Optimal indication of single-incision laparoscopic cholecystectomy using Konyang Standard Method in benign gallbladder diseases

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea

Purpose

The safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis (AC) has not yet been confirmed.

Methods

This single-center retrospective study included patients who underwent laparoscopic cholecystectomy (LC) for AC between April 2010 and December 2020. Propensity scores were used to match patients who underwent SILC with those who underwent conventional multiport LC (CMLC) in the entire cohort and in the two subgroups.

Results

A total of 1,876 patients underwent LC for AC, and 427 (22.8%) underwent SILC. In the propensity score-matched analysis of the entire cohort (404 patients in each group), the length of hospital stay (2.9 days vs. 3.5 days, p = 0.029) was shorter in the SILC group than in the CMLC group. No significant differences were observed in other surgical outcomes. In grade I AC (336 patients in each group), the SILC group showed poorer surgical outcomes than the CMLC group, regarding operation time (57.6 minutes vs. 52.4 minutes, p = 0.001) and estimated blood loss (22.9 mL vs. 13.1 mL, p = 0.006). In grade II/III AC (58 patients in each group), there were no significant differences in surgical outcomes between the two groups. Postoperative pain outcomes were also not significantly different in the two groups, regardless of severity.

Conclusion

This study demonstrated that SILC had similar surgical and pain outcomes to CMLC in patients with AC; however, subgroup analysis showed that SILC was associated with poor surgical outcomes than CMLC in grade I AC. Therefore, SILC should be carefully performed in patients with AC by experienced hepatobiliary surgeons.

Optimal indication for single-incision laparoscopic cholecystectomy in benign gallbladder diseases

Laparoscopic cholecystectomy has become a basic procedure for cholecystectomy due to rapid recovery and cosmetic satisfaction after surgery, and it is currently the primary treatment for most benign gallbladder diseases. Thanks to advances in laparoscopic equipment and techniques, single-incision laparoscopic cholecystectomy (SILC) was introduced. Initially, SILC was performed only on highly selected patients due to the high proficiency required and the potential collision of surgical instruments due to the narrow operating space. However, as surgeons gradually accumulated experience with it and various surgical equipment was introduced, the indications were gradually expanded. Nevertheless, clear indications for SILC have not yet been established. If continuous technological development and large-scale SILC clinical results are accumulated, the indications for SILC will be clearer and can be expanded in the future.