedCrossRef

28.

Chow AG, Purkayastha S, Zacharakis E, Paraskeva P (2011) Single-incision laparoscopic surgery for right hemicolectomy. Arch Surg 146:183–186PubMedCrossRef

29.

Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26(5):1205–1213PubMedCrossRef

30.

Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168PubMedCrossRef

31.

Saccomani G, Arezzo A, Percivale A, Baldo S, Pellicci R (2009) Laparoscopic cholecystectomy can be performed safely with only three ports in the majority of cases. Chir Ital 61:613–616PubMed

32.

Schlager A, Khalaileh A, Shussman N, Elazary R, Keidar A, Pikarsky AJ, Ben-Shushan A, Shibolet O, Horgan S, Talamini M, Zamir G, Rivkind AI, Mintz Y (2010) Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy. Surg Endosc 24:1542–1546PubMedCrossRef

33.

Tognarelli S, Pensabene V, Condino S, Valdastri P, Menciassi A, Arezzo A, Dario P (2011) A pilot study on a new anchoring mechanism for surgical applications based on mucoadhesives. Minim Invasive Ther Allied Technol 20:3–13PubMedCrossRef

34.

Arezzo A, Morino M (2011) Endoscopic surgery through single-port incision: time for a trial? Surg Endosc 25:1709–1711PubMedCrossRef

Title: Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis
Authors: Alberto Arezzo
Gitana Scozzari
Federico Famiglietti
Roberto Passera
Mario Morino
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 7/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2763-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Is single-incision laparoscopic cholecystectomy safe? Results of a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2013

Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials

Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review

Survival following laparoscopic and open colorectal surgery

A population-based analysis of the morbidity and mortality of gallbladder surgery in the elderly

A review of the current status of endoluminal therapy as a primary approach to obesity management

Perioperative inflammatory response in natural orifice translumenal endoscopic surgery