Single-incision laparoscopic cholecystectomy with inflexible laparoscopic instruments and laparoscopy: a single-center experience of 533 cases.

Abstract

Background: Laparoscopic cholecystectomy (LC) has been widely performed as the gold standard for BGDs. Single-incision laparoscopic cholecystectomy (SILC) was considered as an option for minimizing surgical injuries and improving outcomes. However, the benefit of this novel technique, especially with conventional and inflexible instruments and laparoscopy, is still controversial.

Materials and methods: This retrospective cohort study analyzed 958 consecutive cases (533 SILC vs. 425 CLC) from January 2023 to March 2024. SILC was performed via a single transumbilical incision with straight and inflexible instruments whereas CLC with traditional three-port strategy. Information of patients' demographic characteristics and pathological diagnoses was collected and analyzed. Comparative outcomes assessment included validated measures: SF-36 QoL indices, VAS pain scores, Vancouver Scar Scale assessments, hospitalization duration, and Clavien-Dindo complication grading.

Results: Cases from two groups showed similar demographic characteristics and pathological diagnoses. They also had comparable surgical time, estimated intraoperative blood loss and hospital costs. Sixteen cases required supplementary trocars for technical challenges. The SILC group exhibited superior scar satisfaction, though no significant intergroup differences existed in hospitalization duration, postoperative pain scores, or wound infection rates. Longitudinal analysis revealed reduced chronic pain and diarrhea incidence in SILC patients. Six-month postoperative SF-36 assessments showed significant improvements in SILC recipients for Bodily Pain, Vitality, and Role-Emotional domains.

Conclusion: The present study demonstrated SILC with conventional and inflexible instruments to be safe and feasible. SILC was found to be non-inferior to CLC. This technique demonstrated certain advantages, particularly in improving patient satisfaction with wound pain and appearance, while maintaining comparable surgical outcomes, hospital stay duration, and postoperative complication rates to those of CLC.