Critical appraisal of single port access cholecystectomy.
BACKGROUND
Single port access (SPA) cholecystectomy is a new concept in laparoscopic surgery. A review of existing results was performed to evaluate critically the current state of SPA with specific reference to feasibility, safety, learning curve, indications and cost-effectiveness.


METHODS
All papers identified in MEDLINE until 15 February 2010 and all other relevant papers obtained from cited references were reviewed, without any language restriction. Case reports and series of fewer than three patients were excluded.


RESULTS
After selection, 24 studies including 895 patients were analysed. None was randomized. Feasibility seems to be established, with a conversion rate of 2 per cent. SPA was not standardized and there was much technical variation. The learning curve could not be determined. Median follow-up time was 3 (range 0.25-12) months. The overall published complication rate was 5.4 per cent and the biliary complication rate 0.7 per cent. The rate of umbilical complications ranged from 2 to 10 per cent.


CONCLUSIONS
SPA cholecystectomy seems feasible, but standardization, safety and the real benefits for patients need further assessment. Uncontrolled wide adoption of this approach may be responsible for a rise in biliary complications.
Allemann
P
P
Department of Visceral Surgery, University Hospital Vaudois (CHUV), CH 1011 Lausanne, Switzerland.
Schafer
M
M
Demartines
N
N
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics / Q000193:education / Q000379:methods*; D002983:Clinical Competence / Q000592:standards; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*