Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy (Br J Surg 2010; 97: 1007–1012)

Single-incision surgery is regarded as a spin-off from natural orifice transluminal endoscopic surgery. The goals are to reduce postoperative pain and optimize cosmesis by minimizing the surgical trauma to the body wall. The technique combines single-port access with the basic concepts of endoscopic surgery. Both technique and instruments require extensive adaptation to the challenges of this approach. The report by Lee and colleagues is one of the first publications of a randomized comparison between single-incision surgery and the least traumatic traditional endoscopic approach. The study size is based on assumed differences in postoperative pain, but no difference was found. They confirmed better cosmesis by patient assessment. The main drawback was a longer duration of operation. Lee and colleagues should be complimented on their attempt to investigate the value of single-incision surgery in an early development phase. They have confirmed the general idea that the advantage of this technique is limited, but even small steps are of interest in an era focused on technological innovation. Further studies should try to confirm these results but, when the benefit is small, emphasis on adverse events is warranted. This should include confirmation of the critical view of safety in laparoscopic cholecystectomy under all circumstances, rates of umbilical wound infection and hernia during follow-up, cost–benefit analysis, and ergonomic consequences for the surgical team.