Laparoscopic versus single-incision cholecystectomy

Abstract

Background: Although recent reports demonstrate large series of single-incision cholecystectomies, few articles compare single-incision data with traditional laparoscopic cholecystectomy (LC) data. This article compares a large series of single-incision cholecystectomies to a series of traditional LCs performed at an urban tertiary-care center.

Methods: A consecutive series of single-incision cholecystectomies was performed from August 2008 to March 2010. All cholecystectomies were attempted through a single incision on an intent-to-treat basis. Patient demographics, including height, weight, body mass index (BMI), pathologic diagnosis, ASA classification, operative time, complications, narcotic use, and length of stay (LOS), were recorded. Data for a matched cohort of patients undergoing a traditional four-port LC were gathered over a similar time period. Data were compared using a t test with a P<0.05 for significance.

Results: Single-incision cholecystectomy was successful in 81 (76%) of 107 patients. The 26 (24%) converted cases showed a higher BMI (33.0±8.7 vs. 28.4±6.4 kg/m2, P<0.05) and longer operative times (98.3±33 vs. 76.1±23 min, P<0.003). Postoperatively, the converted patients had a longer LOS compared to that of the single-incision group (1.6±1.0 vs. 1.1±0.4 days, P=0.02). Overall, the single-incision group had longer operative times compared to the four-port LC group (81.5±28 vs. 69.1±21 min, P<0.004). However, after the tenth single-incision case, there was no difference in operative times. From a narcotic standpoint, the successful single-incision patients used significantly less narcotic versus the traditional LC group (20±22.7 vs. 32.3±31.2 mg, P=0.02).

Conclusions: The data suggests that individuals with a BMI over 33 may not be candidates for single-incision cholecystectomy. Those patients that undergo a successful single-incision laparoscopic cholecystectomy require fewer narcotics postoperatively and have a shorter LOS. Although this data is intriguing, the overall utility of single-incision procedures requires more analysis and potentially randomized trials.