Solo single-incision laparoscopic cholecystectomy: a safe substitute for conventional laparoscopic cholecystectomy

Background Despite the incremental application of single-incision laparoscopic cholecystectomy (SILC), this procedure has technical difficulties, including physical disturbance and an unstable surgical view through the small incision; therefore, we introduce the solo SILC (S-SILC) technique using a laparoscopic scope holder, as a simple, fixed and easy-to-perform procedure for an unassisted surgeon. Methods We performed a comparative analysis of S-SILC (n = 566) and conventional three-incision laparoscopic cholecystectomy (n = 874) performed from January 2013 to December 2016 at multiple centres. Results There was no significant difference of operative time between the two groups (P = 0.176); however, S-SILC showed a higher incidence of intraoperative gallbladder perforation, especially in the initial period (17.0% versus 2.3%, P < 0.001); and shorter post-operative hospital stay (3.3 +/- 1.7 versus 1.9 +/- 2.7 days, P < 0.001) than conventional three-incision laparoscopic cholecystectomy. There were no significant differences in major post-operative complications between the two groups (P = 0.909) and operation type (P = 0.971) was not a significant risk factor for major post-operative complications in multivariate analysis. Conclusion S-SILC is a feasible and safe procedure; however, careful selection of surgical candidates is necessary in the early period of the experience with this method.