title: The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review.
abstract: OBJECTIVE
  This review aimed to determine the role of single-incision laparoscopic surgery (SILS) in abdominal and pelvic operations.
  
  
  METHODS
  The Medline, EMBASE, and PsycINFO databases were systematically searched until October 2009 using "single-incision laparoscopic surgery" and related terms as keywords. References from retrieved articles were reviewed to broaden the search
  
  
  METHODS
  The study included case reports, case series, and empirical studies that reported SILS in abdominal and pelvic operations.
  
  
  METHODS
  Number of patients, type of instruments, operative time, blood loss, conversion rate, length of hospital stay, length of follow-up evaluation, and complications were extracted from the reviewed items
  
  
  RESULTS
  The review included 102 studies classified as level 4 evidence. Most of these studies investigated SILS in cholecystectomy (n=34), appendectomy (n=24), and nephrectomy (n=17). For these procedures, operative time, hospital stay, and complications were comparable with those of conventional laparoscopy. Conversion to conventional laparoscopy was seldom performed in cholecystectomy (range, 0-24%) and more frequent in appendectomy (range, 0-41%) and nephrectomy (range, 0-33%).
  
  
  CONCLUSIONS
  The potential benefits of SILS include superior cosmesis and possibly shorter operative time, lower costs, and a shortened time to full physical recovery. Careful case selection and a low threshold of conversion to conventional laparoscopic surgery are essential. Multicenter, randomized, prospective studies are needed to compare short- and long-term outcome measures against those of conventional laparoscopic surgery.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital Campus, Praed Street, London, W2 1NY, UK. k.ahmed@imperial.ac.uk
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Tim T
authors.initials: TT
authors.lastname: Wang
authors.forename: Vanash M
authors.initials: VM
authors.lastname: Patel
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: James
authors.initials: J
authors.lastname: Clark
authors.forename: Mariam
authors.initials: M
authors.lastname: Ali
authors.forename: Samer
authors.initials: S
authors.lastname: Deeba
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Paraskeva
mesh_terms: D000005:Abdomen / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods; D010388:Pelvis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology; D018570:Risk Assessment; D012380:Role; D016896:Treatment Outcome