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01.07.2013 | Review | Ausgabe 7/2013

Surgical Endoscopy 7/2013

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

Surgical Endoscopy > Ausgabe 7/2013
Alberto Arezzo, Gitana Scozzari, Federico Famiglietti, Roberto Passera, Mario Morino
Wichtige Hinweise
Presented in part at the XX International Congress of the European Association for Endoscopic Surgery (EAES), June 20–23, 2012, Brussels, Belgium, where it received the Olympus EAES Award for the best oral presentation on single-port surgery.



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).


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.


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).


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.

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