Commentary on “A Comparison Between Single-Incision and Conventional Laparoscopic Cholecystectomy”

Laparoscopic cholecystectomy revolutionized the treatment of gallbladder disease starting in the late 1980s. The safety and efficacy of this surgical modality have since been accepted and proven. Single-port laparoscopic surgery has, more recently, pushed the envelope of perfection by attempting to reduce the number of ports/incisions necessary to complete the operation. A recent explosion of published literature touting the virtues of single-incision laparoscopy, led by cholecystectomy, has yielded few scientific data to validate the benefits. ¹ Ostensibly, fewer incisions mean less pain, better aesthetics, quicker recovery, and the ever so important return to productive life. Recent prospective, randomized series of single-incision laparoscopic cholecystectomy compared with conventional four-port surgery show improved cosmesis, but question the pain advantage and raise the issue of longer operating time.^2,3

In this issue of the journal, Kim et al. ⁴ are among the growing list of experts who have added to our knowledge on single-port laparoscopic cholecystectomy. In their non-randomized comparison with conventional laparoscopy, they have also included patients with acute, chronic, and acalculous cholecystitis. Their results demonstrate less pain and shorter hospital stay but longer operating times for single-port surgery. They have confirmed that, in experienced hands, this technique is feasible and safe, even in the acute setting. Hidden in this article and other studies, however, remain some nagging questions: What exactly is the role of patient selection? What are the true cost differences? Will we discover that the actual rate of incisional hernia cancels the other benefits? The answers to these questions may invariably be trumped by consumer preference, which serves to push the advancement of otherwise marginal surgical innovation.