title: Cosmesis and Body Image in Patients Undergoing Single-port Versus Conventional Laparoscopic Cholecystectomy: A Multicenter Double-blinded Randomized Controlled Trial (SPOCC-trial).
abstract: OBJECTIVE
  To evaluate cosmesis, body image, pain, and quality of life (QoL) after single-port laparoscopic cholecystectomy (SPLC) versus conventional 4-port laparoscopic cholecystectomy (4PLC).
  
  
  BACKGROUND
  The impact of SPLC on improving cosmesis, body image, pain, and QoL has not been evaluated in double-blinded randomized controlled trials (RCT). This approach therefore remains controversial.
  
  
  METHODS
  Between October 2011 and February 2014, 110 patients from 2 centers were randomly assigned to SPLC (n = 55) or 4PLC (n = 55). Primary endpoints were a validated cosmesis (3-24 points) and body image (5-20 points) score after 3 and 12 months. Secondary endpoints included operative duration, postoperative pain, complications, QoL, and length of hospital stay. Patients, physicians, and nurses were blinded until the seventh postoperative day.
  
  
  RESULTS
  Demographics were equally distributed between both groups (mean age: 46 years, SD: 14, 62 females, 34 males). The SPLC-group showed superior mean cosmesis and body image compared with the 4PLC-group at 12-weeks (21 vs 16, P < 0.001 and 5 vs 6, P = 0.013, respectively) and at 1-year (24 vs 16, P < 0.001 and 5 vs 6, P < 0.017, respectively). Operation duration was longer in the SPLC-group (mean 101 vs 90 minutes, p = 0.031). Although postoperative pain was less in the SPLC-group (mean VAS 1 vs 2, p = 0.005), there were no differences in complications, and length of hospital-stay.
  
  
  CONCLUSIONS
  This is the first multicenter double-blinded RCT reporting superior short- and long-term cosmetic and body image, postoperative pain, and QoL in SPLC compared with 4PLC. Although cost-effectiveness is still a subject of ongoing debate, SPLC should be offered to patients undergoing surgery for benign gallbladder disease.
authors.affiliation: *Department of Surgery, University Hospital Zurich, Zurich, Switzerland †Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany ‡Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Lurje
authors.forename: Dimitri Aristotle
authors.initials: DA
authors.lastname: Raptis
authors.forename: Daniel Christian
authors.initials: DC
authors.lastname: Steinemann
authors.forename: Iakovos
authors.initials: I
authors.lastname: Amygdalos
authors.forename: Patryk
authors.initials: P
authors.lastname: Kambakamba
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Mickaël
authors.initials: M
authors.lastname: Lesurtel
authors.forename: Adrian
authors.initials: A
authors.lastname: Zehnder
authors.forename: Roland
authors.initials: R
authors.lastname: Wyss
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
mesh_terms: D000328:Adult; D001828:Body Image; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000523:psychology; D004311:Double-Blind Method; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000523:psychology / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome