Surgery Today

, Volume 46, Issue 3, pp 313–318 | Cite as

Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon: findings of a randomized trial

  • Stefano Partelli
  • Giuliano Barugola
  • Alberto Sartori
  • Stefano Crippa
  • Massimo Falconi
  • Giacomo RuffoEmail author
Original Article



Traditional laparoscopic cholecystectomy (TLC) is performed widely; however, single-incision cholecystectomy (SILC) has been proposed as a better and less traumatic procedure.


In this prospective, double-blinded, randomized study, patients were randomized to undergo either elective SILC or TLC. The primary endpoint was the level of pain after surgery and the secondary endpoints were complications, cosmetic outcomes, and patient satisfaction.


A total of 59 patients were enrolled (SILC, n = 30; TLC, n = 29). The median operative time was longer for the SILC group (55 vs. 40 min; P < 0.0001). Patients in the SILC group had a lower median VAS pain score 4 h after surgery (20 mm for the TLC group vs. 15 mm for the SILC group). Complications were distributed equally. Twenty-eight of the 30 patients in the SILC group vs. 23 of the 29 patients in the TLC group were very satisfied with their operation (P = 0.032). The cosmetic results of SILC were better than those of TLC, with visible scars in 21 patients from the TLC group vs. 3 patients from the SILC group (P = 0.0001).


We found SILC to be a safe, feasible, and adaptable surgical technique. The pain scores at 4 h were significantly better for SILC than for TLC.


Single incision Cholecystectomy Outcomes Pain Randomized Laparoscopic 


  1. 1.
    Navarra G, Pozza E, Occhioneorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84(5):695.CrossRefPubMedGoogle Scholar
  2. 2.
    Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res. 2011;166(2):e109–12.CrossRefPubMedGoogle Scholar
  3. 3.
    Lee PC, Lo C, Lai PS, Chang JJ, Huang SJ, Lin MT, et al. Randomized clinical trial of single-incision laparoscopic cholecystectomy: results of a pilot randomized trial. Br J Surg. 2010;97(7):1007–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Lirici MM, Califano AD, Angelini P, Corcione F. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg. 2011;202(1):45–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Ma J, Cassera MA, Sapun GO, Hammil CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single-port cholecystectomy and four-port cholecystectomy. Ann Surg. 2011;254(1):22–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg. 2011;201(3):369–72.CrossRefPubMedGoogle Scholar
  7. 7.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Beneatos N, Mavridou P, et al. A Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc. 2010;24(8):1842–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg. 2011;98(12):1695–702.CrossRefPubMedGoogle Scholar
  9. 9.
    Brown KM, Moore BT, Sorensen GB, Boettger CH, Tang F, Jones PG, et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc. 2013;27(9):2914–7.CrossRefGoogle Scholar
  10. 10.
    Lai EC, Yang GP, Tang CN, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg. 2011;202(3):254–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Bresadola F, Pasqualucci A, Donini A, Chiarandini P, Anania G, Terrosu G, et al. Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg. 1999;165(1):29–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Rawlings A, Hodgett SE, Matthews BD, Strasberg SM, Quasebarth M, Brunt ML. Single-incision laparoscopic cholecystectomy: initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg. 2010;211(1):1–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Ruffo G, Barugola G, Scopelliti F, Sartori A, Crippa S, Partelli S, et al. SILS cholecystectomy, early experience of a single institution: pilot study of 20 cases. Updates Surg. 2012;64(2):145–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Zehetner J, Pelipad D, Darehzereshki A, Mason RJ, Lipham JC, Katkhouda N. Single-access laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech. 2013;23(3):235–43.CrossRefPubMedGoogle Scholar
  16. 16.
    Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, et al. Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg. 2013;100(2):191–208.CrossRefPubMedGoogle Scholar
  17. 17.
    Feinberg EJ, Agaba E, Feiberg ML, Camacho D, Vemulapalli P. Single-incision laparoscopic cholecystectomy learning curve experience seen in single institution. Surg Laparosc Endosc Percutan Tech. 2012;22(2):114–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Strasberg SM. Single incision laparoscopic cholecystectomy and the introduction of innovative surgical procedures. Ann Surg. 2012;256(1):7–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Joseph M, Philips MR, Farrell TM, Rupp CC. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate. A review and a word of caution. Ann Surg. 2012;256(1):1–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, et al. 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. 2013;216(6):1037–47.CrossRefPubMedGoogle Scholar
  21. 21.
    Yamazaki M, Yasuda H, Koda K. Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today. 2015;45:537–48.CrossRefPubMedGoogle Scholar
  22. 22.
    Reibetanza J, Germer CT, Krajinovic K. Single-port cholecystectomy in obese patients: our experience and a review of the literature. Surg Today. 2013;43(3):255–9.CrossRefGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Stefano Partelli
    • 1
    • 2
  • Giuliano Barugola
    • 1
  • Alberto Sartori
    • 1
  • Stefano Crippa
    • 1
    • 2
  • Massimo Falconi
    • 1
    • 2
  • Giacomo Ruffo
    • 1
    Email author
  1. 1.Department of SurgeryOspedale “Sacro Cuore-Don Calabria”Negrar (Vr)Italy
  2. 2.Polytechnic University of Marche RegionAnconaItaly

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