We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC).
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.
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).
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
All the data used in the study can be obtained from the original articles.
Muhe E (1991) [Laparoscopic cholecystectomy–late results]. Langenbecks Archiv fur Chirurgie Supplement Kongressband Deutsche Gesellschaft fur Chirurgie Kongress. Springer, Berlin, pp 416–423
Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695
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 31:2872–2880
Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol MITAT 21:113–117
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 25:3008–3015
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 50:776–781
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 26:2823–2827
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 26:1205–1213
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 22:521–526
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 18:273–277
Allemann P, Schafer M, Demartines N (2010) Critical appraisal of single port access cholecystectomy. Br J Surg 97:1476–1480
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 256:1–6
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 16:1618–1628
Omar MA, Redwan AA, Mahmoud AG (2017) Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: a prospective randomized study. Surgery 162:96–103
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 104:1141–1159
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 31:3437–3448
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 36:53–58
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) 32:174–178
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 S38
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 27:1896–1906
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–e112
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 221:111–121
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 77:877–880
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 27:3108–3115
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 98:1695–1702
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 39:897–904
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 85:275–282
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 128:3310–3316
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–PC09
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 7:540–546
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 165:353–359
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 101:347–355
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 99:739–744
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 27:147–154
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 202:254–258
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 202:45–52
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 27:1254–1259
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)
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 254:22–27
Madureira FA, Manso JE, Madureira Filho D, Iglesias AC (2014) Inflammation in laparoendoscopic single-site surgery versus laparoscopic cholecystectomy. Surg Innov 21:263–268
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)
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 27:4284–4290
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 48:209–214
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 19:394–398
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 46:313–318
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 24:469–473
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 24:1842–1848
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 85:149–153
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)
Kumar S, Ahmad Z (2019) Single port laparoscopic cholecystectomy compared to the standard laparoscopic cholecystectomy. Int Surg J 2019(6):4
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 21:311–313
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 34:595–598
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 22:396–399
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 22:12–16
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 8:7746–7753
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 69:1–7
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 9:9–12
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 1:10–15
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 8:243–246
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 20:1153–1159
Tyagi S, Sinha R, Tyagi A (2017) Single incision laparoscopic cholecystectomy: less scar, less pain. J Minim Access Surg 13:118–123
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
Romanelli JR, Roshek TB 3rd, Lynn DC, Earle DB (2010) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24:1374–1379
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 19:219–222
Kimura T (1998) Laparoscopic cholecystectomy using fine-caliber instruments. Surg Endosc 12:1449
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)
Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS ONE 8:e76530
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 12:271–289
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 21:528–545
Chuang SH, Lin CS (2016) Single-incision laparoscopic surgery for biliary tract disease. World J Gastroenterol 22:736–747
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 54:1020–1029
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 95:161–168
Pasley WHSC (2013) Long-term follow-up shows no difference in port-site hernia incidence: single incision vs. traditional laparoscopic cholecystectomy. Surg Endosc 27:482
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 97:1007–1012
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 396:709–715
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 165:29–34
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.
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Yunxiao Lyu, Yunxiao Cheng, Bin Wang, Sicong Zhao, and Liang Chen have no conflicts of interest or financial ties to disclose.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Lyu, Y., Cheng, Y., Wang, B. et al. Single-incision versus conventional multiport laparoscopic cholecystectomy: a current meta-analysis of randomized controlled trials. Surg Endosc 34, 4315–4329 (2020). https://doi.org/10.1007/s00464-019-07198-8
- Laparoscopic cholecystectomy
- Systematic review