The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review.
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.
Ahmed
Kamran
K
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
Wang
Tim T
TT
Patel
Vanash M
VM
Nagpal
Kamal
K
Clark
James
J
Ali
Mariam
M
Deeba
Samer
S
Ashrafian
Hutan
H
Darzi
Ara
A
Athanasiou
Thanos
T
Paraskeva
Paraskevas
P
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