Skip to main content
SpringerLink
Log in

Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points.

Methods

Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems.

Results

Mean age of the study group was 44.1 years (±14.8), 87 % were Caucasian, and 77 % were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03).

Conclusions

SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Pelosi MA, Pelosi MA 3rd (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594

    PubMed  CAS  Google Scholar 

  2. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    Article  PubMed  CAS  Google Scholar 

  3. Rivas H, Varela E, Scott D (2010) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412

    Article  PubMed  Google Scholar 

  4. Chang SK, Tay CW, Bicol RA, Lee YY, Madhavan K (2011) A case-control study of single-incision versus standard laparoscopic cholecystectomy. World J Surg 35:289–293

    Article  PubMed  Google Scholar 

  5. Gangl O, Hofer W, Tomaselli F, Sautner T, Fugger R (2011) Single incision laparoscopic cholecystectomy (SILC) versus laparoscopic cholecystectomy (LC)—a matched pair analysis. Langenbecks Arch Surg 396:819–824

    Article  PubMed  Google Scholar 

  6. 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 (2012) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 26(5):1296–1303

    Article  PubMed  Google Scholar 

  7. Love KM, Durham CA, Meara MP, Mays AC, Bower CE (2011) Single-incision laparoscopic cholecystectomy: a cost comparison. Surg Endosc 25:1553–1558

    Article  PubMed  Google Scholar 

  8. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  PubMed  CAS  Google Scholar 

  9. Lien HH, Huang CC, Wang PC, Huang CS, Chen YH, Lin TL, Tsai MC (2010) Changes in quality-of-life following laparoscopic cholecystectomy in adult patients with cholelithiasis. J Gastrointest Surg 14:126–130

    Article  PubMed  Google Scholar 

  10. Shi HY, Lee HH, Chiu CC, Chiu HC, Uen YH, Lee KT (2008) Responsiveness and minimal clinically important differences after cholecystectomy: GIQLI versus SF-36. J Gastrointest Surg 12:1275–1282

    Article  PubMed  Google Scholar 

  11. United States National Institutes of Health (1992) Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 10:1–28

  12. Moore MJ, Bennett CL (1995) The learning curve for laparoscopic cholecystectomy. The Southern surgeons club. Am J Surg 170:55–59

    Article  PubMed  CAS  Google Scholar 

  13. Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP (2001) Common bile duct injury during laparoscopic cholecystectomy and the use of intraoperative cholangiography: adverse outcome or preventable error? Arch Surg 136:1287–1292

    Article  PubMed  CAS  Google Scholar 

  14. Elsey JK, Feliciano DV (2010) Initial experience with single-incision laparoscopic cholecystectomy. J Am Coll Surg 210:620–624, 624–626

    Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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 201:369–372 discussion 372–363

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Bencsath KP, Falk G, Morris-Stiff G, Kroh M, Walsh RM, Chalikonda S (2012) Single-incision laparoscopic cholecystectomy: do patients care? J Gastrointest Surg 16:535–539

    Article  PubMed  Google Scholar 

  19. Bignell M, Hindmarsh A, Nageswaran H, Mothe B, Jenkinson A, Mahon D, Rhodes M (2011) Assessment of cosmetic outcome after laparoscopic cholecystectomy among women 4 years after laparoscopic cholecystectomy: is there a problem? Surg Endosc 25:2574–2577

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Brown and Dr. Margolin received a research Grant from Covidien to fund the current study. Dr. Moore and Dr. Sorensen have received honoraria and proctor fees from Covidien and Ethicon. Mr. Boettger, Ms. Tang, and Mr. Jones have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Saint Luke’s Hospital of Kansas City, Kansas City, MO, USA

    Kimberly M. Brown, B. Todd Moore, G. Brent Sorensen, Conrad H. Boettger & Daniel J. Margolin

  2. Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA

    Kimberly M. Brown, B. Todd Moore, G. Brent Sorensen & Daniel J. Margolin

  3. Saint Luke’s Hospital Mid-America Heart Institute, Kansas City, MO, USA

    Fengming Tang & Phil G. Jones

  4. Department of Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0737, USA

    Kimberly M. Brown

Authors
  1. Kimberly M. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Todd Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Brent Sorensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Conrad H. Boettger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fengming Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Phil G. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel J. Margolin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kimberly M. Brown.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brown, K.M., Moore, B.T., Sorensen, G.B. et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc 27, 3108–3115 (2013). https://doi.org/10.1007/s00464-013-2914-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-2914-7

Keywords

Search

Navigation