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Single-port vs Traditional Laparoscopic Cholecystectomy
observed in gynecologic, urologic, pediatric, gastrointestinal, and bile duct diameter with no stones impacted, and so on. Laboratory
bariatric surgery. 13 investigations for patients in both groups were normal including
serum bilirubin, serum alkaline phosphatase, liver enzymes,
PAtIents And Methods bleeding profile, and hemoglobin level. All cases with symptomatic
All patients who had chronic calcular cholecystitis at the General cholelithiasis and all surgeries were elective.
Surgery department 7 at Mansoura University Hospital between Operative time: In Group A, the mean operative time in minutes
May 2014 and May 2018 were eligible for this study to compare was 95.75 ± 18.37 (Table 2) whereas in the MPLC group, it was
between SPLC and MPLC. Operative and perioperative outcomes, 42.10 ± 5.04, so that the mean operating time in Group B was
including cosmesis and quality of life, were analyzed. Candidates significantly lower than in the SPLC group (p <0.01).
were randomly assigned into two groups: Group A consisted
of 40 cases (single-port laparoscopic cholecystectomy) and Operative times and learning curve: The operative time was
Group B consisted of 40 cases (traditional multiport laparoscopic significantly higher in Group A (Fig. 1). An important reduction in
cholecystectomy). the operative time was achieved as the number of cases undergoing
SPLC had increased. In the first 20 cases, the average operative
Inclusion criteria: (1) age: ≥15 years, (2) sex: male and female, (3) time was 100 minutes whereas in the second 20 patients, it was 80
ultrasound finding of gallbladder stones, (4) biliary colic, and (5) minutes (Fig. 2).
BMI <40.
Intraoperative complications: In the SPLC group, we encountered
Exclusion criteria: (1) age: <15 years, (2) acute pancreatitis, (3)
common bile duct stones, (4) contraindications for single-port intraoperative bleeding in one case. The source of bleeding was
cholecystectomy, namely, ASA classification of 3 or 4 indicating a cystic artery, and we had to convert to MPLC to control the
pregnancy, and (5) BMI >40. bleeding whereas in the MPLC group there was no intraoperative
bleeding (p = 0.311) which is insignificant (Fig. 3). There was no
All candidates underwent proper history taking, thorough intraoperative viscus injury or bile leakage in both groups.
clinical examination, radiological, and full laboratory investigation
stressing on liver status. Conversion to MPLC: In the SPLC group (Fig. 4), the conversion to

Follow-up of the patients: Follow-up of the patients included oper- MPLC was mandated in five patients. In one patient, it was due
ative time, periprocedural operative complications (bleeding, bile to uncontrolled bleeding from a cystic artery. In two patients,
leak, visceral injury, conversion to MPLC or open cholecystectomy). conversion was due to a tense gallbladder with pericholecystic
Postoperative follow-up included postoperative bleeding, bile adhesions and exposure of Calot’s triangle was difficult. Both
leak, hospital stay, wound infection, incisional hernia, and cosmesis patients were male and had a history of recent attack of acute
for one year. All of these data were collected, tabulated, and cholecystitis. In one patient, there was a caterpillar hump anomaly
analyzed carefully using SPSS version 26. of the right hepatic artery occupying most of the cholecystohepatic
triangle and so we had to convert for better delineation of Calot’s
triangle and safe cholecystectomy. In one patient, we converted to
results MPLC then to open procedure due to a thick gallbladder with an
This comparative prospective research was performed on all impacted large stone at the cystic duct.
eligible candidates who were classified into two groups: Group
A consisted of patients who underwent single-port laparoscopic Postoperative complications (bleeding, bile leak): In both groups, we
cholecystectomy and Group B consisted of patients who underwent did not have postoperative bleeding or bile leak.
multiport laparoscopic cholecystectomy.
Postoperative pain and need for additional analgesia: All patients
Demographic Criteria and Clinical Characteristics of in both groups received the same postoperative analgesia
the Patients (paracetamol injection 8 hourly). In the SPLC group, the number
Demographic and clinical characteristics of the patients are shown of patients requiring additional analgesia in the form of NSAIDS
in Table 1. Patients in both groups had same abdominal sonography was 16 (40%) whereas in the MPLC group, the number of patients
finding, such as normal liver, gallbladder stones, normal common requiring additional analgesia was 30 (75%) (p = 0.025), indicating

Table 1: Demographic and clinical characteristics of the patients
SPLC group MPLC group
(n = 40) (n = 40) t p
Age (mean ± SD), years 37.35 ± 10.72 40.70 ± 9.71 1.036 0.307
BMI (mean ± SD) 30.15 ± 4.53 28.35 ± 2.83 1.506 0.140
Sex No. % No. %
Male 8 20% 10 25% 0.143 # 0.705
Female 32 80% 30 75%
Recent attack of acute 6 15% 4 10% 0.229 0.633
cholecystitis
or pancreatitis

222 World Journal of Laparoscopic Surgery, Volume 14 Issue 3 (September-December 2021)