Single-incision laparoscopic surgery for biliary tract disease

Table 1 English prospective randomized control trials of single-incision laparoscopic cholecystectomy vs multi-incision laparoscopic cholecystectomy retrieved online via PubMed from Jan 2012 to Feb 2015 n (%)

Ref.	Journal (Year)	SILC, n	SILC for AC
Chang et al[71]	World J Surg (2015)	50	0
1Pappas-Gogos et al[27]	J Surg Res (2015)	20	N/A
Khorgami et al[72]	J Invest Surg (2014)	30	6 (20)
Jørgensen et al[73]	Br J Surg (2014)	60	1 (1.7)
Deveci et al[75]	J Korean Surg Soc (2013)	50	6 (12)
Noguera et al[40]	Surg Endosc (2013)	40 (20 SILC, 20 flexible SILC)	0
Yilmaz et al[81]	J Korean Surg Soc (2013)	43	0
Zapf et al[76]	Surgery (2013)	49	7 (14.3)
Brown et al[77]	Surg Endosc (2013)	40	0
1Madureira et al[37]	Surg Innov (2013)	28	0
Hu et al[78]	J Laparoendosc Adv Surg Tech A (2013)	30	0
Marks et al[13]	J Am Coll Surg (2013)	119	0
Ostlie et al[96]	J Laparoendosc Adv Surg Tech A (2013)	17	N/A
Abd Ellatif et al[44]	Surg Endosc (2013)	125	0
Luna et al[79]	Surg Endosc (2013)	20	0
1Madureira et al[43]	Surg Endosc (2013)	28	0
Saad et al[82]	Br J Surg (2013)	35	0
Pan et al[42]	World J Gastroenterol (2013)	49	0
Ostlie et al[80]	J Pediatr Surg (2013)	30	0
Vilallonga et al[83]	J Minim Access Surg (2012)	69	14 (20.3)
1Tsimogiannis et al[28]	Surg Endosc (2012)	20	N/A
MILC, n	(Para)umbilical fasciotomy	Working instrument	GB suspension	IOC
50	1 large	Articulated	Suture	Nil
20	1 large + 1 small	Curved	Nil	Nil
30 3ILC + 30 4ILC	3 small	Straight	Nil	N/A
60	1 large	Roticular	Suture	1 (1.7)
50	1 large	Articulated	Suture: 17 (34)	Nil
20	SILC: 1 large; flexible SILC: 3 small	SILC: articulated; flexible SILC: straight	Nil	Nil
40	1 large	N/A	Nil	Nil
51	3 small	Articulated	Suture: 2 (4.1)	5 (10.2)
39	3 small	Straight	Suture: partial	Nil
29	1 large	Curved	Suture	Nil
30	1 large	N/A	N/A	N/A
81	1 large	Articulated (curved)	Nil	Partial
24	N/A	N/A	N/A	N/A
125	2 small	Straight	Suture	Nil
20	1 large	Articulated	Suture: 2 (10)	Nil
29	1 large	Curved	Suture	Nil
35 mini-4ILC + 35 4ILC	1 large	Straight	K wire: 6 (17.1)	Nil
53	2 small	Straight	Suture	Nil
30	1 large	Straight	Nil	Nil
71	1 large	Straight (roticular)	Nil	Nil
20	1 large	Curved	Nil	Nil
MILC incision and size (mm): Paraumbilical, subxiphoid, right subcostal, right flank	Learning curve	Operative time	EBL	Successful	Open conversion	Mortality
4ILC: 10, 5, 5, 5	N/A	S > M	N/A	47 (94)	0	0
4ILC: 10, 10, 5, 5	N/A	S = M	N/A	20 (100)2	0	0
3ILC: 10, 5, 5; 4ILC: 10, 5, 5, 5	N/A	S > 3ILC = 4ILC	N/A	27 (90)	0	0
4ILC: 12, 12, 5, 5	N/A	S > M	S = M	43 (71.7)	0	0
3ILC: 10, 10, 5	10 for op time	S > M	S = M	44 (88)	4 (8)	0
3ILC: 10, 5, 5	N/A	S = flexible S = M	N/A	40 (100)	0	0
4ILC: 10, 10, 10, 10	N/A	S = M	N/A	43 (100)	03	0
4ILC: 12, 5, 5, 5	40 for op time	S > M	S = M	44 (89.8)	0	0
4ILC: 10, 5, 5, 5	N/A	S > M	S = M	39 (97.5)	0	0
4ILC: 10, 5 (10), 5, 5	N/A	S = M	N/A	28 (100)	0	0
Mini-3ILC: 10+5, 2, 2	N/A	S > Mini-3ILC	N/A	28 (93.3)	0	0
4ILC: 10 (12), 5 (10) (12), 5, 5	N/A	S > M	S = M	118 (99.2)	0	0
N/A	N/A	N/A	N/A	N/A	N/A	N/A
4ILC: 10, 10, 5, 5	25 for op time	S = M	S = M	121 (96.8)	0	0
4ILC: 10, 10, 5, 5	N/A	S > M	N/A	18 (90)	0	0
4ILC: 10, 5 (10), 5, 5	20 for method standardization	S = M	N/A	28 (100)	0	0
Mini-4ILC: 10, 3, 3, 3; 4ILC: 10, 10, 5, 5	N/A	S = Mini-4ILC > 4ILC	N/A	34 (97.1)	0	0
3ILC: 10, 10, 5	N/A	S = M	S = M	48 (98.0)	0	0
4ILC: 10, 5, 5, 5	Nil	S > M	N/A	30 (100)	0	0
3ILC (4ILC): 10, 11, 5 (10, 11, 5, 5)	N/A	S = M	N/A	68 (98.6)	0	0
4ILC: 10, 10, 5, 5	N/A	S = M	N/A	20 (100)2	0	0
Overall complication	BDI	Incisional hernia	Pain	LOS
S: 4 (8) = M	0	S: 1 (2) = M	S < M	S = M
0	0	0	N/A	N/A
0	0	0	S < M (3ILC or 4ILC)	S = M (3ILC or 4ILC)
S: 2 (3.3) = M	S: 1 (1.7) →BL	S: 1 (1.7) = M	S = M	S = M
S: 2 (4) = M	0	0	S > M (POD 1)	S = M
S: 0 = flexible S: 1 (5) = M	0	0	S = flexible S = M	Flexible S < S = M
S: 1 (2.3) = M	0	0	S > M (POm 30)	S = M
S: 1 (2.04) = M	0	0	S = M	S = M
N/A	0	N/A	S = M	S = M
S: 3 (10.8) = M (wound complication)	0	0	S < M (POH 24)	N/A
0	0	0	S = Mini-3ILC	S = Mini-3ILC
S: 53 (45) = M	0	S: 10 (8.4) > M	S > M	N/A
N/A	N/A	N/A	N/A	N/A
S: 5 (4) = M	0	0	S < M (early to POW 1)	S = M
S: 1 (5) = M	0	0	S = M	N/A
S: 3 (10.8) = M (wound complication)	0	0	S < M (POH 24)	S: < 24 h = M
S: 8 (22.9) > Mini-4ILC: 0 = 4ILC	0	S: 1 (2.9)	S = Mini-4ILC = 4ILC	S = Mini-4ILC = 4ILC
S = M (port-site complication)	0	0	S < M (POH 8)	S = M
0	0	0	S = M	S = M
S: 3 (4.3) = M	0	S: 1 (1.4)	S < M (POH 12)	S > M
0	0	0	S < M	S = M
Cosmesis	Satisfaction	Cost	Follow-up
S = M	S = M	N/A	6 mo
N/A	N/A	N/A	N/A
S = M (3ILC or 4ILC, late)	S = M (3ILC or 4ILC)	N/A	12 mo
S > M	N/A	N/A	12 mo
S > M	N/A	N/A	24 mo
N/A	N/A	N/A	> 1 yr
N/A	N/A	N/A	7 d
S = M	S = M	S > M	16.4 mo
S > M (POW2)	N/A	S = M	2-4 wk
N/A	N/A	N/A	N/A
S < Mini-3ILC	N/A	N/A	1 mo
S > M	N/A	N/A	< 12 mo
S > M (POM 16-38)	N/A	N/A	Early: 6-12 wk; Late: 16-38 mo
S > M (POM 1,6)	N/A	N/A	6 mo
N/A	N/A	N/A	1 mo
N/A	N/A	N/A	5.92 mo
S = Mini-4ILC > 4ILC (POM 6)	N/A	N/A	12 mo
S > M (POM 2)	N/A	S = M	2 mo
N/A	N/A	S = M	6 wk
S > M	S > M	N/A	7.3 mo
N/A	N/A	N/A	N/A

¹The same populations examined with different end points;

²One case with a procedure converted to 2ILC was excluded;

³Two cases with open conversion were excluded. SILC or S: Single-incision laparoscopic cholecystectomy; flexible SILC or S: Single-incision laparoscopic cholecystectomy using a flexible endoscope; AC: Acute cholecystitis; N/A: Not available; MILC or M: Multi-incision laparoscopic cholecystectomy; GB: Gallbladder; K wire: Kirschner wire; IOC: Intraoperative cholangiography; 4ILC: Four-incision laparoscopic cholecystectomy; 3ILC: Three-incision laparoscopic cholecystectomy; EBL: Estimated blood loss; BDI: Bile duct injury; BL: Bile leak from cystic duct stump; POD: Postoperative day; POm: Postoperative minute; POH: Postoperative hour; POW: Postoperative week; LOS: Length of hospital stay; POM: Postoperative month; large fasciotomy: ≥ 20 mm; small fasciotomy: ≤ 10 mm.