Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis

Laura Evers, Nicole Bouvy, Dion Branje, Andrea Peeters, Laura Evers, Nicole Bouvy, Dion Branje, Andrea Peeters

Abstract

Background: Single-incision laparoscopic cholecystectomy (SILC) might maximize the advantages of laparoscopic cholecystectomy (LC) by reducing postoperative pain and improving cosmesis. However, the safety and feasibility of SILC has not yet been established. This study assesses safety, patient reported outcome measures and feasibility of SILC versus conventional LC.

Methods: Literature search for RCT's comparing SILC with conventional LC in gallstone-related disease was performed in PubMed and Embase. The conventional LC was defined as two 10-mm and two 5-mm ports. Study selection was done according to predefined criteria. Two reviewers assessed the risk of bias. Pooled outcomes were calculated for adverse events, pain, cosmesis, quality of life and feasibility using fixed-effect and random-effects models.

Results: Nine RCT's were included with total of 860 patients. No mortality was observed. More mild adverse events (RR 1.55; 95% CI 0.99-2.42) and significantly more serious adverse events (RR 3.00; 95% CI 1.05-8.58) occurred in the SILC group. Postoperative pain (MD -0.46; 95% CI -0.74 to -0.18) and cosmesis (SMD 2.38; 95% CI 1.50-3.26) showed significantly better results for the SILC group, but no differences were observed in quality of life. Operating time (MD 23.12; 95% CI 11.59-34.65) and the need for additional ports (RR 11.43; 95% CI 3.48-37.50) were significantly higher in the SILC group. No difference was observed in conversion to open cholecystectomy or hospital stay longer than 24 h.

Conclusions: SILC does not provide any clear advantages over conventional LC except for less postoperative pain and improved cosmesis. It is questionable whether these advantages outweigh the higher occurrence of adverse events and shortcomings in feasibility. Considering considerable heterogeneity and low methodological quality of the studies it is advisable to perform well-designed RCT's in the future to address the safety and clinical benefits of SILC.

Keywords: Conventional; Feasibility; Laparoscopic cholecystectomy; Safety; Single-incision.

Conflict of interest statement

Laura Evers, Andrea Peeters, Dion Branje and Nicole Bouvy declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Risk of bias in individual studies
Fig. 4
Fig. 4
Forrest plot of serious adverse events for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). A Mantel–Haenszel fixed-effect model was used to calculate risk ratios with 95% confidence intervals
Fig. 5
Fig. 5
Forrest plot of mild adverse events for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). A Mantel–Haenszel fixed-effect model was used to calculate risk ratios with 95% confidence intervals
Fig. 6
Fig. 6
Forrest plot of post-operative pain for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). An inverse variance random-effects model was used to calculate mean difference with 95% confidence intervals
Fig. 7
Fig. 7
Forrest plot of cosmesis for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). An inverse variance random-effects model was used to calculate standardized mean difference with 95% confidence intervals
Fig. 8
Fig. 8
Forrest plot of quality of life for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). An inverse variance random-effects model was used to calculate standardized mean difference with 95% confidence intervals
Fig. 9
Fig. 9
Forrest plot of conversion to open cholecystectomy for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). A Mantel–Haenszel fixed-effect model was used to calculate risk ratios with 95% confidence intervals
Fig. 10
Fig. 10
Forrest plot of additional ports needed for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). A Mantel–Haenszel fixed-effect model was used to calculate risk ratios with 95% confidence intervals
Fig. 11
Fig. 11
Forrest plot of operating time in minutes for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). An inverse variance random-effects model was used to calculate mean difference with 95% confidence intervals
Fig. 12
Fig. 12
Forrest plot of hospital stay longer than 1 day for single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (LC). An inverse variance random-effects model was used to calculate mean difference with 95% confidence intervals

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Source: PubMed

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