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Single-incision versus conventional multiport laparoscopic cholecystectomy: a current meta-analysis of randomized controlled trials

  • Yunxiao LyuEmail author
  • Yunxiao Cheng
  • Bin Wang
  • Sicong Zhao
  • Liang Chen
Article
  • 76 Downloads

Abstract

Background

We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC).

Methods

We searched PubMed, Embase, Web of Science, the Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials comparing SILC versus MPLC. We evaluated the pooled outcomes for complications, pain scores, and surgery-related events. This study was performed in accordance with PRISMA guidelines.

Results

A total of 48 randomized controlled trials involving 2838 patients in the SILC group and 2956 patients in the MPLC group were included in this study. Our results showed that SILC was associated with a higher incidence of incisional hernia (relative risk = 2.51; 95% confidence interval = 1.23–5.12; p = 0.01) and longer operation time (mean difference = 15.27 min; 95% confidence interval = 9.67–20.87; p < 0.00001). There were no significant differences between SILC and MPLC regarding bile duct injury, bile leakage, wound infection, conversion to open surgery, retained common bile duct stones, total complication rate, and estimated blood loss. No difference was observed in postoperative pain assessed by a visual analogue scale between the two groups at four time points (6 h, 8 h, 12 h, and 24 h postprocedure).

Conclusions

Based on the current evidence, SILC did not result in better outcomes compared with MPLC and both were equivalent regarding complications. Considering the additional surgical technology and longer operation time, SILC should be chosen with careful consideration.

Keywords

Laparoscopic cholecystectomy Single-incision Conventional Meta-analysis Systematic review 

Notes

Acknowledgements

We thank Jane Charbonneau, DVM from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac) for editing the English text of a draft of this manuscript.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Disclosures

Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao, and Liang Chen have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Muhe E (1991) [Laparoscopic cholecystectomy–late results]. Langenbecks Archiv fur Chirurgie Supplement Kongressband Deutsche Gesellschaft fur Chirurgie Kongress. Springer, Berlin, pp 416–423Google Scholar
  2. 2.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695CrossRefPubMedGoogle Scholar
  3. 3.
    Arezzo A, Passera R, Bullano A, Mintz Y, Kedar A, Boni L, Cassinotti E, Rosati R, Fumagalli Romario U, Sorrentino M, Brizzolari M, Di Lorenzo N, Gaspari AL, Andreone D, De Stefani E, Navarra G, Lazzara S, Degiuli M, Shishin K, Khatkov I, Kazakov I, Schrittwieser R, Carus T, Corradi A, Sitzman G, Lacy A, Uranues S, Szold A, Morino M (2017) Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial). Surg Endosc 31:2872–2880CrossRefPubMedGoogle Scholar
  4. 4.
    Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol MITAT 21:113–117CrossRefPubMedGoogle Scholar
  5. 5.
    Joseph S, Moore BT, Sorensen GB, Earley JW, Tang F, Jones P, Brown KM (2011) Single-incision laparoscopic cholecystectomy: a comparison with the gold standard. Surg Endosc 25:3008–3015CrossRefPubMedGoogle Scholar
  6. 6.
    Hauters P, Meunier D, Urgyan S, Jouret JC, Janssen P, Nys JM (1996) Prospective controlled study comparing laparoscopy and the Shouldice technique in the treatment of unilateral inguinal hernia. Ann Chir 50:776–781PubMedGoogle Scholar
  7. 7.
    Solomon D, Shariff AH, Silasi DA, Duffy AJ, Bell RL, Roberts KE (2012) Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study. Surg Endosc 26:2823–2827CrossRefPubMedGoogle Scholar
  8. 8.
    Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26:1205–1213CrossRefPubMedGoogle Scholar
  9. 9.
    Sinan H, Saydam M, Demir P, Ozer MT, Demirbas S (2019) Comparison of single-incision and conventional laparoscopic cholecystectomy in terms of quality of life, body image, and cosmesis. Niger J Clin Pract 22:521–526CrossRefPubMedGoogle Scholar
  10. 10.
    Qu JW, Xin C, Wang GY, Yuan ZQ, Li KW (2019) Feasibility and safety of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy in an ambulatory setting. Hepatobiliary Pancreat Dis Int 18:273–277CrossRefPubMedGoogle Scholar
  11. 11.
    Allemann P, Schafer M, Demartines N (2010) Critical appraisal of single port access cholecystectomy. Br J Surg 97:1476–1480CrossRefPubMedGoogle Scholar
  12. 12.
    Joseph M, Phillips MR, Farrell TM, Rupp CC (2012) Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg 256:1–6CrossRefPubMedGoogle Scholar
  13. 13.
    Garg P, Thakur JD, Garg M, Menon GR (2012) Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg 16:1618–1628CrossRefPubMedGoogle Scholar
  14. 14.
    Omar MA, Redwan AA, Mahmoud AG (2017) Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: a prospective randomized study. Surgery 162:96–103CrossRefPubMedGoogle Scholar
  15. 15.
    Haueter R, Schutz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104:1141–1159CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Evers L, Bouvy N, Branje D, Peeters A (2017) Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis. Surg Endosc 31:3437–3448CrossRefPubMedGoogle Scholar
  17. 17.
    Umemura A, Suto T, Nakamura S, Fujiwara H, Endo F, Nitta H, Takahara T, Sasaki A (2019) Comparison of Single-incision laparoscopic cholecystectomy versus needlescopic cholecystectomy: a single institutional randomized clinical trial. Dig Surg 36:53–58CrossRefPubMedGoogle Scholar
  18. 18.
    Zhao L, Wang Z, Xu J, Wei Y, Guan Y, Liu C, Xu L, Liu C, Wu B (2016) A randomized controlled trial comparing single-incision laparoscopic cholecystectomy using a novel instrument to that using a common instrument. Int J Surg (London, England) 32:174–178CrossRefGoogle Scholar
  19. 19.
    Higgins J, Green SE (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration (eds) Naunyn-Schmiedebergs Archiv für experimentelle Pathologie und Pharmakologie 5, pp S38Google Scholar
  20. 20.
    Abd Ellatif ME, Askar WA, Abbas AE, Noaman N, Negm A, El-Morsy G, El Nakeeb A, Magdy A, Amin M (2013) Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc 27:1896–1906CrossRefPubMedGoogle Scholar
  21. 21.
    Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:e109–e112CrossRefPubMedGoogle Scholar
  22. 22.
    Bingener J, Skaran P, McConico A, Novotny P, Wettstein P, Sletten DM, Park M, Low P, Sloan J (2015) A double-blinded randomized trial to compare the effectiveness of minimally invasive procedures using patient-reported outcomes. J Am Coll Surg 221:111–121CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Borle FR, Mehra B, Ranjan Singh A (2015) Comparison of cosmetic outcome between single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy in rural Indian population: a randomized clinical trial. Indian J Surg 77:877–880CrossRefPubMedGoogle Scholar
  24. 24.
    Brown KM, Moore BT, Sorensen GB, Boettger CH, Tang F, Jones PG, Margolin DJ (2013) Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc 27:3108–3115CrossRefPubMedGoogle Scholar
  25. 25.
    Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702CrossRefPubMedGoogle Scholar
  26. 26.
    Chang SK, Wang YL, Shen L, Iyer SG, Madhavan K (2015) A randomized controlled trial comparing post-operative pain in single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. World J Surg 39:897–904CrossRefPubMedGoogle Scholar
  27. 27.
    Deveci U, Barbaros U, Kapakli MS, Manukyan MN, Simsek S, Kebudi A, Mercan S (2013) The comparison of single incision laparoscopic cholecystectomy and three port laparoscopic cholecystectomy: prospective randomized study. J Korean Surg Soc 85:275–282CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Guo W, Liu Y, Han W, Liu J, Jin L, Li JS, Zhang ZT (2015) Randomized trial of immediate postoperative pain following single-incision versus traditional laparoscopic cholecystectomy. Chin Med J 128:3310–3316CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Hajong R, Hajong D, Natung T, Anand M, Sharma G (2016) A comparative study of single incision versus conventional four ports laparoscopic cholecystectomy. J Clin Diagn Res 10:PC06–PC09PubMedPubMedCentralGoogle Scholar
  30. 30.
    He GL, Jiang ZS, Cheng Y, Lai QB, Zhou CJ, Liu HY, Gao Y, Pan MX, Jian ZX (2015) Tripartite comparison of single-incision and conventional laparoscopy in cholecystectomy: a multicenter trial. World J Gastrointest Endosc 7:540–546CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Ito E, Takai A, Imai Y, Otani H, Onishi Y, Yamamoto Y, Ogawa K, Tohyama T, Fukuhara S, Takada Y (2019) Quality of life after single-incision laparoscopic cholecystectomy: a randomized, clinical trial. Surgery 165:353–359CrossRefPubMedGoogle Scholar
  32. 32.
    Jorgensen LN, Rosenberg J, Al-Tayar H, Assaadzadeh S, Helgstrand F, Bisgaard T (2014) Randomized clinical trial of single-versus multi-incision laparoscopic cholecystectomy. Br J Surg 101:347–355CrossRefPubMedGoogle Scholar
  33. 33.
    Justo-Janeiro JM, Vincent GT, Vazquez de Lara F, de la Rosa Paredes R, Orozco EP, Vazquez de Lara LG (2014) One, two, or three ports in laparoscopic cholecystectomy? Int Surg 99:739–744CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Khorgami Z, Shoar S, Anbara T, Soroush A, Nasiri S, Movafegh A, Aminian A (2014) A randomized clinical trial comparing 4-port, 3-port, and single-incision laparoscopic cholecystectomy. J Investig Surg 27:147–154CrossRefGoogle Scholar
  35. 35.
    Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK (2011) Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg 202:254–258CrossRefPubMedGoogle Scholar
  36. 36.
    Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52CrossRefPubMedGoogle Scholar
  37. 37.
    Luna RA, Nogueira DB, Varela PS, Rodrigues Neto Ede O, Norton MJ, Ribeiro Ldo C, Peixoto AM, de Mendonca YL, Bendet I, Fiorelli RA, Dolan JP (2013) A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy. Surg Endosc 27:1254–1259CrossRefPubMedGoogle Scholar
  38. 38.
    Lurje G, Raptis DA, Steinemann DC, Amygdalos I, Kambakamba P, Petrowsky H, Lesurtel M, Zehnder A, Wyss R, Clavien PA, Breitenstein S (2015) Cosmesis and body image in patients undergoing single-port versus conventional laparoscopic cholecystectomy: a multicenter double-blinded randomized controlled trial (SPOCC-trial). Ann Surg 262:728–734 (discussion 734–725) CrossRefPubMedGoogle Scholar
  39. 39.
    Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 254:22–27CrossRefPubMedGoogle Scholar
  40. 40.
    Madureira FA, Manso JE, Madureira Filho D, Iglesias AC (2014) Inflammation in laparoendoscopic single-site surgery versus laparoscopic cholecystectomy. Surg Innov 21:263–268CrossRefPubMedGoogle Scholar
  41. 41.
    Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, Rivas H, Islam A, Soper N, Paraskeva P, Rosemurgy A, Ross S, Shah S (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047 (discussion 1047–1038) CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Noguera J, Tejada S, Tortajada C, Sanchez A, Munoz J (2013) Prospective, randomized clinical trial comparing the use of a single-port device with that of a flexible endoscope with no other device for transumbilical cholecystectomy: LLATZER-FSIS pilot study. Surg Endosc 27:4284–4290CrossRefPubMedGoogle Scholar
  43. 43.
    Ostlie DJ, Juang OO, Iqbal CW, Sharp SW, Snyder CL, Andrews WS, Sharp RJ, Holcomb GW 3rd, St Peter SD (2013) Single incision versus standard 4-port laparoscopic cholecystectomy: a prospective randomized trial. J Pediatr Surg 48:209–214CrossRefPubMedGoogle Scholar
  44. 44.
    Pan MX, Jiang ZS, Cheng Y, Xu XP, Zhang Z, Qin JS, He GL, Xu TC, Zhou CJ, Liu HY, Gao Y (2013) Single-incision vs three-port laparoscopic cholecystectomy: prospective randomized study. World J Gastroenterol 19:394–398CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Partelli S, Barugola G, Sartori A, Crippa S, Falconi M, Ruffo G (2016) Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial. Surg Today 46:313–318CrossRefPubMedGoogle Scholar
  46. 46.
    Sulu B, Yildiz BD, Ilingi ED, Gunerhan Y, Cakmur H, Anuk T, Yildiz B, Koksal N (2015) Single port vs. four port cholecystectomy-randomized trial on quality of life. Adv Clin Exp Med 24:469–473CrossRefPubMedGoogle Scholar
  47. 47.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848CrossRefPubMedGoogle Scholar
  48. 48.
    Yilmaz H, Arun O, Apiliogullari S, Acar F, Alptekin H, Calisir A, Sahin M (2013) Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study. J Korean Surg Soc 85:149–153CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Zapf M, Yetasook A, Leung D, Salabat R, Denham W, Barrera E, Butt Z, Carbray J, Du H, Wang CE, Ujiki M (2013) Single-incision results in similar pain and quality of life scores compared with multi-incision laparoscopic cholecystectomy: a blinded prospective randomized trial of 100 patients. Surgery 154:662–670 (discussion 670–661) CrossRefPubMedGoogle Scholar
  50. 50.
    Kumar S, Ahmad Z (2019) Single port laparoscopic cholecystectomy compared to the standard laparoscopic cholecystectomy. Int Surg J 2019(6):4Google Scholar
  51. 51.
    Cao ZG, Cai W, Qin MF, Zhao HZ, Yue P, Li Y (2011) Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech 21:311–313CrossRefPubMedGoogle Scholar
  52. 52.
    Rasic Z, Schwarz D, Nesek VA, Zoricic I, Sever M, Rasic D, Lojo N (2010) Single incision laparoscopic cholecystectomy–a new advantage of gallbladder surgery. Coll Antropol 34:595–598PubMedGoogle Scholar
  53. 53.
    Sasaki A, Ogawa M, Tono C, Obara S, Hosoi N, Wakabayashi G (2012) Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial. Surg Laparosc Endosc Percutan Tech 22:396–399CrossRefPubMedGoogle Scholar
  54. 54.
    Sinan H, Demirbas S, Ozer MT, Sucullu I, Akyol M (2012) Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech 22:12–16CrossRefPubMedGoogle Scholar
  55. 55.
    Ye G, Qin Y, Xu S, Wu C, Wang S, Pan D, Wang X (2015) Comparison of transumbilical single-port laparoscopic cholecystectomy and fourth-port laparoscopic cholecystectomy. Int J Clin Exp Med 8:7746–7753PubMedPubMedCentralGoogle Scholar
  56. 56.
    Emre Telciler K, Ilhan E, Yakan S, Cengiz F, Senlikci A, Akturk Hayat E (2014) Single-port laparoscopic cholecystectomy versus the classical four port laparoscopic cholecystectomy: a randomized prospective clinical trial. Minerva Chir 69:1–7PubMedGoogle Scholar
  57. 57.
    Goel AC, Priyanka Gupta, Kumar Atul, Gupta Shalabh, Agarwal Ayush, Bhardwaj Deepak, Mishra Rajneesh Kumar, Fronek Jiri P J (2016) Comparative study of single-incision laparoscopic cholecystectomy with four-port conventional laparoscopic cholecystectomy: a single-center experience. World J Lap Surg 9:9–12Google Scholar
  58. 58.
    Ashok Koirala RS, Thakur Dipendra, Agrawal Sunit, Chaudhary Bhuwan Lal, Poudel Sagar (2019) Comparative study of single incision laparoscopic cholecystectomy with standard four port laparoscopic cholecystectomy for symptomatic cholelithiasis. JKISTMC 1:10–15Google Scholar
  59. 59.
    FAHAD RIZWI MS, KHALID JAVED ABID (2014) Outcome of single incision laparoscopic cholecystectomy (SILC) versus conventional four port laparoscopic cholecystectomy for cholelithiasis—a randomized control trial. PJMHS 8:243–246Google Scholar
  60. 60.
    Dabbagh N, Soroosh A, Khorgami Z, Shojaeifard A, Jafari M, Abdehgah AG, Mahmudzade H (2015) Single-incision laparoscopic cholecystectomy versus mini-laparoscopic cholecystectomy: a randomized clinical trial study. J Res Med Sci 20:1153–1159CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Tyagi S, Sinha R, Tyagi A (2017) Single incision laparoscopic cholecystectomy: less scar, less pain. J Minim Access Surg 13:118–123PubMedPubMedCentralGoogle Scholar
  62. 62.
    Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ (2006) Laparoscopic versus small-incision cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD006229 CrossRefPubMedGoogle Scholar
  63. 63.
    Romanelli JR, Roshek TB 3rd, Lynn DC, Earle DB (2010) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24:1374–1379CrossRefPubMedGoogle Scholar
  64. 64.
    Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG (2009) Single port access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 19:219–222CrossRefPubMedGoogle Scholar
  65. 65.
    Kimura T (1998) Laparoscopic cholecystectomy using fine-caliber instruments. Surg Endosc 12:1449CrossRefPubMedGoogle Scholar
  66. 66.
    Reardon PR, Kamelgard JI, Applebaum B, Rossman L, Brunicardi FC (1999) Feasibility of laparoscopic cholecystectomy with miniaturized instrumentation in 50 consecutive cases. World J Surg 23:128–131 (discussion 131–122) CrossRefPubMedGoogle Scholar
  67. 67.
    Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS ONE 8:e76530CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Milas M, Devedija S, Trkulja V (2014) Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 12:271–289CrossRefPubMedGoogle Scholar
  69. 69.
    Tamini N, Rota M, Bolzonaro E, Nespoli L, Nespoli A, Valsecchi MG, Gianotti L (2014) Single-incision versus standard multiple-incision laparoscopic cholecystectomy: a meta-analysis of experimental and observational studies. Surg Innov 21:528–545CrossRefPubMedGoogle Scholar
  70. 70.
    Chuang SH, Lin CS (2016) Single-incision laparoscopic surgery for biliary tract disease. World J Gastroenterol 22:736–747CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, Kaouk JH, Gill IS (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54:1020–1029CrossRefPubMedGoogle Scholar
  72. 72.
    Gurusamy K, Junnarkar S, Farouk M, Davidson BR (2008) Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 95:161–168CrossRefPubMedGoogle Scholar
  73. 73.
    Pasley WHSC (2013) Long-term follow-up shows no difference in port-site hernia incidence: single incision vs. traditional laparoscopic cholecystectomy. Surg Endosc 27:482Google Scholar
  74. 74.
    Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, Lee PH (2010) Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg 97:1007–1012CrossRefPubMedGoogle Scholar
  75. 75.
    Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg 396:709–715CrossRefPubMedGoogle Scholar
  76. 76.
    Bresadola F, Pasqualucci A, Donini A, Chiarandini P, Anania G, Terrosu G, Sistu MA, Pasetto A (1999) Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg 165:29–34CrossRefPubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Hepatobiliary SurgeryDongyang People’s HospitalDongyangChina
  2. 2.Department of General SurgeryDongyang People’s HospitalDongyangChina

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