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Single-Incision Vs. Standard 4-Port Laparoscopic Cholecystectomy

Wed, 02/19/2014 - 7:10am
Skeptical Scalpel

The saying used to be, "You can get any paper published if you have enough stamps." Now with electronic submission, you don't even need the stamps.

A retrospective study comparing single-incision laparoscopic cholecystectomy (SILC) to standard 4-port laparoscopic cholecystectomy (LC) concluded that "SILC showed no disadvantage concerning risk profiles, operative times, or hospital stay."

According to the abstract, 81.7 percent of the 115 SILC patients had elective surgery vs. 55.5 percent of the 344 in the LC group. The SILC cohort experienced significantly shorter operative times (70 ± 31 vs. LC: 80 ± 27 minutes) and hospital lengths of stay (3.02 ± 1.4 vs. LC: 4.6 ± 2.8 days), p < 0.001 for both. LC was converted to open surgery in 21 cases vs. none of the SILCs, p= 0.003. Rates of bile leak and incisional hernia did not differ.

Do you see any problems with this study? I do.

The groups were not really comparable because the LC group underwent more emergency operations. That difference is significant with a p value of 0.007—conveniently omitted from the abstract. The preponderance of elective cases likely accounts for the SILC group's shorter operative duration, lower rate of conversion to open, and shorter length of stay. The SILC patients were also a mean of 10 years younger.

The average operative time for the LC patients, 80 minutes, is much longer than the 40 to 45 minutes reported in most other recent series such as this one. In statistical circles, measuring one's pet theory against a false comparator is known as setting up a "straw man." I've written about this before. 

Continue reading... 

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