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Comparative outcomes of single-incision laparoscopic, mini-laparoscopic, four-port laparoscopic, three-port laparoscopic, and single-incision robotic cholecystectomy: a systematic review and network meta-analysis

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Abstract

Benign gallbladder diseases are common in surgery department, and the laparoscopic cholecystectomy (LC) is the gold standard procedure for benign diseases of gallbladder. Laparoscopic cholecystectomy is conventionally performed using four laparoscopic ports. However, the clinical application of different LCs is equivocal and there is no comprehensive comparison to explore which surgical options could benefit patients with benign gallbladder diseases. A network meta-analysis (NMA) to evaluate the efficacy of the different LCs could benefit patients with benign gallbladder diseases by comprehensive comparison. A systematic literature search was performed using PubMed, Embase, and Cochran Library. Totally, 17 randomized controlled trials (RCTs) (n = 1627) met study selection criteria and were incorporated in this NMA study. The first ranking probabilities of the five surgical options to alleviate postoperative pain scores were: 54.4% for single-incision robotic cholecystectomy (SIRC), 25.2% for single-incision laparoscopic cholecystectomy (SALC), and 24.9% for mini-laparoscopic cholecystectomy (Mini). The first ranking probabilities for reducing postoperative complications in the surgical options were: 61.3% for three-port laparoscopic cholecystectomy and 21.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing hospital stay(days) in the surgical options were: 32.3% for SIRC, 29.0% for three-port laparoscopic cholecystectomy and 19.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing operation time showed that the three-port technique had the shortest operation time, followed by three-port laparoscopic cholecystectomy (51.3%), four-port laparoscopic cholecystectomy (26.8%), and mini-laparoscopic cholecystectomy (21.6%). Our study found that the optimal surgical plan for different outcomes varies, making it difficult to give a comprehensive recommendation. Three-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy may be the best options in terms of reducing surgical complications and operative time. Meanwhile, SIRC is the best options for relieving postoperative pain relief. SIRC and three-port laparoscopic cholecystectomy can reduce hospital stay (days) compared other LCs.

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Fig. 1
Fig. 2 Network meta-analysis of postoperative pain
Fig. 3 Network meta-analysis of postoperative complications
Fig. 4 Network meta-analysis of hospital stay
Fig. 5 Network meta-analysis of operation time

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Funding

This work was supported by the Key Research and Development Project of Science & Technology Department of Sichuan Province (20ZDYF1129).

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Author notes

  1. Haomin Lin, Jinchang Zhang, and Xujia Li have equally contributed to this work.

Authors and Affiliations

  1. Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, 646000, Luzhou, China

    Haomin Lin, Jinchang Zhang, Xujia Li & Song Su

  2. School of Clinical Medicine, Southwest Medical University, Sichuan, 646000, Luzhou, China

    Yuanquan Li

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  1. Haomin Lin
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Contributions

SS designed the study. XL and JZ prepared first and final draft of the article. YL and HL performed data extraction and quality assessment. HL performed the literature review and screening. HL performed data analysis.

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Correspondence to Song Su.

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Lin, H., Zhang, J., Li, X. et al. Comparative outcomes of single-incision laparoscopic, mini-laparoscopic, four-port laparoscopic, three-port laparoscopic, and single-incision robotic cholecystectomy: a systematic review and network meta-analysis. Updates Surg 75, 41–51 (2023). https://doi.org/10.1007/s13304-022-01387-2

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