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          Comparative Study of Single-incision Laparoscopic Cholecystectomy with Four-port Conventional Laparoscopic Cholecystectomy
          Table 3: Comparative analysis of single-incision laparoscopic   made during this study were comparable to previous
          cholecystectomy with laparoscopic cholecystectomy in terms of   studies. 12,15,18  Though SILC seems an good alternative to
          postoperative pain
                                                              LC in terms of cosmetic outcome, there are added benefits
                             Standard four                    when compared with LC in terms of postoperative com-
           Pain analysis by    port lap      SILC
           VAS scoring       cholecystectomy  (n = 30) p-value  plications, mean hospital stay, and pain. LC has definitely
           Mean VAS at 12 hrs  3.23          3.33   >0.05     less operative difficulty and mean operative time than
           Mean VAS at 24 hrs  2.20          2.40   >0.05     SILC. Single-incision laparoscopic cholecystectomy can
           Mean VAS at 3rd Day  1.20         1.1    >0.05     be offered to selected group of patients.

                                                              CONCLUSION
             The mean VAS score for analysis of pain in postop-
          erative period was almost similar in both the groups  Single-incision laparoscopic cholecystectomy is a promis-
          done at 12 hours, 24 hours and on 3rd postoperative day  ing alternate method for uncomplicated cholelithiasis in
          (p > 0.05) (Table 3).                               terms of cosmetic outcome, but it does not have any major
                                                              benefits when compared with conventional LC.
          DISCUSSION
                                                              REFERENCES
          Cholelithiasis is a common condition in India, especially
          in Northern India. Conventional open cholecystectomy     1.  Jarnagin WR, editor. Blumgart’s surgery of the liver, biliary
                                                                  tract and pancreas. 5th ed. Philadelphia: Elsevier Saunders;
          is known for decades, but with advent of laparoscopic   2012.
          surgery, LC has now become the gold standard treatment     2.  Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D,
                         1
          for cholelithiasis.  In the present era, newer techniques   Coumaros D. Surgery without scars: report of transluminal
          have been introduced and now scarless surgery in the    cholecystectomy in a human being. Arch Surg 2007 Sep;
          form of SILC and NOTES is possible. 5,8,9               142(9):823-826.
             This study showed a female predominance with a     3.  Richak S. Three-port versus standard four-port laparoscopic
                                                                  cholecystectomy. Surg Endosc 2003;17:1434-1436.
          mean age of 38.5 years (18–60), which is comparable to     4.  Ramachandran CS, Arora V. Two-port laparoscopic cholecys-
          various studies conducted on the similar topic. 6,7     tectomy: an innovative new method for gall bladder removal.
             Intraoperative complications like biliary spillage and   J Laparoendosc Adv Surg Tech A 1998 Oct;8(5):303-308.
          bleeding were significantly higher in the SILC group.     5.  Cugura JF, Jankovie J, Kulis T, Kivac I, Beslin MB. Single
          Previous studies showed safety and feasibility of SILC   incision laparoscopic surgery cholecystectomy; where are
                                                                  we? Acta Clin Croat 2008 Dec;47(4):245-248.
          with no significant intraoperative complications. 12-14      6.  Erbella JJ, Bunch GM. Single incision laparoscopic chol-
          Few studies showed increased rate of intraoperative     ecystectomy: the first 100 outpatients. Surg Endosc 2010
          complications  in  SILC,  but  these  are  statistically   Aug;24(8):1958-1961.
                     15
          insignificant.  Operative difficulty, such as compromised     7.  Cotirlet A, Nedelcu M, Popa E, Anghel R, Rau S, Motoc I,
          vision, insufficient retraction, difficult gallbladder   Tincu E. Single incision laparoscopic cholecystectomy.
                                                                  Chirurgia (Bucur) 2014 Nov-Dec;109(6):769-773.
          extraction, and difficult instrumentation was noticed     8.  Asakuma M, Perretta S, Allemann P, Cahill R, Con SA, Solano C,
          significantly higher in SILC. Previous few studies had   Pasupathy S, Mutter D, Dallemagne B, Marescaux J. Chal-
          reported similar observations. 15                       lenges and lessons learned from NOTES cholecystectomy
             Mean operative time was significantly higher for SILC   initial experience: a stepwise approach from the labora-
          as compared with LC due to more operative difficulty in   tory to clinical application. J Hepatobiliary Pancreat Surg
                                                                  2009;16(3):249-254.
          SILC. Few studies and meta-analysis had shown similar     9.  Bessler M, Stevens PD, Milone L, Parikh M, Fowler D.
          results as our study, and some studies had shown similar   Transvaginal laparoscopically assisted endoscopic chol-
          operative time in SILC. 12,14,16                        ecystectomy: a hybrid approach to natural orifice surgery.
             Postoperative complications and mean hospital stay   Gastrointest Endosc 2007 Dec;66(6):1243-1245.
          were similar in both groups. There was no incidence     10.  Pelosi MA, Pelosi MA. Laparoscopic appendectomy using a
                                                                  single umbilical puncture (minilaparoscopy). J Reprod Med
          of bile duct injury and port-site hernia in both groups.   1992 Jul;37(7):588-594.
          Surgical site infection rates were similar in both groups.     11.  Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I.
          These findings are comparable to most of previous studies   One-wound laparoscopic cholecystectomy. Br J Surg 1997
          and meta-analysis available in literature. 17-20  Postopera-  May;84(5):695.
          tive pain was similar in both SILC and LC in 12 hours,     12.  Singh M, Mehta KS, Yasir M, Kaur A, Aiman A, Sharma A,
                                         21
          24 hours, and 3rd postoperative day.  Cosmetic outcome   Kaur N. Single-incision laparoscopic cholecystectomy using
                                                                  conventional laparoscopic instruments and comparison
          of our cases in SILC group was significantly better than   with three-port cholecystectomy. Indian J Surg 2015 Dec;77
          LC at 6th week and 12th week. Most of the observations   (Suppl 2):546-550.
          World Journal of Laparoscopic Surgery, January-April 2016;9(1):9-12                               11
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