World Journal of Laparoscopic Surgery

Register      Login

VOLUME 14 , ISSUE 3 ( September-December, 2021 ) > List of Articles


Laparoscopic Cholecystectomy: Single-port vs Traditional Procedure: Our Experience

Selmy S Awad, Ibrahim Dawoud, Waleed Althobiti, Shaker Alfaran, Saleh Alghamdi, Saleh Alharthi, Khaled Alsubaie, Soliman Ghedan, Rayan Alharthi, Majed Asiri, Azzah Alzahrani, Nawal Alotaibi, Mohamed Shetiwy

Keywords : Laparoscopic cholecystectomy, Single-port, Traditional

Citation Information : Awad SS, Dawoud I, Althobiti W, Alfaran S, Alghamdi S, Alharthi S, Alsubaie K, Ghedan S, Alharthi R, Asiri M, Alzahrani A, Alotaibi N, Shetiwy M. Laparoscopic Cholecystectomy: Single-port vs Traditional Procedure: Our Experience. World J Lap Surg 2021; 14 (3):221-226.

DOI: 10.5005/jp-journals-10033-1482

License: CC BY-NC 4.0

Published Online: 05-03-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Laparoscopic surgery is widely accepted as a reliable alternative to the open approach across surgical disciplines. Benefits of single-incision laparoscopic surgery (SILS), as exemplified here by single-port laparoscopic cholecystectomy (SPLC), have yet to be formally proved. However, the hypothesized benefits of SILS would include those of standard traditional laparoscopic surgery plus improved esthetic outcomes, with surgery being performed through a single hidden incision. Methods: All patients who had chronic calcular cholecystitis at the General Surgery Department at Mansoura University Hospital between May 2014 and May 2018 were eligible for this study to compare SPLC with multiport laparoscopic cholecystectomy (MPLC). Operative and perioperative outcomes, including cosmesis, were analyzed. Results: SPLC had been performed in Group A (40 patients), mean age was 37.35 ± 10.72, 80% were females, and mean BMI was 30.15 ± 4.53. MPLC was performed in Group B (40 patients), mean age was 40.70 ± 9.71, 75% were females, and mean BMI was 28.35 ± 2.83. The average duration of postoperative hospital stay in SPLC cases was 24 hours and in MPLC group was 25.20 hours, with p = 0.330, which was insignificant. In the SPLC group, the mean operative time was 95.75 minutes whereas in the MPLC group the mean operative time was 42.10 minutes. Therefore, the mean operative time in the SPLC group was significantly higher than in the MPLC group (p <0.01). Esthetic results were better in the SPLC group than in the MPLC group. Conclusion: Based on the current findings, SPLC seems to be a safe procedure in uncomplicated cholecystitis with rapid recovery, less postoperative pain, less wound infection, and better cosmesis. The operative time was long. However, patients should be aware of the risks of port-site incisional hernia and instructed to avoid heavy work and exercises during the first three postoperative months.

  1. Reynolds W Jr. The First Laparoscopic Cholecystectomy. JSLS 2001;5(1):89–94. PMID: 11304004.
  2. Mühe E. Long-term Follow-Up After Laparoscopic Cholecystectomy. Endoscopy 1992;24(9):754–758. PMID: 1468391.
  3. Vemulapalli P, Agaba EA, Camacho D. Single Incision Laparoscopic Cholecystectomy: A Single Center Experience. Int J Surg 2011;9(5): 410–413. PMID: 21515426.
  4. Kimura T, Sakuramachi S, Yoshida M, et al. Laparoscopic Cholecystectomy Using Fine-Caliber Instruments. Surg Endosc 1998;12(3):283–286. PMID: 9502715.
  5. Mrksić MB, Farkas E, Cabafi Z, et al. Komplikacije laparoskopske holecistektomije [Complications in laparoscopic cholecystectomy]. Med Pregl 1999;52(6–8):253–257. PMID: 10518382.
  6. Hugh TB, Kelly MD, Mekisic A. Rouvière's Sulcus: A Useful Landmark in Laparoscopic Cholecystectomy. Br J Surg 1997;84(9):1253–1254. PMID: 9313706.
  7. Xu F, Xu CG, Xu DZ. A New Method of Preventing Bile Duct Injury in Laparoscopic Cholecystectomy. World J Gastroenterol 2004;10(19):2916–2918. PMID: 15334701.
  8. Way LW, Stewart L, Gantert W, et al. Causes and Prevention of Laparoscopic Bile Duct Injuries: Analysis of 252 Cases from a Human Factors and Cognitive Psychology Perspective. Ann Surg 2003;237(4):460–469. PMID: 12677139.
  9. Hugh TB. New Strategies to Prevent Laparoscopic Bile Duct Injury—Surgeons Can Learn from Pilots. Surgery 2002;132(5):826–835. PMID: 12464867.
  10. Riall TS, Zhang D, Townsend CM Jr, et al. Failure to Perform Cholecystectomy for Acute Cholecystitis in Elderly Patients is Associated with Increased Morbidity, Mortality, and Cost. J Am Coll Surg 2010;210(5):668–679. PMID: 20421027.
  11. Mittermair C, Schirnhofer J, Brunner E, et al. Single Port Laparoscopy in Gastroenterology and Hepatology: A Fine Step Forward. World J Gastroenterol 2014;20(42):15599–15607. PMID: 25400443
  12. Katkhouda N. Single Access Laparoscopic Surgery (SALS). In: Katkhouda Namir Advanced Laparoscopic surgery: Technique and tips. 2nd ed. Los Angeles, CA: Springer Science+Business Media. 2010; P257–63.
  13. Hirano Y, Watanabe T, Uchida T, et al. Single-incision Laparoscopic Cholecystectomy: Single Institution Experience and Literature Review. World J Gastroenterol 2010;16(2):270–274. PMID: 20066749.
  14. Rane A, Dasgupta P. Single-incision Laparoscopic Surgery. BJU Int 2009;103(4):429–30. PMID: 18778354.
  15. Piskun G, Rajpal S. Transumbilical Laparoscopic Cholecystectomy Utilizes No Incisions Outside the Umbilicus. J Laparoendosc Adv Surg Tech A 1999;9(4):361–364. PMID: 10488834.
  16. Strasberg SM, Hertl M, Soper NJ. An Analysis of the Problem of Biliary Injury During Laparoscopic Cholecystectomy. J Am Coll Surg 1995;180(1):101–125. PMID: 8000648.
  17. Adams DB. The Importance of Extrahepatic Biliary Anatomy in Preventing Complications at Laparoscopic Cholecystectomy. Surg Clin North Am 1993;73(4):861–871. PMID: 8378825.
  18. Antonio M Lacy, Homero R, Salivadora D. Colorectal surgery. In: Assalia A, Gagner M, Schein M Controversies in Laparoscopic surgery. New York: Springer Science+Business media Inc 2006: p. 361–79.
  19. Federico A, Assalia A, Gagner M. Pancreatic surgery. In: Assalia A, Gagner M, Schein M. Controversies in Laparoscopic surgery. New York, USA: Springer Science+Business Media Inc 2006: p. 345–P356.
  20. Gkegkes ID, Mourtarakos S, Iavazzo C. Single-incision Laparoscopic Splenectomy. JSLS 2014;18(3):e2014.00350. PMID: 25392670.
  21. Steiner CA, Bass EB, Talamini MA, et al. Surgical Rates and Operative Mortality for Open and Laparoscopic Cholecystectomy in Maryland. N Engl J Med 1994;330(6):403–408. PMID: 8284007.
  22. Ou ZB, Li SW, Liu CA, et al. Prevention of common bile duct injury during laparoscopic cholecystectomy. Hepatobiliary Pancreat Dis Int 2009;8(4):414–417. PMID: 19666412.
  23. Najmaldin A, Guillou P. A Guide to Laparoscopic surgery. New Jersey: Wiley-Blackwell 1998: p. 7–14.
  24. Sharma A, Soni V, Baijal M, et al. Single Port Versus Multiple Port Laparoscopic Cholecystectomy—A Comparative Study. Indian J Surg 2013;75(2):115–122. PMID: 24426405.
  25. James A Dickerson II, Chan W Park, Aurora D Pryor. Single-Site Access Surgery. In: Nathaniel J. Soper, Carol E.H. Scott-Conner the SAGES Manual Volume 1 Basic Laparoscopy and Endoscopy. London: Springer Science+Business Media, LLC. 2012: p. 87–98.
  26. Litwin DE, Cahan MA. Laparoscopic Cholecystectomy. Surg Clin North Am 2008;88(6):1295–ix. PMID: 18992596.
  27. Carbonell AM 2nd. Minimally Invasive Gastric Surgery. Surg Clin North Am 2011;91(5):1089–1103. PMID: 21889031.
  28. Rao PP, Rao PP, Bhagwat S. Single-incision Laparoscopic Surgery—Current Status and Controversies. J Minim Access Surg 2011;7(1):6–16. PMID: 21197236.
  29. Jeffrey W Milsom, Bartholomaus Bohm, Kiyokazu Nakajima. Small bowel resection. In: Jeffrey W. Milsom, Bartholomaus Bohm, Kiyokazu Nakajima Laparoscopic Colorectal surgery. 2nd ed. New York: Springer Science+Business media Inc 2006: p. 111–118.
  30. Mostaedi R, Milosevic Z, Han HS, et al. Laparoscopic Liver Resection: Current Role and Limitations. World J Gastrointest Oncol 2012;4(8):187–192. PMID: 22912914.
  31. Ahmed K, Wang TT, Patel VM, et al. The Role of Single-Incision Laparoscopic Surgery in Abdominal and Pelvic Surgery: A Systematic Review. Surg Endosc 2011;25(2):378–396. PMID: 20623239.
  32. Prasad A, Mukherjee KA, Kaul S, et al. Postoperative Pain after Cholecystectomy: Conventional Laparoscopy Versus Single-Incision Laparoscopic Surgery. J Minim Access Surg 2011;7(1):24–27. PMID: 21197238.
  33. Merchant AM, Cook MW, White BC, et al. Transumbilical Gelport Access Technique for Performing Single Incision Laparoscopic Surgery (SILS). J Gastrointest Surg 2009;13(1):159–62. PMID: 18972166.
  34. Raj K Goel, Jihad H Kaouk. Difficulties in Single-Port Laparoscopic Procedures. In: Ahmed Al-Kandari.and Inderbir S. Gill Difficult Conditions in Laparoscopic Urologic Surgery. London: Springer-Verlag London Limited 2011: p. 395–404.
  35. Benhidjeb T, Stark M, Jakob R, et al. Single-access surgery: less is more? In: Andrea Tinelli, Ed. Laparoscopic entry. London: Springer-Verlag 2012: p. 133–160.
  36. Froghi F, Sodergren MH, Darzi A, et al. Single-incision Laparoscopic Surgery (SILS) in General Surgery: A Review of Current Practice. Surg Laparosc Endosc Percutan Tech 2010;20(4):191–204. PMID: 20729685.
  37. Broeders IA. Randomized Clinical Trial of Single-Incision Laparoscopic Cholecystectomy Versus Minilaparoscopic Cholecystectomy (Br J Surg 2010;97:1007–1012). Br J Surg 2010;97(7):1012. PMID: 20632265
  38. Khambaty F, Brody F, Vaziri K, et al. Laparoscopic versus Single-Incision Cholecystectomy. World J Surg 2011;35(5):967–972. PMID: 21359686.
  39. Autorino R, Cadeddu JA, Desai MM, et al. Laparoendoscopic Single-site and Natural Orifice Transluminal Endoscopic Surgery in Urology: A Critical Analysis of the Literature. Eur Urol 2011;59(1):26–45. PMID: 20828918.
  40. Cantore F, Colombo EM, Giuseppe MD, et al. Single Access Cholecystectomy Using Standard Laparoscopic Instruments. Updates Surg 2011;63(1):31–34. PMID: 21267691.
  41. Culp BL, Cedillo VE, Arnold DT. Single-incision Laparoscopic Cholecystectomy Versus Traditional Four-Port Cholecystectomy. Proc (Bayl Univ Med Cent) 2012;25(4):319–323. PMID: 23077377.
  42. Agaba EA, Rainville H, Ikedilo O, et al. Incidence of Port-Site Incisional Hernia After Single-Incision Laparoscopic Surgery. JSLS 2014;18(2):204–210. PMID: 24960483.
  43. Henriksen NA, Al-Tayar H, Rosenberg J, et al. Cost assessment of Instruments for Single-Incision Laparoscopic Cholecystectomy. JSLS 2012;16(3):353–359. PMID: 23318059.
  44. Lewis T, Aggarwal R, Kwasnicki R, et al. Does Previous Laparoscopic Experience Improve Ability to Perform Single-Incision Laparoscopic Surgery? Surg Endosc 2012;26(5):1214–1219. PMID: 22179448.
  45. Romanelli JR, Roshek TB 3rd, Lynn DC, et al. Single-port Laparoscopic Cholecystectomy: Initial Experience. Surg Endosc 2010;24(6):1374–1379. PMID: 20039073.
  46. Homero Rivas. Complications in single-incision laparoscopic surgery. In: David S. Tichansky, John Morton, Daniel B. Jones, Eds. The SAGES manual of quality, outcomes and patient safety. : Springer. 2012;p. 347–54.
  47. Gunaratnam C, Bernstein M. Factors Affecting Surgical Decision-Making-A Qualitative Study. Rambam Maimonides Med J 2018 29;9(1):e0003. PMID: 29406843.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.