title: Evaluating systemic stress response in single port vs. multi-port laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Acute-phase proteins and inflammatory cytokines mediate measurable responses to surgical trauma, which are proportional to the extent of tissue injury and correlate with post-operative outcome. By comparing systemic stress following multi-port (LC) and single-incision laparoscopic cholecystectomy (SILC), we aim to determine whether reduced incision size induces a reduced stress response.
  
  
  METHODS
  Thirty-five consecutive patients were included, 11 underwent SILC (mean ± SEM; age 44.8 ± 3.88 year; BMI 27 ± 1.44 kg/m(2)) and 24 underwent LC (56.17 ± 2.80 year; 31.72 ± 1.07 kg/m(2), p < 0.05). Primary endpoint measures included levels of interleukin-6 and C-reactive protein measured pre- and post-operatively. Length-of-stay (LOS) and postoperative morbidity were secondary endpoints.
  
  
  RESULTS
  No statistically significant differences were found between SILC and LC for interleukin-6 and C-reactive protein levels, LOS and duration of surgery. There was also no correlation between systemic stress response and operative parameters. There were no intra-operative complications.
  
  
  CONCLUSIONS
  SILC appears to be a safe, feasible technique with potential advantages of cosmesis, reduced incisional pain, and well-being recommending its use. These data indicate no difference in systemic stress and morbidity between SILC and LC. A larger, multi-centred, randomised prospective trial is warranted to further investigate and confirm this finding.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, Academic Surgical Unit, St Mary's Hospital, Paddington, UK. colleen.mcgregor06@imperial.ac.uk
authors.forename: Colleen G C
authors.initials: CG
authors.lastname: McGregor
authors.forename: Mikael H
authors.initials: MH
authors.lastname: Sodergren
authors.forename: Alec
authors.initials: A
authors.lastname: Aslanyan
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Wright
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Paraskeva
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological
chemical_list: D015850:Interleukin-6; D002097:C-Reactive Protein