Table 2 Comparison of clinical trials comparing SILC versus 4PLC��SILC/LESSC (single-incision laparoscopic cholecystectomy/laparoendoscopic single-site cholecystectomy), 4PLC (four port laparoscopic cholecystectomy). selleck chemicals ARQ197 There are several blinded randomized trials comparing standard LC to SILC/LESS cholecystectomy with varied results regarding patient outcomes. An outcome that has had a significant difference in several studies comparing SILC/LESS cholecystectomy versus LC is the cosmetic result. Patients are more satisfied with the hidden or infraumbilical single surgical scar than the four scars created by the LC [13, 17, 19]. In an attempt to try and reduce the bias associated with cosmetic evaluation, Marks et al. and Bucher et al.

used body image scale, a scar scale photo series 10-point scoring questionnaire in order to compare results between SILC/LESS and LC patients. However regardless of the scale used, there is still an element of personal preference and opinion involved with the evaluation of cosmetic results. Aside from cosmetic perception, the only consistently reproducible and statistically significant result among series is a prolonged time of surgery for the SILC/LESS cholecystectomy groups versus standard LC groups [12�C14, 16�C20]. A study by Qiu et al. [34] focused specifically on the learning curve phenomenon associated with SILC/LESS cholecystectomy and saw an improvement in operative times as experience was gained [34] this was similar to what was observed by others [18�C20].

The increased operating time may be a combination of factors among which the lack of surgeon experience and the technical difficulty behind SILC/LESS cholecystectomy could be involved. However, increased operating time means increased duration of general anesthesia and thus increased patient risk. Although no anesthesia-related complications were reported in the mentioned trials, a significant number of the studies used ASA class III or IV as a cut-off point for patients suitable for SILC/LESS cholecystectomy [13, 14, 19], thus the use of SILC/LESS cholecystectomy in patients in which there are foreseeable anesthesia-related complications remains limited. One of the ultimate goals of the development of SILS/LESS cholecystectomy is a reduction in postoperative pain perception and a decreased used of analgesic medications [9].

The evaluation of postoperative pain is consistently included as a primary or secondary outcome in recent studies [12�C20] but lacking in previous studies [6]. The outcome however remains obscure as there are reports in which there is no difference in pain perception between SILC/LESS cholecystectomy and LC groups [14, 16, 18], increased perception in the SILC/LESS cholecystectomy group [15, 19], and decreased pain perception in the SILC/LESS cholecystectomy groups [12, 17]. The lack of consistent Drug_discovery evidence regarding pain perception requires further evaluation in randomized clinical trials.