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Erschienen in: Surgical Endoscopy 5/2012

01.05.2012 | Review

Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis

verfasst von: S. R. Markar, A. Karthikesalingam, S. Thrumurthy, L. Muirhead, J. Kinross, P. Paraskeva

Erschienen in: Surgical Endoscopy | Ausgabe 5/2012

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Abstract

Background

Single-incision laparoscopic surgery (SILS) has gained increasing attention due to the potential to maximize the benefits of laparoscopic surgery. The aim of this systematic review and pooled analysis was to compare clinical outcome following SILS and standard multiport laparoscopic cholecystectomy for the treatment of gallstone-related disease.

Methods

An electronic search of Embase and Medline databases for articles from 1966 to 2011 was performed. Publications were included if they were randomised controlled studies in which patients underwent either single-incision or multiport cholecystectomy. The primary outcome measures for the meta-analysis were postoperative complications and postoperative pain score [visual analogue scale (VAS) on the day of surgery]. Secondary outcome measures were operating time and length of hospital stay. Weighted mean difference was calculated for the effect size of SILS on continuous variables, and pooled odds ratios were calculated for discrete variables.

Results

In total, 375 cholecystectomy operations from 7 randomised controlled trials were included, 195 by single-incision (SILS) and 180 by conventional multiport. Operating time was significantly longer in the SILS group compared to the standard multiport laparoscopic cholecystectomy group (weighted mean difference = 2.13; P = 0.0001). There was no significant difference in the incidence of postoperative complications, postoperative pain score (VAS), or the length of hospital stay between the two groups.

Conclusion

The results of this meta-analysis demonstrate that single-incision laparoscopic cholecystectomy is a safe procedure for the treatment of uncomplicated gallstone disease, with postoperative outcome similar to that of standard multiport laparoscopic cholecystectomy. Future high-powered randomized studies should be focused on elucidating subtle differences in postoperative complications, reported postoperative pain, and cosmesis following SILS cholecystectomy in more severe biliary disease.
Literatur
1.
Zurück zum Zitat Bittner R (2004) The standard of laparoscopic cholecystectomy. Langenbecks Arch Surg 389:157–163PubMedCrossRef Bittner R (2004) The standard of laparoscopic cholecystectomy. Langenbecks Arch Surg 389:157–163PubMedCrossRef
2.
Zurück zum Zitat Muhe E (1986) The first laparoscopic cholecystectomy. Langenbecks Arch Surg 369:804 Muhe E (1986) The first laparoscopic cholecystectomy. Langenbecks Arch Surg 369:804
3.
Zurück zum Zitat Kaiser AM, Corman ML (2001) History of laparoscopy. Surg Oncol Clin N Am 10:483–492PubMed Kaiser AM, Corman ML (2001) History of laparoscopy. Surg Oncol Clin N Am 10:483–492PubMed
4.
Zurück zum Zitat Keus F, de Jong JA, Gooszen HG, can Laarhoven CJ (2006) Laparoscopic vs open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Sys Rev (4):CD006231 Keus F, de Jong JA, Gooszen HG, can Laarhoven CJ (2006) Laparoscopic vs open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Sys Rev (4):CD006231
5.
Zurück zum Zitat DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRef
6.
Zurück zum Zitat Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166(2):e109–e112PubMedCrossRef Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166(2):e109–e112PubMedCrossRef
7.
Zurück zum Zitat Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98(7):991–995PubMedCrossRef Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98(7):991–995PubMedCrossRef
8.
Zurück zum Zitat Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254(1):22–27PubMedCrossRef Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254(1):22–27PubMedCrossRef
9.
Zurück zum Zitat Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, Lee PH (2010) Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 97(7):1007–1012PubMedCrossRef Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, Lee PH (2010) Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 97(7):1007–1012PubMedCrossRef
10.
Zurück zum Zitat Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52PubMedCrossRef Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52PubMedCrossRef
11.
Zurück zum Zitat Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372 (discussion 372–373)PubMedCrossRef Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372 (discussion 372–373)PubMedCrossRef
12.
Zurück zum Zitat Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomize controlled trial. Surg Endosc 24(8):1842–1848PubMedCrossRef Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomize controlled trial. Surg Endosc 24(8):1842–1848PubMedCrossRef
13.
Zurück zum Zitat Chow A, Purkayastha S, Aziz O, Pefanis D, Paraskeva P (2010) Single-incision laparoscopic surgery for cholecystectomy: a retrospective comparison with 4-port laparoscopic cholecystectomy. Arch Surg 145(12):1187–1191PubMedCrossRef Chow A, Purkayastha S, Aziz O, Pefanis D, Paraskeva P (2010) Single-incision laparoscopic surgery for cholecystectomy: a retrospective comparison with 4-port laparoscopic cholecystectomy. Arch Surg 145(12):1187–1191PubMedCrossRef
14.
Zurück zum Zitat Rasic Z, Schwarz D, Nesek VA, Zoricic I, Sever M, Rasic D, Lojo N (2010) Single incision laparoscopic cholecystectomy–a new advantage of gallbladder surgery. Coll Antropol 34(2):595–598PubMed Rasic Z, Schwarz D, Nesek VA, Zoricic I, Sever M, Rasic D, Lojo N (2010) Single incision laparoscopic cholecystectomy–a new advantage of gallbladder surgery. Coll Antropol 34(2):595–598PubMed
15.
Zurück zum Zitat Chang SK, Tay CW, Bicol RA, Lee YY, Madhavan K (2011) A case-control study of single-incision versus standard laparoscopic cholecystectomy. World J Surg 35(2):289–293PubMedCrossRef Chang SK, Tay CW, Bicol RA, Lee YY, Madhavan K (2011) A case-control study of single-incision versus standard laparoscopic cholecystectomy. World J Surg 35(2):289–293PubMedCrossRef
16.
Zurück zum Zitat Love KM, Durham CA, Meara MP, Mays AC, Bower CE (2011) Single-incision laparoscopic cholecystectomy: a cost comparison. Surg Endosc 25(5):1553–1558PubMedCrossRef Love KM, Durham CA, Meara MP, Mays AC, Bower CE (2011) Single-incision laparoscopic cholecystectomy: a cost comparison. Surg Endosc 25(5):1553–1558PubMedCrossRef
17.
Zurück zum Zitat Fronza JS, Linn JG, Nagle AP, Soper NJ (2010) A single institution’s experience with single incision cholecystectomy compared to standard laparoscopic cholecystectomy. Surgery 148(4):731–734PubMedCrossRef Fronza JS, Linn JG, Nagle AP, Soper NJ (2010) A single institution’s experience with single incision cholecystectomy compared to standard laparoscopic cholecystectomy. Surgery 148(4):731–734PubMedCrossRef
18.
Zurück zum Zitat Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35(9):2092–2101PubMedCrossRef Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35(9):2092–2101PubMedCrossRef
19.
Zurück zum Zitat Antoniou SA, Pointner R, Granderath FA (2011) Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 25:367–377PubMedCrossRef Antoniou SA, Pointner R, Granderath FA (2011) Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 25:367–377PubMedCrossRef
Metadaten
Titel
Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis
verfasst von
S. R. Markar
A. Karthikesalingam
S. Thrumurthy
L. Muirhead
J. Kinross
P. Paraskeva
Publikationsdatum
01.05.2012
Verlag
Springer-Verlag
Erschienen in
Surgical Endoscopy / Ausgabe 5/2012
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-011-2051-0

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