Single incision laparoscopic surgery (SILS) where do we stand?

Background-Aim The generalized trend for reduction of surgical trauma and its repercussions has led to advancements in Minimal Access Surgery (MAS), such as Single Incision Laparoscopic Surgery (SILS) and, more specifically, Single Incision Laparoscopic Cholecystectomy (SILC) which has progressively attracted the interest of the global surgical community. In the era of evidence-based medicine, the weaknesses, merits and dangers surrounding this revolutionary technique need to be analysed before being introduced into broad practice. This review attempts to compare SILC with MLC (Multi-Lumen Laparoscopic Cholecystectomy) in regard to its indications, contraindications, post-operative complications and emerging name dilemmas as they arise in pilot SILS programs. Material-Method Internet and contemporary literature research for SILS. Data sources: Pubmed, Biocentral, Google, Journal of Minimal Access Surgery, Surgical Endoscopy, UptoDate, Research-Gate. Keywords: Laparoscopic Cholecystectomy, Laparo Endoscopic Surgery, SILS, SILC, LESS Results SILC to MLC conversion rate was 9.3 % and conversion to open 0.4%. Post-operative complications ranged from 0–20 %. The commonest intra-operative complications included choledochal cyst perforation with bile leak and bleeding. Typical post-operative complications were haematoma formation, bile leak and choledocholithiasis. The risk of complication was lower in patients younger than 45, while operative time increased with BMI >30. While operating on acute cholecystitis did not increase the complication rate, it incurred a longer operative time. The surgical infection rate was 2.1%. To date, just two randomized trials comparing SILC with MLC have become available, both of small power. In regard to post-operative pain, the first study found no significant change in pain score, analgesia need or discharge time, whereas the second noted a significant reduction in post-operative reflect shoulder pain within 6 hours and in surgical site pain within 12 hours. Furthermore, the first trial described an improved cosmetic result, lesser surgical scar length and longer intra-operative times. Conclusions SILC seems to possess the same indications as MLC, but its contraindications resemble those of MLC during its slope phase of the learning curve. It seems that the new technique is superior in terms of the cosmetic result, while post-operative pain and return to normal activities appear to be comparable or better. A statistically signi