Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy: A updated Meta-analysis of Randomized Controlled Trials

Weizhong Tang; Bo Zhao; Xiaoyong Cai; Yu Lei; Jianjun Li; Yansong Xu; Yubin Huang; Fei Huang; Wenqi Lu; Wenshu Jiang; Xiaojian Jin

Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy: A updated Meta-analysis of Randomized Controlled Trials

Weizhong Tang^1*, Bo Zhao², Xiaoyong Cai², Yu Lei², Jianjun Li², Yansong Xu¹, Yubin Huang², Fei Huang², Wenqi Lu², Wenshu Jiang², Xiaojian Jin²

¹Department of Anal and Colorectal Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China

²Department of general Surgery, the Second Affiliated Hospital of Guangxi Medical University, Guangxi, China

*Corresponding author: Weizhong Tang, Department of Colorectal Surgery, Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning 530021, China. Tel: +867715322120; Email: tangweizhong6985@163.com.cn

Received Date: 07 July, 2017; Accepted Date: 11 July, 2017; Published Date: 18 July, 2017

Citation: Tang W, Zhao B, Cai X, Lei Y, Li J, et al. (2017) Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy: A updated Meta-analysis of Randomized Controlled Trials. J Surg 2017: 153. DOI: 10.29011/2575-9760.000153

1. Abstract

1.1.Objectives: To assess the clinical efficacy of Single-Incision Laparoscopic Cholecystectomy (LESS) compared with Traditional Laparoscopic Cholecystectomy (TLC) based on published literature.

1.2. Subjects and Methods: An online systematic search Randomized Controlled Trials (RCTs) comparing LESS with TLC were included Pubmed, Embase and the Cochrane Library. The inclusion and extraction of the data were completed by two authors independently. Meta-analysis was performed using version Review Manager 5.1.4 software. The clinical outcomes measures were demographics, postoperative Visual Analog Scale pain score, operative complication rate, intraoperative blood loss, cosmetic score, postoperative hospital stay, operating time, wound length; operating time, quality of life score was evaluated by Odds Ratio (OR) and Standard Mean Difference (SMD) according to the different types of data. A meta-analysis of the outcomes was conducted.

1.3. Results: Fifteen RCTs involving 1069 patients met the predefined inclusion criteria. The cosmetic score of the LESS group was statistically higher than that for TLC. (SMD, 0.55; 95 % CI, 0.20, 0.90; p = 0.002); the postoperative hospital stay of the LESS group was statistically shorter than that for TLC. (SMD, -0.24; 95 % CI, -0.44, -0.04; p = 0.02); the operating time of LESS groups was statistically longer than TLC. (SMD, 0.83; 95 % CI, 0.52, 1.14; p < 0.00001); the wound length of LESS was statistically smaller than TLC. (SMD, -2.90; 95 % CI, - 4.22, -1.58; p < 0.0001); the quality of life of LESS was statistically better than that for TLC. (SMD, 1.17; 95 % CI, 0.06, 2.28; p =0.04); There was no significant difference between the two groups with Visual Analog Scale pain score, intraoperative blood loss, perioperative complication rate.

1.4. Conclusion: LESS is associated with a higher cosmetic score, shorter postoperative hospital stays, smaller wound length, better short-term quality of life compared with TLC.

2. Keywords: Laparoscopic Cholecystectomy; Meta-Analysis; Single-Incision; Traditional Laparoscopic Cholecystectomy

Figure 1: Meta-analysis of Visual Analog Scale pain score in Laparoendoscopic Single-Site (LESS) cholecystectomy versus Traditional Laparoscopic Cholecystectomy (TLC) patients. CI, confidence interval; SD, Standard Deviation; IV: Inverse Variance.

Figure 2: Meta-analysis of perioperative complication rate in LESS versus TLC patients.

Figure 3: Meta-analysis of intraoperative blood loss in LESS versus TLC patients.

Figure 4: Meta-analysis of cosmetic score in LESS versus TLC patients.

Figure 5: Meta-analysis of postoperative hospital stay in LESS versus TLC patients.

Figure 6: Meta-analysis of operating time in LESS versus TLC patients.

Figure 7: Meta-analysis of wound length in LESS versus TLC patients.

Figure 8: Meta-analysis of QoF in LESS versus TLC patients.

Reference (year)	Design type	Patients (n)		Age (years)		Gender (M/F)		Journal	Comparison	Measured outcomes
Reference (year)	Design type	LESS	TL	LESS	TL	LESS	TL	Journal	Comparison	Measured outcomes
Lai, et al. (2011) [9]	RCT	27	24	54.3±12.0	51.7±13.3	16/8	16/11	The American Journal of Surgery	Four-port TL VS. LESS	1, 3, 4, 5,7
Ostlie, et al. (2012) [10]	RCT	30	30	13.3±3.3	14.0±3.2	24/6	24/6	Journal of Pediatric Surgery	Four-port TL VS. LESS	1,5,6,8
Aprea, et al. (2010) [11]	RCT	25	25	44.0±10.0	45.5± 9.4	-	-	Journal of Surgical Research	Four-port TL VS. LESS	1,4,5,6
Evangelos, et al. (2010) [12]	RCT	20	20	47.9± 9.8	49.2±16.9	13/12	19/6	Surg Endosc	Four-port TL VS. LESS	1,2,3
Phillips, et al. (2012) [13]	RCT	117	80	45.6	44.1	28/29	23/56	Surg Endosc	Four-port TL VS. LESS	1,2,4,6
Madureira, et al. (2013) [14]	RCT	28	29	50	56	28/89	23/56	Surg Endosc	Four-port TL VS. LESS	1,2,6,7
Renato, et al. (2013) [15]	RCT	20	20	-	-	-	-	Surg Endosc	Four-port TL VS. LESS	1,6
Jun, et al. (2011) [16]	RCT	21	22	57.3±16.0	45.8±11.9	-	-	Annals of Surgery	Four-port TL VS. LESS	1,2,4,6
Saad, et al. (2012) [17]	RCT	35	35	49±14	45±17	26/9	28/7	British Journal of Surgery	Four-port TL VS. LESS	2,4,5,6
Sasaki, et al. (2012) [18]	RCT	27	27	56.6 (14.2)	/58.2 (12.3)	14/13	14/13	Surg Laparosc Endosc Percutan Tech	Four-port TL VS. LESS	1,2,3,4,5,6
Zhan Guo Cao, et al. (2011) [19]	RCT	57	51	62.2±5.1	59.7±4.4	23/34	21/29	Surg Laparosc Endosc Percutan Tech	Four-port TL VS. LESS	1,2,3,5,6,7
Bucher, et al. (2011) [20]	RCT	75	75	42	44	-	-	British Journal of Surgery Society	Four-port TL VS. LESS
Asakuma, et al. (2011) [21]	RCT	24	25	57	66	11/13	13/12	British Journal of Surgery	Four-port TL VS. LESS	1,5,6
MingweiZheng, et al. (2012) [22]	RCT	30	30	43.6± 11.3	46.8± 14.4	13/17	16/14	Informa Healthcare	Four-port TL VS. LESS	1,4,6
Lirici, et al. (2011) [23]	RCT	20	20	-	-	-	-	The American Journal of Surgery	Four-port TL VS. LESS	1,6

Table 1: Baseline Characteristics of Studies Included.

Reference (year)	Randomization	Blinding	Withdrawals and dropouts	Jadad score	Setting
Lai, et al. (2011) [9]	Yes	Double-blind	Clearly reported	4	Single center
Aprea, et al. (2010) [11]	Yes	Single-blind	Clearly reported	4	Single center
Evangelos, et al. (2010) [12]	Yes	Single-blind	Clearly reported	4	Single center
Phillips, et al. (2012) [13]	Yes	Single-blind	Clearly reported	4	Multicenter
Madureira, et al. (2013) [14]	Yes	Single-blind	Clearly reported	4	Single center
Renato, et al. (2013) [15]	Yes	Single-blind	Clearly reported	4	Single center
Jun, et al. (2011) [16]	Yes	Double-blind	Clearly reported	4	Single center
Saad, et al. (2012) [17]	Yes	Double-blind	Clearly reported	4	Single center
Sasaki, et al. (2012) [18]	Yes	Double-blind	Clearly reported	4	Single center
Zhan Guo Cao, et al. (2011) [19]	Yes	Double-blind	Clearly reported	4	Single center
Bucher, et al. (2011) [20]	Yes	Not stated	Clearly reported	3	Single center
Mingwei Zheng, et al. (2012) [22]	Yes	Double-blind	Clearly reported	4	Single center
Lirici, et al. (2011) [23]	Yes	Single-blind	Clearly reported	4	Multicenter
Asakuma, et al. (2011) [21]	Yes	Single-blind	Clearly reported	4	Single center
Daniel J. Ostlie, et al. (2012) [10]	Yes	Single-blind	Clearly reported	4	Single center

Table 2: Quality Assessment of Studies Included.

Single-Incision Laparoscopic Cholecystectomy Versus Traditional Laparoscopic Cholecystectomy: A updated Meta-analysis of Randomized Controlled Trials

Journal of Surgery