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Invited Critique
December 20, 2010

Single-Incision Laparoscopic Surgery: Are We Doomed to Repeat the Mistakes of the Past?Comment on “Single-Incision Laparoscopic Surgery for Cholecystectomy”

Author Affiliations

Author Affiliation: Department of Surgery, Stanford University, Stanford, California.

Arch Surg. 2010;145(12):1191-1192. doi:10.1001/archsurg.2010.266

Although Chow and colleagues postulate several potential benefits to SILS, thus far the only proven ones have been improved cosmesis and patient satisfaction. Patient satisfaction is an important outcome variable, but it decreases in importance if the new procedure is associated with increased operative time, increased cost, and/or increased complication rates without any other benefits.

There was a significant learning curve associated with the transition from open to laparoscopic surgery, and many of the arguments made against laparoscopic cholecystectomy 20 years ago are similar to the arguments currently voiced against SILS. However, the transition from open to laparoscopic surgery was associated with significant patient-related benefits including less pain, shortened hospital stay, earlier return to normal activities, and a decrease in some complications. These benefits do not appear to apply to SILS. The benefit is much smaller, yet many people have found the difficulty in learning laparoscopic surgery to be similar to that in learning SILS. Single-incision laparoscopic surgery is associated with significant technical difficulties including poor ergonomics, lack of triangulation, multiple collisions, and need for a skilled assistant.

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