Single-Incision Versus Conventional Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis
Background: This review aims to evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) as compared to conventional laparoscopic cholecystectomy (CLC). Methods: A literature search for studies comparing the feasibility and safety of SILC with CLC was performed. Perioperative complications, postoperative pain, cosmetic satisfaction, conversion rates operative time, length of stay (LOS), estimated blood loss (EBL), total incision length, time to return to work / normal activity, and cost of stay were extracted. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated for continuous and dichotomous variables, respectively. Results: Forty-three studies, including 2291 cases for SILC and 2281 cases for CLC, were included. Our analysis showed that compared with CLC, SILC was associated with significantly reduced postoperative pain on the day of surgery (WMD, -0.47; p = 0.005), lower rate of analgesic use (26.5% vs. 36.1%; p = 0.004), better cosmetic satisfaction scores (WMD, 0.84; p = 0.0006), shorter LOS (WMD, -0.18d; p = 0.03), and shorter incision length (WMD, -9.67 mm; p = 0.004). However, SILC was associated with significantly longer operative time compared to CLC (WMD, 13.65min; p < 0.00001). No significant differences were observed in perioperative complications, analgesic requirement, conversions to open surgery, EBL, time to return to work / normal activity, or cost of stay. Conclusions: In this analysis, which included the largest number of patients thus far, SILC appeared to be feasible and safe. Whether SILC benefits LOS over CLC remains to be further investigated, as well as cost of stay.
Laparoscopic Cholecystectomy, Single-Incision, Single-Port Access, Laparoendoscopic Single-Site, Single-Incision Laparoscopic Surgery
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