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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2016; 22(2): 736-747
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.736
Single-incision laparoscopic surgery for biliary tract disease
Shu-Hung Chuang, Chih-Sheng Lin
Shu-Hung Chuang, Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, Hsin-Chu 30071, Taiwan
Shu-Hung Chuang, Department of Healthcare Management, Yuanpei University of Medical Technology, Hsin-Chu 30015, Taiwan
Chih-Sheng Lin, Department of Biological Science and Technology, National Chiao Tung University, Hsin-Chu 30068, Taiwan
Author contributions: Chuang SH and Lin CS solely contributed to this paper.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Shu-Hung Chuang, MD, PhD, Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu 30071, Taiwan.
Telephone: +886-3-6119595 Fax: +886-3-6110900
Received: April 27, 2015
Peer-review started: May 4, 2015
First decision: August 31, 2015
Revised: September 19, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: January 14, 2016

Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.

Keywords: Laparoendoscopic single-site surgery, Laparoscopic cholecystectomy, Laparoscopic common bile duct exploration, Laparoscopic hepaticojejunostomy, Single-incision laparoscopic surgery

Core tip: Single-incision laparoscopic surgery (SILS) has been employed in various fields to minimize traumatic effects. Single-incision laparoscopic cholecystectomy (SILC) has been the most widely studied SILS approach to date. Hundreds of studies on SILC have failed to present conclusive results. Only a small number of studies on single-incision laparoscopic common bile duct exploration (SILCBDE) and single-incision laparoscopic hepaticojejunostomy (SILH) have been published. This paper serves as an updated review of SILC approaches and as the only existing review on SILCBDE and SILH. Our findings underscore the safety and efficacy of SILC, SILCBDE, and SILH and potential benefits and disadvantages of these methods in relation to conventional multi-incision laparoscopic surgery approaches.