NEW YORK – Procedure times are longer and complications more frequent with single-port laparoscopic cholecystectomy than with the “classic” 4-port technique, an Oregon team has found.

Dr. Paul D. Hansen and colleagues at Providence Portland Medical Center note in the Annals of Surgery online April 13th that multiple port sites may contribute significantly to postop pain, and there is a potential hernia risk at port sites. While single-port laparoscopic cholecystectomy is seen as an alternative to the conventional 4-port approach, they say, any benefit remains to be proven.

The authors therefore conducted a comparison trial of the two approaches, in which 43 patients were randomized to undergo single-port or 4-port laparoscopic cholecystectomy.

There were no difference between the groups in parameters such as intraoperative complications, blood loss or length of stay, according to the report, and there were no conversions to open laparotomy.

However, mean operative time with the single-port technique was 88.5 minutes compared with 44.8 minutes with the classic technique, the team found. Over the course of the study, operative time with the single-port device declined from 100 to 82 minutes, suggesting a learning-curve effect, but the difference was not statistically significant.

Postoperative pain scores at discharge were slightly higher in the single-port group than the 4-port group (2.7 vs 1.8; p=0.06). Patient satisfaction with the procedure was 8.9 on a 10-point scale for the single-port procedure and 9.2 for the classic technique (p=0.59), and corresponding satisfaction rates for the cosmetic results were 9.3 vs 8.9.

Three patients in each group had wound infections requiring oral antibiotics, but other complications occurred only in the single-port group; these included one case each of retained bile duct stone, port-site hernia, and a port-site postop hemorrhage, the investigators report.

“In summary, on the basis of our RCT, single-port laparoscopic cholecystectomy had a longer operative time and seemed to incur more postoperative complications, which may be related to the learning curve,” Dr. Hansen and colleagues conclude. “However, both single-port laparoscopic cholecystectomy and classic laparoscopic cholecystectomy produced similar levels of patient satisfaction and pain, as well as patient-perceived functional health status.”

They add, “Larger randomized trials performed later in the learning curve with single-port laparoscopic cholecystectomy may identify more subtle advantages of one method over another.”

Reference:

Randomized Controlled Trial Comparing Single-Port Laparoscopic Cholecystectomy and 4-Port Laparoscopic Cholecystectomy


Ann Surg 2011