Effectiveness and Safety of Single-Incision Laparoscopic Cholecystectomy versus Conventional Multiport Laparoscopic Cholecystectomy: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIE Fujia ¹ , YANG Que ¹ , FAN Zelin ¹ , LI Xin ¹ , WANG Xufeng ¹ ,  CAO Nong ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;2. The First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

CAO Nong, Email: caonong1955@yahoo.cn

Keywords：

Cholecystectomy; Single-incision laparoscopic; Conventional multiport laparoscopic; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130249

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review the effectiveness and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional multiport laparoscopic cholecystectomy (CMLC).
Methods 　We electronically searched PubMed, EMbase, The Cochrane Library (Issue 1, 2013), CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) on SILC versus CMLC from inception to January 1st, 2013. According to the Cochrane methods, the reviewers screened literature, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.2 software.
Results 　Finally, 17 RCTs involving 1 233 patients were included. The results of meta-analysis showed that, compared with CMLC, SILC was lower in 24 h postoperative pain score (visual analogue scale, VAS) (SMD= –0.40, 95%CI –0.76 to –0.04, P=0.03), higher in cosmetic results score (SMD=1.56, 95%CI 0.70 to 2.43, P=0.000 4), and longer in operative time (MD=13.11, 95%CI 7.06 to 19.16, P lt;0.000 1). However, no significant difference was found in 6 h postoperative pain scores (VAS), postoperative complications, port-site hernia and hospital stay between the two groups.
Conclusion 　SILC is a safe and effective technique for the treatment of uncomplicated benign gallbladder diseases, and it has certain advantages compared with CMLC, which is recommended in clinical application.

Citation： XIE Fujia,YANG Que,FAN Zelin,LI Xin,WANG Xufeng,CAO Nong. Effectiveness and Safety of Single-Incision Laparoscopic Cholecystectomy versus Conventional Multiport Laparoscopic Cholecystectomy: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(12): 1455-1462. doi: 10.7507/1672-2531.20130249 Copy

1.	中华人民共和国国家卫生和计划生育委员会（前国家卫生部）. 2012中国卫生统计提要, 2012. Available from:URL:http://www.chinacdc.cn/tjsj/gjwstjsj/201206/t20120608_63463.htm.
2.	Mühe, E. The first laparoscopic cholecystectomy. Langenbecks Arch Surg, 1986, 369: 804.
3.	Podolsky ER, Curcillo II, Rottman SJ, et al. Single port access (SPA) surgery-initial experience of a novel minimal access approach applied across surgical specialties. Surg Endosc, 2008, 22(11): 172-174.
4.	Moher D, Alessandro L, Jennifer T, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 2009, 151(4): 264-269.
5.	陈耀龙, 蔡羽嘉, 王梦书, 等. 循证医学术语介绍II . 中国循证医学杂志, 2009, 9(2): 143-146.
6.	吴泰相, 商洪才, 卞兆祥. 随机对照实况试验的概念, 设计和实施. 中国循证医学杂志, 2009, 9(12): 1277-1280.
7.	艾昌林, 段玉蓉, Wiffen P, 等. 系统评价员选择中文生物医学期刊数据库的策略研究. 中国循证医学杂志, 2010, 10(6): 749-753.
8.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011.
9.	陈耀龙, 李晓, 梅又文, 等. 循证医学术语介绍V. 中国循证医学杂志, 2009, 9(7): 734-739.
10.	王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
11.	Madureira FA, Manso JE, Madureira Fo D, et al. Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc, 2012, 27(3): 1009-1015.
12.	Vilallonga R, Barbaros U, Sümer A, et al. Single-port transumbilical laparoscopic cholecystectomy: a prospective randomised comparison of clinical results of 140 cases. J Minim Access Surg, 2012, 8(3): 74-78.
13.	Sasaki A, Ogawa M, Tono C, et al. Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(5): 396-399.
14.	Chang SK, Wang YL, Shen L, et al. Interim report: A randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg, 2012, 6(1): 14-20.
15.	Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg, 2011, 98(7): 991-995.
16.	Zheng M, Qin M, Zhao H. Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol, 2012, 21(2): 113-117.
17.	Lirici MM, Califano AD, Angelini P, et al. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg, 2011, 202(1): 45-52.
18.	Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg, 2011, 98(12): 1695-1702.
19.	Cao ZG, Cai W, Qin MF, et al. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): 311-313.
20.	Aprea G, Coppola-Bottazzi E, Guida F, et al. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. Journal of Surgical Research, 2011, 166(2): E109-E112.
21.	Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg, 2011, 254(1): 22-27.
22.	Lai EC, Yang GP, Tang CN, et al. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg, 2011, 202(3): 254-258.
23.	Lee PC, Lo C, Lai PS, et al. Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg, 2010, 97(7): 1007-1012.
24.	Sinan H, Demirbas S, Ozer MT, et al. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 12-16.
25.	Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc, 2012, 26(5): 1296-1303.
26.	Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc, 2010, 24(8): 1842-1848.
27.	耿良元, 白剑峰, 孙跃明, 等. 单切口与传统腹腔镜胆囊切除术的随机对比研究. 腹腔镜外科杂志, 2012, 17(3): 173- 176.
28.	王萍, 谢蟪旭, 张绮, 等. 如何在 Cochrane 系统评价中设计资料提取表. 中国循证医学杂志, 2011, 11(3): 341-345.
29.	Kilian M, Raue W, Menenakos C, et al. Transvaginal-hybrid vs. single-port-access vs. ’conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg, 2011, 396(5): 709-715.
30.	Navarra G., Pozza E, Occhionorelli S, et al. One‐wound laparoscopic cholecystectomy. British Journal of Surgery, 1997, 84(5): 695.
31.	Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc, 2011, 25(2): 367-377.
32.	Sajid MS, Ladwa N, Kalra L, et al. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World Journal of Surgery, 2012, 36(11): 2644-2653.
33.	Markar SR, Karthikesalingam A, Thrumurthy S, et al. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical Endoscopy, 2012, 26(5): 1205-1213.
34.	Joseph M, Phillips M, Rupp CC. Single-incision laparoscopic cholecystectomy: a combined analysis of resident and attending learning curves at a single institution. The American Surgeon, 2012, 78(1): 119-124.
35.	Feinberg EJ, Agaba E, Feinberg ML, et al. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(2): 114-117.
36.	Solomon D, Bell RL, Duffy AJ, et al. Single-port cholecystectomy: small scar, short learning curve. Surg Endosc, 2010, 24(12): 2954-2957.
37.	Tsujie M, Ikenaga M, Miyamoto A, et al. Effectiveness of a surgical glove port with homemade trocars made of syringes for single incision laparoscopic cholecystectomy. Hepato-gastroenterology, 2012, 59(120): 2407-2409.
38.	Arain NA, Rondon L, Hogg DC, et al. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surgical Endoscopy, 2012, 26(12): 3457-3466.
39.	Kroh M, El-Hayek K, Rosenblatt S, et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surgical Endoscopy, 2011, 25(11): 3566-3573.

1. 中华人民共和国国家卫生和计划生育委员会（前国家卫生部）. 2012中国卫生统计提要, 2012. Available from:URL:http://www.chinacdc.cn/tjsj/gjwstjsj/201206/t20120608_63463.htm.
2. Mühe, E. The first laparoscopic cholecystectomy. Langenbecks Arch Surg, 1986, 369: 804.
3. Podolsky ER, Curcillo II, Rottman SJ, et al. Single port access (SPA) surgery-initial experience of a novel minimal access approach applied across surgical specialties. Surg Endosc, 2008, 22(11): 172-174.
4. Moher D, Alessandro L, Jennifer T, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 2009, 151(4): 264-269.
5. 陈耀龙, 蔡羽嘉, 王梦书, 等. 循证医学术语介绍II . 中国循证医学杂志, 2009, 9(2): 143-146.
6. 吴泰相, 商洪才, 卞兆祥. 随机对照实况试验的概念, 设计和实施. 中国循证医学杂志, 2009, 9(12): 1277-1280.
7. 艾昌林, 段玉蓉, Wiffen P, 等. 系统评价员选择中文生物医学期刊数据库的策略研究. 中国循证医学杂志, 2010, 10(6): 749-753.
8. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1. 0 [updated March 2011]. The Cochrane Collaboration, 2011.
9. 陈耀龙, 李晓, 梅又文, 等. 循证医学术语介绍V. 中国循证医学杂志, 2009, 9(7): 734-739.
10. 王丹, 翟俊霞, 牟振云, 等. Meta 分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
11. Madureira FA, Manso JE, Madureira Fo D, et al. Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc, 2012, 27(3): 1009-1015.
12. Vilallonga R, Barbaros U, Sümer A, et al. Single-port transumbilical laparoscopic cholecystectomy: a prospective randomised comparison of clinical results of 140 cases. J Minim Access Surg, 2012, 8(3): 74-78.
13. Sasaki A, Ogawa M, Tono C, et al. Single-port versus multiport laparoscopic cholecystectomy: a prospective randomized clinical trial. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(5): 396-399.
14. Chang SK, Wang YL, Shen L, et al. Interim report: A randomized controlled trial comparing postoperative pain in single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy. Asian J Endosc Surg, 2012, 6(1): 14-20.
15. Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg, 2011, 98(7): 991-995.
16. Zheng M, Qin M, Zhao H. Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol, 2012, 21(2): 113-117.
17. Lirici MM, Califano AD, Angelini P, et al. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg, 2011, 202(1): 45-52.
18. Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg, 2011, 98(12): 1695-1702.
19. Cao ZG, Cai W, Qin MF, et al. Randomized clinical trial of single-incision versus conventional laparoscopic cholecystectomy: short-term operative outcomes. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): 311-313.
20. Aprea G, Coppola-Bottazzi E, Guida F, et al. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. Journal of Surgical Research, 2011, 166(2): E109-E112.
21. Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg, 2011, 254(1): 22-27.
22. Lai EC, Yang GP, Tang CN, et al. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg, 2011, 202(3): 254-258.
23. Lee PC, Lo C, Lai PS, et al. Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy. Br J Surg, 2010, 97(7): 1007-1012.
24. Sinan H, Demirbas S, Ozer MT, et al. Single-incision laparoscopic cholecystectomy versus laparoscopic cholecystectomy: a prospective randomized study. Surg Laparosc Endosc Percutan Tech, 2012, 22(1): 12-16.
25. Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc, 2012, 26(5): 1296-1303.
26. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc, 2010, 24(8): 1842-1848.
27. 耿良元, 白剑峰, 孙跃明, 等. 单切口与传统腹腔镜胆囊切除术的随机对比研究. 腹腔镜外科杂志, 2012, 17(3): 173- 176.
28. 王萍, 谢蟪旭, 张绮, 等. 如何在 Cochrane 系统评价中设计资料提取表. 中国循证医学杂志, 2011, 11(3): 341-345.
29. Kilian M, Raue W, Menenakos C, et al. Transvaginal-hybrid vs. single-port-access vs. ’conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg, 2011, 396(5): 709-715.
30. Navarra G., Pozza E, Occhionorelli S, et al. One‐wound laparoscopic cholecystectomy. British Journal of Surgery, 1997, 84(5): 695.
31. Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc, 2011, 25(2): 367-377.
32. Sajid MS, Ladwa N, Kalra L, et al. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World Journal of Surgery, 2012, 36(11): 2644-2653.
33. Markar SR, Karthikesalingam A, Thrumurthy S, et al. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surgical Endoscopy, 2012, 26(5): 1205-1213.
34. Joseph M, Phillips M, Rupp CC. Single-incision laparoscopic cholecystectomy: a combined analysis of resident and attending learning curves at a single institution. The American Surgeon, 2012, 78(1): 119-124.
35. Feinberg EJ, Agaba E, Feinberg ML, et al. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 2012, 22(2): 114-117.
36. Solomon D, Bell RL, Duffy AJ, et al. Single-port cholecystectomy: small scar, short learning curve. Surg Endosc, 2010, 24(12): 2954-2957.
37. Tsujie M, Ikenaga M, Miyamoto A, et al. Effectiveness of a surgical glove port with homemade trocars made of syringes for single incision laparoscopic cholecystectomy. Hepato-gastroenterology, 2012, 59(120): 2407-2409.
38. Arain NA, Rondon L, Hogg DC, et al. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surgical Endoscopy, 2012, 26(12): 3457-3466.
39. Kroh M, El-Hayek K, Rosenblatt S, et al. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surgical Endoscopy, 2011, 25(11): 3566-3573.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of Single-Incision Laparoscopic Cholecystectomy versus Conventional Multiport Laparoscopic Cholecystectomy: A Meta-Analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content