title: Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study.
abstract: OBJECTIVE
  This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).
  
  
  METHODS
  Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded.
  
  
  RESULTS
  Mean age (TVC: 33.5 ± 3.0 year; SILC: 38.4 ± 3.3 year; 4PLC: 35.5 ± 4.1 year; p = 0.58) and mean BMI (TVC: 28.8 ± 1.5 kg/m(2); SILC: 31.8 ± 1 kg/m(2); 4PLC: 31.4 ± 2.2 kg/m(2); p = 0.35) were not statistically significant. However, mean operative time (TVC: 67 ± 3.9 min; SILC: 48.9 ± 2.6 min; 4PLC: 42.3 ± 3.9 min; p < 0.001) was significantly longer for TVC. Numerical pain scales showed significantly lower pain scores on POD 1 and 3 for TVC compared with SILC and 4PLC (TVC: 4.1 ± 0.5 and 2.9 ± 0.7; SILC: 6.1 ± 0.5 and 5.3 ± 0.5; 4PLC: 5.7 ± 0.4 and 4.7 ± 0.3; p = 0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4 ± 1.5 days; SILC: 13.1 ± 1.3 days; 4PLC: 14.1 ± 1.4 days; p < 0.001) also was significantly faster for patients in the TVC group. One conversion in the TVC group to a 4PLC was necessary due to adhesions within the pelvis. One dislodged IUD was seen and immediately replaced in the TVC group. One hernia was observed in the SILC group.
  
  
  CONCLUSIONS
  Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3 days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA. d.solomon@yale.edu
authors.forename: Daniel
authors.initials: D
authors.lastname: Solomon
authors.forename: Amir H
authors.initials: AH
authors.lastname: Shariff
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006547:Hernia / Q000209:etiology; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies