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Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy?



Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. Single-incision laparoscopic surgery has recently emerged as a less invasive potential alternative to conventional three- or four-port laparoscopy. However, the feasibility of single-incision laparoscopic cholecystectomy (SILC) remains unclear, and there are no rigorous criteria in the literature. Identifying patients at risk of failure of this new technique is essential. The aim of our study was to determine risk factors that may predict failure of the procedure.


From May 2010 to March 2012, 110 consecutive patients underwent SILC and were reviewed retrospectively. The main feasibility criterion was the procedure failure rate, defined as addition of supplementary port(s) and prolonged (>60 min) operative time. The factors evaluated were age, gender, height, weight, body mass index, previous abdominal surgery, indication for surgery and gallbladder suspension.


There was conversion in 16 patients (14.5 %), and the operative time exceeded 60 min for 20 patients (30.9 %). Univariate analysis showed a significant independent association between additional port requirement and each of weight as a continuous value, weight ≥80 kg, BMI >26.5 kg/m2 and height >172 cm. Univariate analysis also showed a significant independent association between prolonged operative duration (>60 min) and each of height and weight as continuous values, height >172 cm and previous abdominal surgery. In the multivariate analysis, only weight remained independently associated with additional port requirement, and height remained independently associated with prolonged operative duration.


Preoperative identification of the factors increasing the risk of conversion may assist surgeons in making decisions concerning the management of patients, including appropriate use of SILC.

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  1. 1.

    Cameron JL, Gadacz TR (1991) Laparoscopic cholecystectomy. Ann Surg 213:1–2

  2. 2.

    Gadacz TR, Talamini MA, Lillemoe KD, Yeo CJ (1990) Laparoscopic cholecystectomy. Surg Clin North Am 70:1249–1262

  3. 3.

    Cuschier A, Terblanche J (1990) Laparoscopic cholecystectomy: evolution, not revolution. Surg Endosc 4:125–126

  4. 4.

    National Institutes of Health Organization, Gallstones and Laparoscopic Cholecystectomy, NIH Consensus Statement, Natcher Conference Center, NIH, Bethesda, Md, USA, 1992

  5. 5.

    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

  6. 6.

    Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS One 2;8(10). doi:10.1371/0076530

  7. 7.

    Antoniou SA, Pointner R, Granderath FA (2011) Single incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 25:367–377

  8. 8.

    Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, Noya G, Boselli C (2013) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic choleystectomy. Br J Surg 100:191–208

  9. 9.

    Cuesta MA, Berends F, Veenhof AA (2008) The « invisible cholecystectomy » : a transumbilical laparoscopic operation without a scar. Surg Endosc 22:1211–1213

  10. 10.

    Bignell M, Hindmarsh A, Nageswaran H, Mothe B, Jenkinson A, Mahon D, Rhodes M (2011) Assessment of cosmetic outcome after laparoscopic cholecystectomy among women 4 years after laparoscopic cholecystectomy: is there a problem? Surg Endosc 25:2574–2577

  11. 11.

    Monkhouse SJ, Court EL, Beard LA, Bunni J, Burgess P (2012) A retrospective wound review of standardfour-port laparoscopic cholecystectomy: is there need for single-port laparoscopic surgery? Surg Endosc 26:255–260

  12. 12.

    Bucher P, Pugin F, Ostermann S, Ris F, Chilcott M, Morel P (2011) Population perception of surgical safety and body image trauma: a plea for scarless surgery? Surg Endosc 25:408–415

  13. 13.

    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy vs classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848

  14. 14.

    Jørgensen LN, Rosenberg J, Al-Tayar H, Assaadzadeh S, Helgstrand F, Bisgaard T (2014) Randomized clinical trial of single- versus multi-incision laparoscopic cholecystectomy. Br J Surg 101:347–355

  15. 15.

    Chuang SH, Chen PH, Chang CM, Lin CS (2013) Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis. World J Gastroenterol 19:7743–7750

  16. 16.

    Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK (2011) Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg 202:254–258

  17. 17.

    Joseph M, Phillips MR, Farell TM, Rupp CC (2012) Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word caution. Ann Surg 256:1–6

  18. 18.

    Alptekin H, Yilmaz H, Acar F, Kafali M, Sahin M (2012) Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 22:731–737

  19. 19.

    Shussman N, Schlager A, Elazary R, Khalaileh A, Keidar A, Rivkind AI, Mintz Y (2011) Single-incision laparoscopic cholecystectomy: lessons learned for success. Surg Endosc 25:404–407

  20. 20.

    Rao PP, Bhagwat SM, Rane A, Rao PP (2008) The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HBP (Oxford) 10:336–340

  21. 21.

    Broderick RC, Omelanczuk P, Harnsberger CR, Fuchs HF, Berducci M, Nefa J, Nicolia J, Almadani M, Jacobsen GR, Sandler BJ, Horgan S (2014) Laparoscopic cholecystectomy using a novel single-incision surgical platform through a standard 15 mm trocar: initial experience and technical details. Surg Endosc. doi:10.1007/s00464-014-3779-0

  22. 22.

    Tacchino R, Greco F, Matera D (2009) Single-Incision Laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23:896–899

  23. 23.

    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

  24. 24.

    Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo PG 2nd, Desai MM, Evanko JC, Falcone T, Fazio V, Gettman M, Gumbs AA, Haber GP, Kaouk JH, Kim F, King SA, Ponsky J, Remzi F, Rivas H, Rosemurgy A, Ross S, Schauer P, Sotelo R, Speranza J, Sweeney J, Teixeira J (2010) Consensus statement of the consortiumfor laparoendoscopic, single-site surgery. Surg Endosc 24:762–768

  25. 25.

    Islam A, Castellvi AO, Tesfay ST, Castellvi AD, Wright AS, Scott DJ (2011) Early surgeon impressions and technical difficulty associated with laparoedoscopic single-site surgery: a Society of American Gastrointestinal and Endoscopic Surgeons Learning Center study. Surg Endosc 25:1296–1303

  26. 26.

    Gumbs AA, Milone L, Sinha P, Bessler M (2009) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13:533–534

  27. 27.

    Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy: a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35:2092–2101

  28. 28.

    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427

  29. 29.

    Hall T, Dennison AR, Bilku DK, Metcalfe MS, Garcea G (2012) Single-incision Laparoscopic Cholecystectomy A systematic review. Arch Surg 147:657–666

  30. 30.

    Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH (2006) Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg 30:1698–1704

  31. 31.

    Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM (1997) Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 21:629–633

  32. 32.

    Tang B, Cuschieri A (2006) Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg 10:1081–1091

  33. 33.

    Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK, Kim DG (2009) Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech A 19:495–499

  34. 34.

    Eldar S, Sabo E, Nash E, Abrahamson J, Mattei I (1997) Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg 21:540–545

  35. 35.

    Khambaty F, Brody F, Vaziri K, Edwards C (2011) Laparoscopic versus single-incision cholecystectomy. World J Surg 35:967–972

  36. 36.

    Chaudhary S, Bhullar JS, Subhas G, Mittal VK, Kolachalam R (2013) Single-incision laparoscopic cholecystectomy (SILC) using non-articulating instruments and conventional trocars-single surgeon experience. J Gastointest Surg 17:809–813

  37. 37.

    Rivas H, Varela E, Scott D (2010) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412

  38. 38.

    Erbella J, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24:1958–1961

  39. 39.

    Schirmer BD, Dix J, Edge SB, Hyser MJ, Hanks JB, Aguilar M (1992) Laparoscopic cholecystectomy in the obese patient. Ann Surg 216:146–152

  40. 40.

    Hussien M, Appadurai IR, Delicata RJ, Carey PD (2002) Laparoscopic cholecystectomy in the grossly obese : 4 years experience and review of literature. HPB 4:157–161

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Hélène Meillat, David Jérémie Birnbaum, Régis Fara, Julien Mancini, Stéphane Berdah, Thierry Bège have no financial or any other kind of personal conflicts of interest.

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Correspondence to Hélène Meillat.

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Meillat, H., Birnbaum, D.J., Fara, R. et al. Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy?. Surg Endosc 29, 3594–3599 (2015). https://doi.org/10.1007/s00464-015-4115-z

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  • Single incision
  • Cholecystectomy
  • Morbidity
  • Laparoscopy