Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of the literature

Minimally invasive surgery is gradually becoming the mainstay of surgical treatment. In addition to the current mainstream four-port cholecystectomy, current research has looked upon the possibility of a single-incision laparoscopic cholecystectomy (SILC). In this meta-analysis, we aim to compare conventional multi-port laparoscopic cholecystectomy (CLC) to single-incision laparoscopic cholecystectomy in terms of operative time, cosmesis and postoperative pain.

A literature search was carried out in PubMed, MEDLINE, EMBASE, and Google Scholar, using the MESH terms ‘randomised controlled trial’, ‘laparoscopy’, ‘single port’, ‘multi-port’ and ‘cholecystectomy’. Randomised controlled trials (RCT) comparing SILC versus CLC published between January 2010 and January 2021 were included. Data were collected on operative time, cosmesis and postoperative pain visual analogue score (VAS) at 6 and 24 h.

Seven randomised controlled trials were used. When compared to CLC, SILC had comparable operative time (chi² = 273.78; p < 0.00001; CI −2.19, 24.12; I² = 98%) and VAS pain score at 6 h (chi² = 19.77; p < 0.0001; CI −0.49, 0.15; I² = 90%). CLC had a significantly better cosmetic outcome (chi² = 16.07; p < 0.0003; CI 0.89, 1.38; I² = 88%). SILC demonstrated a significantly better VAS pain score at 24 h (chi² = 45.15; p < 0.00001; CI −0.37, −0.02; I² = 91%).

This meta-analysis demonstrated that except for improved postoperative pain at 24 h, SILC did not show improved outcomes when compared to CLC. With the presently published RCTs, we are unable to provide statistical analysis on further outcomes such as postoperative complications. Hence, the choice of procedure remains largely the decision of the operating surgeon.