SINGLE TRANS-UMBILICAL VERSUS MULTI-INCISION LAPAROSCOPIC CHOLECYSTECTOMY USING CONVENTIONAL LAPAROSCOPIC INSTRUMENTS; A RANDOMIZED CONTROLLED CLINICAL TRIAL

Document Type : Original Article

Authors

1 Department of Surgery, Medical Research Institute

2 Department of Surgery, Faculty of Medicine, Alexandria University, Egypt

Abstract

Summery Background data: Laparoscopic cholecystectomy has traditionally been performed using multiple 
incisions. Single-incision laparoscopic surgery has emerged as an alternative technique to improve cosmoses 
and minimize complications associated with multiple incisions.
Objective: To compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus multiincision laparoscopic cholecystectomy (MILC) using conventional laparoscopic instruments.
Methods: 64 patients undergoing cholecystectomy for symptomatic gall stones, dyskinesia or polyp who were 
willing to be part of this comparison were included in the study. Patients were randomized into two groups 
of 32 per each. Only conventional instruments were used in both groups to keep the cost of surgery the same. 
No special ports, reticulating instruments or flexible telescopes were used.
Results: Of the attempted SILC cases, 26 (81.25%) were successfully completed, with the remainder requiring 
one to three additional skin incisions. There were no conversions to open in either group. Operative time was 
significantly longer in SILC cases compared with MILC [65(45-120) Vs 40(25-70) P_ 0 .0001]. There was a 
tendency toward greater postoperative pain in the MILC group. No intra-operative complications but two 
cases of port site hernias reported two months post-operative in SILC group. Significant better cosmetic 
outcome was observed in SILC cases.
Conclusion: SILC is feasible and promising. It is possible to do this procedure without using special 
equipment and could be an effective alternative to standard four-incision laparoscopic cholecystectomy. With 
the possibility that after the initial learning curve, when the operative time reduces, the postoperative pain 
may also decrease. More studies are needed to demonstrate safety, selection criteria and benefits over 
conventional laparoscopic cholecystectomy.

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