RANDOMIZED CONTROL TRIAL OF CONVENTIONAL LAPAROSCOPIC VERSUS SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Background:From big incision to minimally invasive multiport classic laparoscopic cholecystectomy (CLC) and now to single incision laparoscopic cholecystectomy (SILC) surgeryhas travelled a long way. There are proposedadvantages and potential disadvantages of SILC compared to the gold standard CLC. However, debate still exists whether SILC has anything more to offer. We compared various parameters of patient satisfaction, quality of life and short term surgical outcomes between CLC and SILC. Method: RCT was conducted forduration of one year. Patients were assigned into SILC and CLC groups. Operative time, length of hospital stay, quality of life (SF 36 questionnaire), patients overall and cosmetic satisfaction and postoperative pain using 10-point visual analogue scale (VAS) were assessed.The data analysis was done using software SPSS version20.0. Results: A total of 36 patients (28 women and 8 men) with mean age 39.88±11.99 yearswere allocated into SILC (n=18) and CLC (n=18) groups.The mean operative time for SILC was significantly longer than CLC (66.33 vs 46.50 minutes, P=0.001). VAS recorded higher pain in first 24 hours postoperatively in SILC than CLC group (4.467 vs 2.667, P=0.06). However, at the time of discharge patients in CLC had greater pain than SILC group (0.22 vs 0.133, P>0.99).No significant variability was seen in length of hospital stay (SILC 3.60 vs CLC 3.38 days, P=0.47). The QOL on first follow up visit showed statistically significant difference in two of the domain of SF 36, namely vitality and bodily pain. Patients overall and cosmetic satisfaction showed no superiority of SILC over CLC. Conclusions:Although patient prefers SILC in wake of cosmetic reasons, still it is a long way off from replacing CLC. Larger operative time and lack of standardization makes SILC still an evolving procedure and judicious patient selection is must for better outcome.