• laparoscopic cholecystectomy
• local infiltration analgesia
• pain
• recovery
• rectus sheath block

• Applied Medicine Research Project Fund of Hefei Health Committee
• Postgraduate Innovation Research and Practice Program of Anhui Medical University

• cholecystectomy
• marionette technique
• single-incision laparoscopic

Single incision laparoscopic cholecystectomy has become more popular recently. Because it yields shorter hospitalization, less postoperative pain, and better cosmetic outcomes. As it minimizes the number of incisions, it causes less trauma to the anterior abdominal wall and this decreases the operative mortality and morbidity. In this study, our aim is to share our results from the procedure so that surgeons in the field may consider adopting this approach when performing a laparoscopic cholecystectomy.

This is a retrospective study of 125 patients that underwent single-incision cholecystectomy. These patients underwent the procedure in a specialized center. We extracted data and surveyed patients who underwent the procedure between 2017 and 2019, and that were performed by the same consultant using the standard tools of laparoscopic surgery. All patients were followed for 12 months. The postoperative survey includes; the cosmetic appearance of the surgical site, pain management after the procedure, and patient satisfaction with this experience.

Most of the patients were satisfied with postoperative pain management and their cosmetic appearance. Most of the patients were females diagnosed with cholelithiasis preoperatively. The mean age of the patients was 37.43 ± 10.72 years, the mean BMI of the participants was 29.68 ± 6.51 kg/m² and the mean operative time was 25.56 ± 10.42 min.

Single incision laparoscopic cholecystectomy has the potential to become the procedure of choice for cholecystectomy.

•

Single incision laparoscopic cholecystectomy has become more popular recently. Because it yields shorter hospitalization, less postoperative pain, and better cosmetic outcomes.

• Cholecystectomy
• Laparoscopic
• Robotic
• Single-incision

Laparoscopic cholecystectomy (LC) is the standard treatment for acute cholecystitis (AC), and it should be performed within 72 h of symptoms onset if possible. In many undesired situations, LC was performed beyond the golden 72 h. However, the safety and feasibility of prolonged LC (i.e., performed more than 72 h after symptoms onset) are largely unknown, and therefore were investigated in this study.

We retrospectively enrolled the adult patients who were diagnosed as AC and were treated with LC at the same admission between January 2015 and October 2018 in an emergency department of a tertiary academic medical center in China. The primary outcome was the rate and severity of adverse events, while the secondary outcomes were length of hospital stay and costs.

Among the 104 qualified patients, 70 (67.3%) underwent prolonged LC and 34 (32.7%) underwent early LC (< 72 h of symptom onset). There were no differences between the two groups in mortality rate (none for both), conversion rates (prolonged LC 5.4%, and early LC 8.8%, P = 0.68), intraoperative and postoperative complications (prolonged LC 5.7% and early LC 2.9%, P ≥ 0.99), operation time (prolonged LC 193.5 min and early LC 198.0 min, P = 0.81), and operation costs (prolonged LC 8,700 Yuan, and early LC 8,500 Yuan, P = 0.86). However, the prolonged LC was associated with longer postoperative hospitalization (7.0 days versus 6.0 days, P = 0.03), longer total hospital stay (11.0 days versus 8.0 days, P < 0.01), and subsequently higher total costs (40,400 Yuan versus 31,100 Yuan, P < 0.01).

Prolonged LC is safe and feasible for patients with AC for having similar rates and severity of adverse events as early LC, but it is also associated with longer hospital stay and subsequently higher total cost.

• 72 h of symptoms onset
• Acute cholecystitis
• Prolonged versus early laparoscopic cholecystectomy

To describe the techniques, short-term outcomes, and learning curve of solo single-incision laparoscopic cholecystectomy (Solo-SILC) using a laparoscopic scope holder.

A total of 591 patients who underwent Solo-SILC from July 2014 to December 2016 performed by four experienced hepatobiliary surgeons were retrospectively assessed. Solo-SILC was performed using the parallel method using a scope holder. The moving average method was used to investigate the learning curve in terms of operative time.

In total, 590 Solo-SILC procedures were performed. Very few procedures were converted to multi-port laparoscopic cholecystectomy. There was one case of bile duct injury. The mean operative time (59.93±25.77 min) was shorter than that in other studies of SILC. Three postoperative complications, delaying bile leakage, occurred in the patients treated by one surgeon. These cases were resolved by ultrasound-guided puncture and drainage. The learning curve for surgeons A, B, and C was overcome after 14, 12, and 12 cases. Surgeon D, who had the most experience with SILC, had no obvious learning curve.

Hepatobiliary surgeons experienced in LC can perform Solo-SILC almost immediately. Solo-SILC using the parallel technique represents a more stable option and is a promising treatment for gallbladder disease.

• Cholecystectomy
• Laparoscopy
• Learning curve
• Minimally invasive surgical procedures

It is now established that prophylactic drainage is not needed after laparoscopic cholecystectomy (LC) for chronic calculous cholecystitis. However, the benefit of drains versus their potential harm for acute calculous cholecystitis (ACC) following laparoscopic LC has been questioned. Therefore, we conducted a comparative study to assess the need for drainage.

Between January 2014 and October 2016, 212 patients with ACC undergoing LC undergo either drainage (n= 106) or no drainage (n= 106). The primary end points were the number of patients with postoperative drain-related complications, early and late Visual Analogue Scale (VAS) score, and hospital stay. Secondary end points included estimated blood loss, postoperative recovery, analgesia requirement, and cosmetic satisfaction result.

There was no bile duct injury and mortality in both groups. The overall complication rate was 12.5% with no significant difference between those with or without drainage (P=0.16). Normal activity resumption was significantly faster and the postoperative hospital stay was slightly shorter in the nondrainage group (P =0.03 and P= 0.04, respectively). The early VAS score in the drainage group was significantly higher (p< 0.05). There were no significant differences between the two groups in postoperative hematology test, late VAS score, and patient satisfaction of cosmetic outcome.

Routine drainage for patients with ACC after LC may not be justified with similar drain-related complications compared with nondrainage group.

• Comparison
• Early results
• Laparoscopic cholecystectomy
• Multi port
• Quality of life
• Single incision

Since multiport laparoscopic cholecystectomy has become a standard treatment for gallbladder (GB) disease, a single incision laparoscopic surgical technique has been tried to decrease the surgical site pain and achieve a better cosmetic out come in selected patients. The development of devices dedicated for single incision laparoscopic cholecystectomy (SILC) is expanding the indication of this single incision laparoscopic technique to more complicated GB diseases. Mirizzi syndrome (MS) is one of the complex uncommon gallstone diseases in patients undergoing cholecystectomy. Because the laparoscopic procedure has become a routine treatment for cholecystectomy, several studies have reported their experience with the laparoscopic technique for the treatment of MS with a comparable outcome in Csendes type I or II. Because the indication for SILC cholecystectomy is expanded to more complicated GB conditions, and the desire of patients for a less painful, better cosmetic surgical outcome has increased, our medical center used this single incision laparoscopic surgical technique for MS Csendes types I and II patients. Here, we report 2 successful cases of SILC for patients with MS types I and II without significant morbidity.

• Cholecystitis
• Laparoscopic cholecystectomy
• Mirizzi syndrome
• Single incision

• Laparoscopic cholecystectomy
• Needlescopic cholecystectomy
• Randomized clinical trial
• Single-incision laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) does not require advanced techniques, and its performance has therefore rapidly spread worldwide. However, the rate of biliary injuries has not decreased. The concept of the critical view of safety (CVS) was first documented two decades ago. Unexpected injuries are principally due to misidentification of human factors. The surgeon’s assumption is a major cause of misidentification, and a high level of experience alone is not sufficient for successful LC. We herein describe tips and pitfalls of LC in detail and discuss various technical considerations. Finally, based on a review of important papers and our own experience, we summarize the following mandatory protocol for safe LC: (1) consideration that a high level of experience alone is not enough; (2) recognition of the plateau involving the common hepatic duct and hepatic hilum; (3) blunt dissection until CVS exposure; (4) Calot’s triangle clearance in the overhead view; (5) Calot’s triangle clearance in the view from underneath; (6) dissection of the posterior right side of Calot’s triangle; (7) removal of the gallbladder body; and (8) positive CVS exposure. We believe that adherence to this protocol will ensure successful and beneficial LC worldwide, even in patients with inflammatory changes and rare anatomies.

• Laparoscopic cholecystectomy
• Gallbladder
• Critical view of safety
• Biliary injury
• Protocol

• Biliary Tract Diseases/etiology
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Clinical Competence
• Clinical Protocols
• Elective Surgical Procedures
• Humans
• Learning Curve
• Patient Safety
• Risk Factors
• Treatment Outcome

• nerve block
• port sites
• rectus sheath block
• robotic cholecystectomy

• Adult
• Aged
• Anesthetics, Local/administration & dosage
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Female
• Follow-Up Studies
• Humans
• Middle Aged
• Nerve Block/methods
• Pain Measurement
• Pain, Postoperative/prevention & control
• Prospective Studies
• Rectus Abdominis/drug effects
• Risk Assessment
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods
• Robotics
• Single-Blind Method
• Treatment Outcome
• Ultrasonography, Interventional/methods

• Perception
• single-incision laparoscopic surgery
• surgeon

• Articulating instrumentation
• Performance assessment
• Simulation
• Single-port access surgery
• Surgical education

• Single-incision
• cholecystectomy
• conventional
• laparoscopic
• technique

• Interpersonal and Communication Skills
• Practice-Based Learning and Improvement
• Systems-Based Practice
• curved instrument
• learning curve
• single-port training curriculum
• straight instrument

• Adult
• Clinical Competence
• Education, Medical/methods
• Equipment Design
• Humans
• Hungary
• Laparoscopy/education
• Laparoscopy/instrumentation
• Motor Skills
• Prospective Studies
• Simulation Training
• Surgical Instruments
• Surveys and Questionnaires

• Intracorporeal suturing
• Objective and subjective assessment
• Reduced port laparoscopic surgery
• Single-port surgery

• Cholecystectomy
• GB (gall bladder)
• Laparoscopic
• SILC
• SILS
• Single incision

The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them.

A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality.

The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

• Hiatal exposure
• laparoscopic surgery
• liver retraction techniques
• single incision surgery

• Postoperative pain
• rectus sheath block
• single-incision laparoscopic cholecystectomy

• 8-Isoprostane
• Laparoendoscopic single-site cholecystectomy
• Oxidative stress
• Standard laparoscopic cholecystectomy
• Uric acid

Safety and relief of symptoms appeared to be most important to patients with gallbladder disease, whereas postprocedural aesthetics was less important.

Single-incision laparoscopic cholecystectomy (SILC) is gradually being adopted into general surgical practice. The potential risks and benefits are still being studied, and little is known about how patients perceive this new surgical technique.

After providing patients with basic educational materials on laparoscopic cholecystectomy (LC) and SILC, we administered a questionnaire exploring patients' perspectives of the importance of postoperative pain, scar appearance, risk of complications, and cost regarding their preference for SILC versus LC.

Among 100 patients (mean age, 43.3 years), the majority were women (85%), white (85%), college educated (77%), and privately insured (85%). Indications included biliary dyskinesia (43%), biliary colic (48%), and acute cholecystitis (9%). Patients stated that they would be somewhat or very interested in SILC if recommended by their surgeon (89%), although 35% were somewhat or very concerned about the lack of long-term results. The majority would accept no additional risk to undergo SILC. Scar appearance was somewhat or very important to <40% of patients, whereas pain was somewhat or very important to 79%. Only 27% of patients would spend >$100 to undergo SILC. When asked to rank pain, appearance, symptom resolution, personal cost, and risk of complications, 52% ranked symptom resolution, 20% ranked pain, and 19% ranked risk of complications as most important.

Safety and relief of symptoms are most important to patients with gallbladder disease, whereas postprocedural esthetics was relatively unimportant and few would be willing to pay more for SILC versus LC. However, if the surgeon recommends SILC, most patients would trust this recommendation.

• Adult
• Aged
• Aged, 80 and over
• Cholecystectomy, Laparoscopic/methods
• Cholecystitis/surgery
• Drainage/methods
• Female
• Gallbladder
• Humans
• Length of Stay/statistics & numerical data
• Liver
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Treatment Outcome

AIM: To explore the technique for laparoendoscopic single-site distal pancreatectomy.

METHODS: Laparoendoscopic single-site spleen-preserving distal pancreatectomy was performed in pigs using a novel flexible multichannel port, a curved laparoscopic multifunctional operative device and a fish hook retractor, which provided a favorable operative field.

RESULTS: Six pigs were involved in this study, and five survived the procedure. The first animal died following injury to the superior mesenteric vein and uncontrolled intraoperative bleeding. Except for this failure, the mean operative time was 155 min (range: 102-236 min). A steep learning curve was observed in the study, with a mean operative time of 177 min in the first two operations vs 134 min in the last three operations. The mean blood loss was 50 mL, and the postoperative course was uneventful. The animals were sacrificed three weeks after the procedures, and no pancreatic leakage or abdominal infection was found macroscopically.

CONCLUSION: Laparoendoscopic single-site distal pancreatectomy is a safe and feasible procedure and can be implemented in humans in selected cases at qualified surgical centers.

• Laparoendoscopic single-site surgery
• LESS
• Pancreatectomy
• Fish hook retraction
• Curved laparoscopic multifunctional operative device

• Animals
• Blood Loss, Surgical
• Equipment Design
• Laparoscopes
• Laparoscopy/adverse effects
• Laparoscopy/instrumentation
• Learning Curve
• Models, Animal
• Operative Time
• Pancreatectomy/adverse effects
• Pancreatectomy/instrumentation
• Pancreatectomy/methods
• Sus scrofa
• Time Factors

Adverse events because of medical errors are a leading cause of death in the United States (US) exceeding the mortality rates of motor vehicle accidents, breast cancer, and AIDS. Improvements can and should be made to reduce the rates of preventable surgical errors because they account for nearly half of all adverse events within hospitals. Although minimally invasive surgery (MIS) has proven patient benefits such as reduced postoperative pain and hospital stay, its operative environment imposes substantial physical and cognitive strain on the surgeon increasing the risk of error. To mitigate errors and protect patients, a multidisciplinary approach is needed to improve MIS. Clinical human factors, and biomedical engineering principles and methodologies can be used to develop and assess laparoscopic surgery instrumentation, practices, and procedures. First, the foundational understanding and the imperative to transform health care into a high-quality and safe system is discussed. Next, a generalized perspective is presented on the impact of the design and redesign of surgical technologies and processes on human performance. Finally, the future of this field and the research needed to further improve the quality and safety of MIS is discussed.

• health care quality
• human factors and ergonomics
• minimally invasive surgery
• patient safety

• cholecystectomy
• laparoscopy
• meta-analysis
• outcome
• single incision

AIM: To assesse the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC).

METHODS: SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside.

RESULTS: From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ≥ 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%.

CONCLUSION: The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.

• Bile ducts
• Cholecystectomy
• Single port
• Single incision

• Bile Ducts/injuries
• Biliary Tract Diseases/etiology
• Cholecystectomy, Laparoscopic/adverse effects
• Humans
• Patient Safety
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome

• Aged
• Cholecystectomy/instrumentation
• Cholecystectomy/methods
• Cholecystectomy, Laparoscopic/instrumentation
• Colectomy/instrumentation
• Cost-Benefit Analysis
• Equipment Design
• Equipment Reuse/economics
• Female
• Gallstones/surgery
• Gastrectomy/instrumentation
• Gastrectomy/methods
• Humans
• Laparoscopy/instrumentation
• Length of Stay/economics
• Male
• Middle Aged
• Obesity, Morbid/surgery
• Operative Time
• Splenectomy/instrumentation

Results of this study suggest that strategic laparoscopy for improved cosmesis cholecystectomy is feasible, safe, and decreases the cumulative incision length as well as the number of incisions in patients with favorable body habitus and previous surgical history.

Until the advent of single-incision laparoscopic surgery, few advances were aimed at improving cosmesis with laparoscopic cholecystectomy. Criticisms of the single-incision laparoscopic surgery technique include a larger incision and increased incidence of wound-related complications. We present our initial experience with a novel technique aimed at performing strategic laparoscopy for improved cosmesis (SLIC) for cholecystectomy.

Twenty-five patients with biliary symptoms were selected for SLIC cholecystectomy. Access to the abdomen was obtained with a 5-mm optical trocar in the left upper quadrant and a 5-mm trocar in the umbilicus. Retraction was performed by a transabdominal suture in the dome of the gallbladder and a needlescopic grasper. Age, American Society of Anesthesiologists score, body mass index, operative time, length of stay, pathology results, and short-term complications at follow-up were prospectively recorded.

The 25 female patients had a mean age of 34.3 years and mean body mass index of 24 kg/m². American Society of Anesthesiologists scores ranged from 1 to 3. The mean operative time was 51.3 minutes. Pathology revealed chronic cholecystitis in all patients. All procedures were performed on an outpatient basis. The only complication was one ultrasonography-documented deep vein thrombosis. All 25 planned SLIC cholecystectomies were successfully completed.

SLIC cholecystectomy is feasible and safe. This technique decreases the cumulative incision length, as well as the number of incisions, leading to very desirable cosmetic results in patients with a favorable body habitus and surgical history.

• Cholecystectomy
• Laparoscopy
• Surgery

• da Vinci Single-Site robotic system
• laparoendoscopic single site cholecystectomy (LESS-C)
• laparoendoscopic single site surgery (LESS)
• robotic single port cholecystectomy (R-LESS-C)

• Adult
• Cholecystectomy/methods
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Robotic Surgical Procedures
• Young Adult

• Laparoscopic
• cholecystectomy
• single incision
• single port

• Adult
• Aged
• Cholecystectomy, Laparoscopic/economics
• Cholecystectomy, Laparoscopic/statistics & numerical data
• Female
• Gallbladder Diseases/economics
• Gallbladder Diseases/surgery
• Humans
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Treatment Outcome

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).

METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.

RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.

CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.

• Single incision laparoscopic surgery
• Cholecystectomy
• Learning curve
• Suture-suspension

• Adolescent
• Adult
• Aged
• Analysis of Variance
• Blood Loss, Surgical
• Chi-Square Distribution
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Clinical Competence
• Female
• Humans
• Learning Curve
• Length of Stay
• Male
• Middle Aged
• Patient Discharge
• Postoperative Complications/etiology
• Retrospective Studies
• Suture Techniques/adverse effects
• Task Performance and Analysis
• Time Factors
• Treatment Outcome
• Young Adult

Cost for single-port cholecystectomy in the outpatient setting was found to be greater than the cost for micro-laparoscopic or conventional laparoscopic cholecystectomy.

This study compares hospital costs and clinical outcomes for conventional laparoscopic, single-port, and mini-laparoscopic cholecystectomy from US hospitals.

Eligible patients were aged ≥18 years and undergoing laparoscopic cholecystectomy with records in the Premier Hospital Database from 2009 through the second quarter of 2010. Patients were categorized into 3 groups—conventional laparoscopic, single port, or mini-laparoscopic—based on the International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes and hospital charge descriptions for surgical tools used. A procedure was considered mini-laparoscopic if no single-port surgery products were identified in the charge master descriptions and the patient record showed that at least 1 product measuring <5 mm was used, not more than 1 product measuring >5 mm was used, and the measurements of the other products identified equaled 5 mm. Summary statistics were generated for all 3 groups. Multivariable analyses were performed on hospital costs and clinical outcomes. Models were adjusted for demographics, patient severity, comorbid conditions, and hospital characteristics.

In the outpatient setting, for single-port surgery, hospital costs were approximately $834 more than those for mini-laparoscopic surgery and $964 more than those for conventional laparoscopic surgery (P < .0001). Adverse events were significantly higher (P < .0001) for single-port surgery compared with mini-laparoscopic surgery (95% confidence interval for odds ratio, 1.38–2.68) and single-port surgery versus conventional surgery (95% confidence interval for odds ratio, 1.37–2.35). Mini-laparoscopic surgery hospital costs were significantly (P < .0001) lower than the costs for conventional surgery by $211, and there were no significant differences in adverse events.

These findings should inform practice patterns, treatment guidelines, and payor policy in managing cholecystectomy patients.

• Agujas percutáneas
• Cirugía endoscópica transluminal a través de orificios naturales
• Cirugía sin huella
• Colecistectomía laparoscópica
• Laparo endoscopic single site
• Laparoendoscopic single-site surgery
• Laparoscopic cholecystechtomy
• Natural orifice translumenal endoscopic surgery
• Percutaneous needle
• Puerto único
• Scarless surgery
• Single port