World Journal of Surgery

, Volume 37, Issue 5, pp 991–998 | Cite as

Single-Port Cholecystectomy Versus Multi-Port Cholecystectomy: A Prospective Cohort Study with 222 Patients

  • Markus J. Wagner
  • Hans KernEmail author
  • Alexander Hapfelmeier
  • Jan Mehler
  • Michael H. Schoenberg



The aim of this study was to compare single-port access cholecystectomy (SPA) with the standard laparoscopic technique (LC) regarding the duration of the operation, complications, learning curve, late postoperative quality of life (QoL) and the incidence of incisional hernias.


Between June 2009 and December 2011, a total of 122 SPA cholecystectomies were performed in our hospital. Simultaneously, 310 patients were operated on with the LC technique. In the LC group, 100 patients met the same criteria defined for SPA surgery. The two groups (SPA and LC) were compared by multivariable regression analysis. Endpoints of this study were quality of life (QoL) after 6 months by the EQ-5D questionnaire 5L and the incidence of incisional hernia 1 year after surgery. Operating time, hospital stay, and perioperative complications were also measured and compared. The median follow-up was 9.2 months (3–25 months).


The patients in the SPA group were younger and more often female. The mean operating time for group SPA was 73 min (35–136 min)—significantly longer than that for group LC with 60 min (33–190 min) (p < 0.001). Additional trocars were used in 8 of 122 (6.5 %) SPA patients. A conversion to open cholecystectomy was not necessary in SPA patients. The conversion rate in the LC group to open cholecystectomy was 2 % (2/100). The perioperative and postoperative complications and incisional hernia (5.5 %) were the same in both groups. QoL was significantly better in the SPA group in terms of mobility (p = 0,002), usual activity (p = 0.036), and overall anxiety (p = 0.026).


SPA cholecystectomy is safe, although the operation is significantly longer. No differences in terms of major complications or the incidence of incisional hernia were seen after 1 year. QoL was significantly better in patients operated on with the SPA technique.


Laparoscopic Cholecystectomy Incisional Hernia Bile Duct Injury Open Cholecystectomy Multivariable Regression Analysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

The authors declare that they have no commercial association that might pose a conflict of interest in connection with this article. They also have no financial or personal relationships with other people or organizations that could have influenced this work.


  1. 1.
    Semm K (1983) Endoscopic appendectomy. Endoscopy 15:59–64PubMedCrossRefGoogle Scholar
  2. 2.
    Mühe E (1986) Die erste Cholecystektomie durch das Laparoskop. Langebecks Arch 369:804CrossRefGoogle Scholar
  3. 3.
    Mühe E (1992) Long-term follow-up after laparoscopic cholecystectomy. Endoscopy 24:754–758PubMedCrossRefGoogle Scholar
  4. 4.
    Mouret P (1991) From the first laparoscopic cholecystectomy to the frontiers of laparoscopic surgery: the future prospectives. Dig Surg 8:124–125CrossRefGoogle Scholar
  5. 5.
    Cuschieri A (1990) Minimal access surgery: the birth of a new era. J R Coll Surg Edinb 35:345–347PubMedGoogle Scholar
  6. 6.
    Bittner R (2004) The standard of laparoscopic cholecystectomy. Langenbecks Arch Surg 389:157–163PubMedCrossRefGoogle Scholar
  7. 7.
    Navarra G, Pozza E, Occhionorelli S et al (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695PubMedCrossRefGoogle Scholar
  8. 8.
    Pfluke JM, Parker M, Stauffer JA et al (2011) Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg 212:113–118PubMedCrossRefGoogle Scholar
  9. 9.
    Antoniou SA, Pointner R, Granderath FA (2010) Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 25:367–377PubMedCrossRefGoogle Scholar
  10. 10.
    Pollard JS, Fung AK, Ahmed I (2012) Are natural orifice transluminal endoscopic surgery and single-incision surgery viable techniques for cholecystectomy? J Laparoendosc Adv Surg Tech A 22(1):1–14PubMedCrossRefGoogle Scholar
  11. 11.
    Hodgett SE, Hernandez JM, Morton CA et al (2008) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192PubMedCrossRefGoogle Scholar
  12. 12.
    Podolsky ER, Rottman SJ, Poblete H et al (2009) Single Port Access (SPA™) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 19:219–222PubMedCrossRefGoogle Scholar
  13. 13.
    Chow A, Purkayastha S, Aziz O (2010) Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surg Endosc 24:709–714PubMedCrossRefGoogle Scholar
  14. 14.
    Romanelli JR, Roshek TB, Lynn DC et al (2009) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24:1374–1379PubMedCrossRefGoogle Scholar
  15. 15.
    Edwards C, Bradshaw A, Ahearne P et al (2010) Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases. Surg Endosc 24:2241–2247PubMedCrossRefGoogle Scholar
  16. 16.
    Duron VP, Nicastri GR, Gill PS (2010) Novel technique for a single-incision laparoscopic surgery (SILS) approach to cholecystectomy: single-institution case series. Surg Endosc 25:1666–1671PubMedCrossRefGoogle Scholar
  17. 17.
    Bucher P, Pugin F, Buchs N et al (2008) Single Port access laparoscopic cholecystectomy (with video). World J Surg 33:1015–1019. doi: 10.1007/s00268-008-9874-4 CrossRefGoogle Scholar
  18. 18.
    Curcillo PG, Wu AS, Podolsky ER et al (2010) Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860PubMedCrossRefGoogle Scholar
  19. 19.
    Rivas H, Varela E, Scott D (2009) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412PubMedCrossRefGoogle Scholar
  20. 20.
    Erbella J, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24:1958–1961PubMedCrossRefGoogle Scholar
  21. 21.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G et al (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848PubMedCrossRefGoogle Scholar
  22. 22.
    Lee PC, Lo C, Lai PS et al (2010) Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 97:1007–1012PubMedCrossRefGoogle Scholar
  23. 23.
    Marks J, Tacchino R, Roberts K et al (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201:369–373PubMedCrossRefGoogle Scholar
  24. 24.
    Aprea G, Bottazzi EC, Guida F et al (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:109–112CrossRefGoogle Scholar
  25. 25.
    Ma J, Cassera MA, Spaun GO et al (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254:22–27PubMedCrossRefGoogle Scholar
  26. 26.
    Bucher P, Pugin F, Buchs NC et al (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702PubMedCrossRefGoogle Scholar
  27. 27.
    Sinan H, Demirbas S, Ozer MT et al (2012) Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 22:12–16PubMedCrossRefGoogle Scholar
  28. 28.
    Dubois F, Icard P, Berthelot G et al (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 211:60–62PubMedCrossRefGoogle Scholar
  29. 29.
    Dubois F, Berthelot G, Levard H (1995) Coelioscopic cholecystectomy: experience with 2006 cases. World J Surg 19:748–752. doi: 10.1007/BF00295921 PubMedCrossRefGoogle Scholar
  30. 30.
    Strasberg S, Eagon C (2000) The “hidden cystic duct” syndrome and the infundibular technique of laparoscopic cholecystectomy: the danger of the false infundibulum. J Am Coll Surg 191:661–667PubMedCrossRefGoogle Scholar
  31. 31.
    Podolsky ER, Curcillo PG (2010) Reduced-port surgery: preservation of the critical view in single-port-access cholecystectomy. Surg Endosc 24:3038–3043PubMedCrossRefGoogle Scholar
  32. 32.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  33. 33.
    EuroQual (2009) EQ 5D User Guide, p 1–24Google Scholar
  34. 34.
    Brazier J, Roberts J, Tsuchiya A et al (2004) A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 13:873–884PubMedCrossRefGoogle Scholar
  35. 35.
    Greiner CCW (2008) Der EQ-5D der EuroQol-Gruppe, p 1–12Google Scholar
  36. 36.
    Gill IS, Advincula AP, Aron M et al (2009) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768PubMedCrossRefGoogle Scholar
  37. 37.
    Curcillo PG, Wu AS, Podolsky ER et al (2011) Reduced-Port-Chirurgie. Chirurg 82:391–397PubMedCrossRefGoogle Scholar
  38. 38.
    Garg P, Thakur JD, Garg M et al (2012) Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 16:1618–1628PubMedCrossRefGoogle Scholar
  39. 39.
    Archer SB, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234:549–558; discussion 558–559PubMedCrossRefGoogle Scholar
  40. 40.
    Savassi-Rocha P, Almeida S, Sanches M (2003) Iatrogenic bile duct injuries: a multicenter study of 91, 232 laparoscopic cholecystectomies. Surg Endosc 17:1356–1361PubMedCrossRefGoogle Scholar
  41. 41.
    Connor S, Garden OJ (2006) Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 93:158–168PubMedCrossRefGoogle Scholar
  42. 42.
    Gangl O, Hofer W, Tomaselli F et al (2011) Single incision laparoscopic cholecystectomy (SILC) versus laparoscopic cholecystectomy (LC): a matched pair analysis. Langenbecks Arch Surg 396:819–824PubMedCrossRefGoogle Scholar
  43. 43.
    Eypasch E, Troidl H (1993) Immediate improval in quality of life after laparoscopic cholecystectomy. Minim Invasive Ther Allied Technol 2:139–146CrossRefGoogle Scholar
  44. 44.
    Barkun J, Barkun A, Meakins J (1993) Laparoscopic versus open cholecystectomy: the Canadian experience. Am J Surg 165:455–458PubMedCrossRefGoogle Scholar
  45. 45.
    Topçu O, Karakayali F, Kuzu MA et al (2003) Comparison of long-term quality of life after laparoscopic and open cholecystectomy. Surg Endosc 17:291–295PubMedCrossRefGoogle Scholar
  46. 46.
    Plaisier PW, van der Hul RL, Nijs HGT et al (1995) Quality of life and the course of biliary and gastrointestinal symptoms after laparoscopic and conventional cholecystectomy. Dig Surg 12:87–91CrossRefGoogle Scholar
  47. 47.
    Ainslie WG, Catton JA, Davides D et al (2003) Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy. Surg Endosc 17:766–772PubMedCrossRefGoogle Scholar
  48. 48.
    Nassar A, Ashkar K (1997) Laparoscopic cholecystectomy and the umbilicus. Br J Surg 84:630–633PubMedCrossRefGoogle Scholar
  49. 49.
    Tonouchi H (2004) Trocar site hernia. Arch Surg 139:1248–1256PubMedCrossRefGoogle Scholar
  50. 50.
    Bunting DM (2010) Port-site hernia following laparoscopic cholecystectomy. JSLS 14:482–489CrossRefGoogle Scholar
  51. 51.
    Krajinovic K, Ickrath P, Germer CT et al (2011) Trocar-site hernia after single-port cholecystectomy: not an exceptional complication? J Laparoendosc Adv Surg Tech A 21:919–921PubMedCrossRefGoogle Scholar
  52. 52.
    Bucher P, Pugin F, Ostermann S et al (2010) Population perception of surgical safety and body image trauma: a plea for scarless surgery? Surg Endosc 25:408–415PubMedCrossRefGoogle Scholar
  53. 53.
    Rao A, Kynaston J, MacDonald ER et al (2010) Patient preferences for surgical techniques: should we invest in new approaches? Surg Endosc 24:3016–3025PubMedCrossRefGoogle Scholar
  54. 54.
    Lamadé W, Friedrich C, Ulmer C et al (2010) Impact of body image on patients’ attitude towards conventional, minimal invasive, and natural orifice surgery. Langenbecks Arch Surg 396:331–336PubMedCrossRefGoogle Scholar
  55. 55.
    Connor S (2009) Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg 33:1020–1021. doi: 10.1007/s00268-009-9951-3 PubMedCrossRefGoogle Scholar
  56. 56.
    Krajinovic K, Germer CT (2011) Laparoskopische single-port-Chirurgie. Chirurg 82:398–405PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Markus J. Wagner
    • 1
  • Hans Kern
    • 1
    Email author
  • Alexander Hapfelmeier
    • 2
  • Jan Mehler
    • 1
  • Michael H. Schoenberg
    • 1
    • 3
  1. 1.Department of SurgeryRotkreuzklinikum MünchenMunichGermany
  2. 2.Department for Medical Statistics and EpidemiologyTechnische Universität MunichMunichGermany
  3. 3.Red Cross Hospital MunichMunichGermany

Personalised recommendations