title: Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial.
abstract: BACKGROUND
  Single-incision laparoscopic cholecystectomy (SILC) is a newer approach that may be a safe alternative to traditional laparoscopic cholecystectomy (TLC) based on retrospective and small prospective studies. As the demand for single-incision surgery may be driven by patient perceptions of benefits, we designed a prospective randomized study using patient-reported outcomes as our end points.
  
  
  METHODS
  Patients deemed candidates for either SILC or TLC were offered enrollment in the study. After induction of anesthesia, patients were randomized to SILC or TLC. Preoperative characteristics and operative data were recorded, including length of stay (LOS). Pain scores in recovery and for 48 h and satisfaction with wound appearance at 2 and 4 weeks were reported by patients. We used the gastrointestinal quality of life index (GIQLI) survey preoperatively and at 2 and 4 weeks postoperatively to assess recovery. Procedural and total hospital costs per case were abstracted from hospital billing systems.
  
  
  RESULTS
  Mean age of the study group was 44.1 years (±14.8), 87% were Caucasian, and 77% were female, with no difference between groups. Operative times were longer for SILC (median = 57 vs. 47 min, p = 0.008), but mean LOS was similar (6.8 ± 4.2 h SILC vs. 6.2 ± 4.8 h TLC, p = 0.59). Operating room cost and encounter cost were similar. GIQLI scores were not significantly different preoperatively or at 2 or 4 weeks postoperatively. Patients reported higher satisfaction with wound appearance at 2 weeks with SILC. There were no differences in pain scores in recovery or in the first 48 h, although SILC patients required significantly more narcotic in recovery (19 mg morphine equivalent vs. 11.5, p = 0.03).
  
  
  CONCLUSIONS
  SILC is a longer operation but can be done at the same cost as TLC. Recovery and pain scores are not significantly different. There may be an improvement in patient satisfaction with wound appearance. Both procedures are valid approaches to cholecystectomy.
authors.affiliation: Saint Luke's Hospital of Kansas City, Kansas City, MO, USA. kim.brown@utmb.edu
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brown
authors.forename: B Todd
authors.initials: BT
authors.lastname: Moore
authors.forename: G Brent
authors.initials: GB
authors.lastname: Sorensen
authors.forename: Conrad H
authors.initials: CH
authors.lastname: Boettger
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.forename: Phil G
authors.initials: PG
authors.lastname: Jones
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Margolin
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D016037:Single-Blind Method; D016896:Treatment Outcome