Skip to main content
SpringerLink
Log in

A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to compare the postoperative inflammatory response and severity of pain between single-incision laparoscopic surgery (SILS) cholecystectomy and conventional laparoscopic cholecystectomy (LC).

Methods

Two groups of 20 patients were prospectively randomized to either conventional LC or SILS cholecystectomy. Serum interleukin-6 (IL-6) levels were assayed before surgery, at 4–6 h, and at 18–24 h after the procedure. Serum C-reactive protein (CRP) levels also were assayed at 18–24 h after surgery. Pain was measured at each of three time points after surgery using the visual analogue scale (VAS). The number of analgesia doses administered in the first 24 h after the procedure also was recorded and 30-day surgical outcomes were documented.

Results

The groups had equivalent body mass index (BMI), age, and comorbidity distribution. Peak IL-6 levels occurred 4–6 h after surgery, and the median level was 12.8 pg/ml in the LC and 8.9 pg/ml in the SILS group (p = 0.5). The median CRP level before discharge was 1.6 mg/dl in the LC and 1.9 mg/dl in the SILS group (p = 0.38). There was no difference in either analgesic use or pain intensity as measured by the VAS between the two groups (p = 0.72). The length of the surgical procedure was significantly longer in the SILS group (p < 0.001). No intraoperative complications occurred in either group.

Conclusions

Single-incision laparoscopic surgery does not significantly reduce systemic inflammatory response, postoperative pain, or analgesic use compared with LC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Glaser F, Sannwald GA, Buhr HJ, Kuntz C, Mayer H, Klee F, Herfarth C (1995) General stress response to conventional and laparoscopic cholecystectomy. Ann Surg 221(4):372–380

    Article  PubMed  CAS  Google Scholar 

  2. Biffl WL, Moore EE, Moore FA, Peterson VM (1996) Interleukin-6 in the injured patient. Marker of injury or mediator of inflammation? Ann Surg 224(5):647–664

    Article  PubMed  CAS  Google Scholar 

  3. Pfluke JM, Parker M, Stauffer JA, Paetau AA, Bowers SP, Asbun HJ, Smith CD (2011) Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg 212(1):113–118

    Article  PubMed  Google Scholar 

  4. Spaw AT, Reddick EJ, Olsen DO (1991) Laparoscopic laser cholecystectomy: analysis of 500 procedures. Surg Laparosc Endosc 1(1):2–7

    PubMed  CAS  Google Scholar 

  5. Lin E, Calvano SE, Lowry SF (2000) Inflammatory cytokines and cell response in surgery. Surgery 127(2):117–126

    Article  PubMed  CAS  Google Scholar 

  6. Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP (1998) Laparoscopic surgery and the systemic immune response. Ann Surg 227(3):326–334

    Article  PubMed  Google Scholar 

  7. Bruce DM, Smith M, Walker CB, Heys SD, Binnie NR, Gough DB, Broom J, Eremin O (1999) Minimal access surgery for cholelithiasis induces an attenuated acute phase response. Am J Surg 178(3):232–234

    Article  PubMed  CAS  Google Scholar 

  8. Kristiansson M, Saraste L, Soop M, Sundqvist KG, Thörne A (1999) Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy. Acta Anaesthesiol Scand 43(2):146–152

    Article  PubMed  CAS  Google Scholar 

  9. McGregor CG, Sodergren MH, Aslanyan A, Wright VJ, Purkayastha S, Darzi A, Paraskeva P (2011) Evaluating systemic stress response in single port vs. multi-port laparoscopic cholecystectomy. J Gastrointest Surg 15(4):614–622

    Article  PubMed  Google Scholar 

  10. Solomon D, Bell RL, Duffy AJ, Roberts KE (2010) Single-port cholecystectomy: small scar, short learning curve. Surg Endosc 24(12):2954–2957

    Article  PubMed  Google Scholar 

  11. Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372 discussion 372–373

    Article  PubMed  Google Scholar 

  12. 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(2):e109–e112

    Article  PubMed  Google Scholar 

  13. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single trans-umbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24(8):1842–1848

    Article  PubMed  Google Scholar 

  14. Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98(7):991–995

    Article  PubMed  CAS  Google Scholar 

  15. 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(1):22–27

    Article  PubMed  Google Scholar 

  16. 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(3):254–258

    Article  PubMed  Google Scholar 

  17. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, Denoto G, Rivas H, Islam A, Soper N, Gecelter G, Rubach E, Paraskeva P, Shah S (2011) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc. doi:10.1007/s00464-011-2028-z

    Google Scholar 

  18. Fronza JS, Linn JG, Nagle AP, Soper NJ (2010) A single institution’s experience with single incision cholecystectomy compared to standard laparoscopic cholecystectomy. Surgery 148(4):731–734 discussion 734–736

    Article  PubMed  Google Scholar 

  19. Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, Dunham R, Fendley S, Neff M, Copper C, Bessler M, Gumbs AA, Norton M, Iannelli A, Mason R, Moazzez A, Cohen L, Mouhlas A, Poor A (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24(8):1854–1860

    Article  PubMed  Google Scholar 

  20. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2011) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc. doi:10.1007/s00464-011-2051-0

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Daltro Ibiapina and all the members of the Second Surgical Clinics who assisted with the process of admission and care of our patients and to the Department of Anesthesiology for complying with the study protocol. Special thanks are extended to Dr. Lucas Prata and Dr. Rafael Diniz who assisted with the elaboration of this protocol. And finally, thanks to Dr. Nathan Bronson for the kind review of this paper.

Disclosures

Drs. Renato A. Luna, Daniel B. Nogueira, Pablo S. Varela, Eduardo de O. Rodrigues Neto, Maria Júlia R. Norton, Luciana do Carmo B. Ribeiro, Agatha M. Peixoto, Yara L. de Mendonça, Isidro Bendet, Rossano A. Fiorelli, and James P. Dolan have no conflicts of interest or financial ties to disclose.

Funding

All single-port devices were provided without cost by EDLO S/A Produtos Médicos, the IL-6 assays were performed by Sergio Franco Medicina Diagnostica laboratory at no costs for the investigator, and all of the patients were treated under the Brazilian public health system.

Author information

Authors and Affiliations

  1. Second Clinics of General Surgery, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil

    Renato A. Luna, Daniel B. Nogueira, Pablo S. Varela, Eduardo de O. Rodrigues Neto, Maria Júlia R. Norton, Luciana do Carmo B. Ribeiro, Agatha M. Peixoto & Yara L. de Mendonça

  2. Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA

    Renato A. Luna & James P. Dolan

  3. Immunology section of the Sergio Franco Laboratory, Rio de Janeiro, Brazil

    Isidro Bendet

  4. Universidade Federal do Estado do Rio de Janeiro—UNIRIO Medical School, Rio de Janeiro, Brazil

    Renato A. Luna & Rossano A. Fiorelli

Authors
  1. Renato A. Luna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel B. Nogueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pablo S. Varela
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eduardo de O. Rodrigues Neto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Júlia R. Norton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luciana do Carmo B. Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Agatha M. Peixoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yara L. de Mendonça
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Isidro Bendet
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Rossano A. Fiorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. James P. Dolan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renato A. Luna.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luna, R.A., Nogueira, D.B., Varela, P.S. et al. A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy. Surg Endosc 27, 1254–1259 (2013). https://doi.org/10.1007/s00464-012-2589-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2589-5

Keywords

Search

Navigation