Single-Incision Laparoscopic Cholecystectomy A Systematic Review

Objectives: To compare the morbidity, pain, cosmesis, and cost-effectiveness of single-incision laparoscopic cholecystectomy (SILC) with standard laparoscopic cholecystectomy (SLC). Data Sources: Existing literature in MEDLINE through July 31, 2011. Study Selection: We reviewed all studies identified through MEDLINE. References were cross-checked to ensure capture of cited pertinent articles. Case reports and series of less than 4 cases were excluded. Data Synthesis: In total we analyzed 49 studies, including 2336 patients. Seven studies consisted of randomized trials and 11 of case-matched control series (compared with SLC). The technical aspects of SILC were not standardized. Median follow-up time was 4 weeks, although 27 stud-ies (55.1%) reported no follow-up. The overall median complication rate was 7.37% (range, 0-28.6%), and the overall rate of biliary duct complications was 0.39%. Postoperative pain was similar or worse in SILC compared with SLC in 10 of 13 articles reporting pain outcomes (76.9%). Six articles investigating cosmesis after SILC compared outcomes with those of SLC. Three articles demonstrated significantly improved cosmesis after SILC. Conclusions: The perceived benefits of SILC compared with SLC are improved cosmesis and reduced surgical trauma. No definitive evidence suggests that such improvements can be gained by SILC. Complications are more common, may be underestimated owing to the lack of sufficient follow-up, and may be associated with a shift from safe practice.