title: Laparoendoscopic single-site cholecystectomy vs three-port laparoscopic cholecystectomy: a large-scale retrospective study.
abstract: OBJECTIVE
  To perform a large-scale retrospective comparison of laparoendoscopic single-site cholecystectomy (LESSC) and three-port laparoscopic cholecystectomy (TPLC) in a single institution.
  
  
  METHODS
  Data were collected from 366 patients undergoing LESSC between January 2005 and July 2008 and were compared with the data from 355 patients undergoing TPLC between August 2008 and November 2011 in our department. Patients with body mass index greater than 35 kg/m(2), a history of major upper abdominal surgery, signs of acute cholecystitis, such as fever, right upper quadrant tenderness with or without Murphy's sign, elevated white blood cell count, imaging findings suggestive of pericholecystic fluid, gallbladder wall thickening > 4 mm, and gallstones > 3 cm, were excluded to avoid bias.
  
  
  RESULTS
  Altogether, 298 LESSC and 315 TPLC patients met the inclusion criteria. The groups were well matched with regard to demographic data. There were no significant differences in terms of postoperative complications (contusion: 19 vs 25 and hematoma at incision: 11 vs 19), hospital stay (mean ± SD, 1.4 ± 0.2 d vs 1.4 ± 0.7 d) and visual analogue pain score (mean ± SD, 8 h after surgery: 2.3 ± 1.4 vs 2.3 ± 1.3 and at day 1: 1.2 ± 0.4 vs 1.3 ± 1.2) between the LESSC and TPLC patients. Four patients required the addition of extra ports and 2 patients were converted to open surgery in the LESSC group, which was not significantly different when compared with TPLC patients converted to laparotomy (2 vs 2). LESSC resulted in a longer operating time (mean ± SD, 54.8 ± 11.0 min vs 33.5 ± 9.0 min), a higher incidence of intraoperative gallbladder perforation (56 vs 6) and higher operating cost (mean ± SD, 1933.7 ± 64.4 USD vs 1874.7 ± 46.2 USD) than TPLC. No significant differences in operating time (mean ± SD, 34.3 ± 6.0 min vs 32.7 ± 8.7 min) and total cost (mean ± SD, 1881.3 ± 32.8 USD vs 1876.2 ± 33.4 USD) were found when the last 100 cases in the two groups were compared. A correlation was observed between reduced operating time of LESSC and increased experience (Spearman rank correlation coefficient, -0.28). More patients in the LESSC group expressed satisfaction with the cosmetic result (98% vs 85%).
  
  
  CONCLUSIONS
  LESSC is a safe and feasible procedure in selected patients with benign gallbladder diseases, with the significant advantage of cosmesis.
authors.affiliation: Second Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Cheng
authors.forename: Ze-Sheng
authors.initials: ZS
authors.lastname: Jiang
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Xu
authors.forename: Zhi
authors.initials: Z
authors.lastname: Zhang
authors.forename: Ting-Cheng
authors.initials: TC
authors.lastname: Xu
authors.forename: Chen-Jie
authors.initials: CJ
authors.lastname: Zhou
authors.forename: Jia-Sheng
authors.initials: JS
authors.lastname: Qin
authors.forename: Guo-Lin
authors.initials: GL
authors.lastname: He
authors.forename: Yi
authors.initials: Y
authors.lastname: Gao
authors.forename: Ming-Xin
authors.initials: MX
authors.lastname: Pan
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002681:China; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery; D003362:Cost-Benefit Analysis; D003560:Cysts / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011127:Polyps / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cholecystectomy; Laparoscopy; Retrospective studies; Single site