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Single-port vs Traditional Laparoscopic Cholecystectomy
SPLC can be done safely with standard straight laparoscopic improvements in instrumental technology may guide minimizing
instruments. In our study 10 patients out of 40 were operated by of the operative times further. 41,43,44
the standard laparoscopic instruments and all were completed Another issue that must be understood with SILS is cross-
successfully. According to Cantore et al.’s study of 20 candidates handedness. Early in our current study, we struggled with hand
(16 women, 4 men) of SILC, 4 (20%) had had previous abdominal placement outside the abdomen as the sphere of space that the
surgery (appendectomy in all patients). Traditional straight external components of the instrumentation and the surgeons’
laparoscopic instruments were used. All patients were successfully hands inhabit is decidedly smaller. 45,46
operated without additional skin slits. This study concluded that In general aspects, case results and safety from any operative
SILC with traditional straight laparoscopic instruments is feasible technique may be affected by three various, but equally significant,
and safe. 40 items: the patients’ health (or disease); surgeons (expertise,
47
In recent years, SILS and NOTES have received attention for training, and his/her surgical team); and technology used. In
both clinical and industrial aspects. The key advantages in favor our current research, simple cases with straightforward diseases
of these two techniques are the esthetic outcome, fast recovery of are the most proper cases for this procedure. Thus, one might
patients, and reduced need for analgesia. 18–20 SILS is considered think that patients who are morbidly obese, those with previous
superior to other NOTES because it does not involve manipulation abdominal surgeries (especially ventral hernia repairs with mesh),
of instruments through internal hollow organs such as the stomach very tall candidates, or cases with multiple comorbidities may be
or vagina. 31,32,37 excluded (at least at an early time of experience with an operator’s
In our present research, the mean operative time in the single-port use).
first group as a new procedure was 95.75 minutes, which was In general, all periprocedural complications linked to
significantly higher than in the MPLC group (42.10 minutes). laparoscopy will also be potential concerns in SILS. At present, most
According to one research, which was carried out on 60 patients clinical research studies have not reported a higher complication
divided into two equal groups of 30 candidates each, Group I was rate, or more serious entities of complications, after SILS. In fact,
offered MPLC and in Group II, SILC was done. Length of stay, pain the available experience has revealed the same results with SILS as
score, operative time, and wound infection rates were compared compared to conventional laparoscopic approach, with the addition
between the two groups. Operative times in Group I and Group II of many of its proposed and unique benefits, such as improved
were 38.50 ± 8.92 minutes and 80.17 ± 30.16 minutes, respectively. esthetic outcomes from virtually hidden scars. 45,46
p value was 0.0001, which indicates an important difference There may be a subset of potential complications, which may
between the two groups. 41 prove to be more common with SILS as compared with other
As the number of cases undergoing SPLC increased, there was traditional procedures. Of particular concern is that electrical
an important reduction in the operative time with improvement injuries could be more prone to occur, at least in theory. These
of the learning curve. In our current study, operative time after first may occur as a result of the near proximity of laparoscopic
20 SPLC techniques showed a significant reduction. This correlates instruments, with close contact, to each other. However, it did
24
with the recorded “learning curve” in other research studies. not occur in our study. 46
In one study, the postoperative incidence of port-site incisional
hernia in the 1st group was higher postoperatively (2 cases out
of 20). An issue that many operators expressed about SILS is the conclusIon
probability of a high occurrence of port-site incisional umbilical SILS allowed for better cosmesis, less pain and faster recovery, less
hernias postoperatively. The concern behind this query was that wound infections, ease of tissue retrieval, combination procedure,
SILS requires a bigger fascial incision (20–30 mm) to accept a and patient acceptance. Standard instruments can be used, and
multichannel port device. So careful closure of the fascial defect natural orifices need not be violated. SPLC can be done safely with
and postoperative instructions to avoid heavy work and exercises standard straight laparoscopic instruments. With improvement of
within the first three months post-operatively are obligatory. 24,39,42 the learning curve of the technique, operative times have been
In our study, the instrumental cost of the SPLC using a minimized significantly.
commercial port and curved instruments was significantly higher
than the cost for MPLC. According to a previous experience, two orcId
consecutive series of cases with SILC were assessed and revealed
that the instrumental cost of SILC using a commercial port was Selmy Mohamed Awad https://orcid.org/0000-0002-2724-5599
significantly higher (median $1123) than the cost for MPLC (median
43
$441, p = 0005). SPLC has secondary advantages including references
improved esthetic outcomes, LoS, and a rapid return to work
Therefore, the cost of the SPLC procedure should not be the reason 1. Reynolds W Jr. The First Laparoscopic Cholecystectomy. JSLS
2001;5(1):89–94. PMID: 11304004.
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Major technical difficulties with this novel procedure are the tectomy. Endoscopy 1992;24(9):754–758. PMID: 1468391.
sacrifice that have to be made in terms of ergonomics and comfort. 3. Vemulapalli P, Agaba EA, Camacho D. Single Incision Laparoscopic
Because all camera and instruments are accommodated through Cholecystectomy: A Single Center Experience. Int J Surg 2011;9(5):
the same slit, the triangulation of instruments around the target 410–413. PMID: 21515426.
was lost. In our current research, this resulted in an initial significant 4. Kimura T, Sakuramachi S, Yoshida M, et al. Laparoscopic
increase in the operative time. However, in our study with an Cholecystectomy Using Fine-Caliber Instruments. Surg Endosc
1998;12(3):283–286. PMID: 9502715.
improvement of the learning curve of the technique, operative 5. Mrksić MB, Farkas E, Cabafi Z, et al. Komplikacije laparoskopske
times have been minimized significantly and are now very near to holecistektomije [Complications in laparoscopic cholecys-
the mean time taken for traditional laparoscopy. Future technical tectomy]. Med Pregl 1999;52(6–8):253–257. PMID: 10518382.

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