However, increased operating time means increased duration of general anesthesia and thus increased patient risk. Although no anesthesia-related complications were reported in the mentioned trials, a significant number of the studies used ASA class III or IV as a cut-off point for www.selleckchem.com/products/BI6727-Volasertib.html patients suitable for SILC/LESS cholecystectomy [13, 14, 19], thus the use of SILC/LESS cholecystectomy in patients in which there are foreseeable anesthesia-related complications remains limited. One of the ultimate goals of the development of SILS/LESS cholecystectomy is a reduction in postoperative pain perception and a decreased used of analgesic medications [9]. The evaluation of postoperative pain is consistently included as a primary or secondary outcome in recent studies [12�C20] but lacking in previous studies [6].

The outcome however remains obscure as there are reports in which there is no difference in pain perception between SILC/LESS cholecystectomy and LC groups [14, 16, 18], increased perception in the SILC/LESS cholecystectomy group [15, 19], and decreased pain perception in the SILC/LESS cholecystectomy groups [12, 17]. The lack of consistent evidence regarding pain perception requires further evaluation in randomized clinical trials. In comparing outcomes between procedures, one of the key points to evaluate is the presence or absence of intraoperative and postoperative complications. A procedure can be considered safe only if the rate of complications is similar to that of the current gold-standard.

When comparing the rate of complications between SILC and LESS cholecystectomy numerous studies have reported both, no significant difference with regard to complication rate [6, 15, 17, 22] or an increased complication rate when comparing SILS/LESS cholecystectomy to LC [14, 18]. With regard to the study by Phillips et al. [14] it is interesting to note that this is the same cohort of patients as an initial report by Marks et al. In the original report by Marks et al. [13] there was no significant difference in complications. However in the report by Phillips et al. [14], the number of patients increased and so did the complications associated with single-incision surgery [14]. This is the largest case series published so far and in theory the learning curve has leveled off, indicating that the complications are inherent to the procedure itself, questioning the feasibility of widespread application of the SILC/LESS cholecystectomy.

One of the complications that has been discussed the most is the increased risk of a postincisional hernia after SILS/LESS surgery due to an increase in size of the defect in the fascia. This complication has tried to be avoided by turning multiple fascial defects into a single incision, however, results have AV-951 been inconclusive. [6, 14, 25, 35].