Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study Mohammed A. Omar, MD, a Alaa A. Redwan, MD, PhD, b and Ahmed G. Mahmoud, MD, b Qena and Sohag, Egypt Background. Laparoscopic cholecystectomy is the standard treatment for symptomatic gallbladder disease. Single-incision laparoscopic surgery was developed with the aim of decreasing the invasiveness of conventional laparoscopy. The aim of this study was to compare the clinical outcome of single-incision laparoscopic cholecystectomy with 3-port laparoscopic cholecystectomy. Methods. From February 2014 to September 2016, 187 patients with symptomatic cholecystolithiasis were randomized to a single-incision laparoscopic cholecystectomy group (89 patients) or a 3-port laparoscopic cholecystectomy group (98 patients). The primary outcomes were a postoperative pain score (at 6 hours and 1 day) and patients of complications, while the secondary outcomes were operative time, estimated blood loss, opioid requirements, duration of hospital stay, and patient satisfaction with aesthetic effects. Results. When comparing 3-port laparoscopic cholecystectomy and single-incision laparoscopic cholecystectomy, there were differences in the (mean ± standard deviation) operative time (58.9 ± 18.6 minutes vs 45.2 ± 11.8 minutes; P < .001), success rate (93% vs 99%; P < .01), conversion rate (7% vs 1%; P < .001), and aesthetic score (7.9 ± 1.6 vs 6.7 ± 1.4; P = .008). There were no statistically significant differences in estimated blood loss, postoperative pain, opioid require- ment, complications, and hospital stay between both groups. Conclusion. Single-incision laparoscopic cholecystectomy is a safe and feasible procedure in selected patients. The main advantage is the superior aesthetic results, while the main disadvantage is a greater operative time with some technical difficulties. (Surgery 2017;j:j-j.) From the General Surgery Department, a South Valley University, Qena, Egypt; and the General Surgery De- partment, b Sohag University, Sohag, Egypt LAPAROSCOPIC CHOLECYSTECTOMY (LC) is the standard treatment for symptomatic gallbladder disease. 1 The technique of LC continues to develop toward less invasiveness by decreasing the number of tradi- tionally used 4 ports resulting in the development of safer and feasible 3-port 2 and 2-port LC. 3 Single- incision laparoscopic cholecystectomy (SILC) ap- peared as a new method in 1997. 4 With SILC, multiple instruments are used either through a single-port device with multiple channels or through multiple, closely placed ports. 5 The suggested advantages of SILC include less ports, less postoperative pain and narcotic require- ments, a better aesthetic result, and quicker return to normal activity. 6,7 Hence, use of the SILC tech- nique is rapidly growing among surgeons and pa- tients, and in many practices, SILC has become an alternative technique to traditional multiport LC. In contrast, the disadvantages include a more difficult technique, greater operative time, greater cost, and possibly increased morbidity. 8,9 At the time of this study, there were no available prospec- tive, randomized, controlled trials in the literature sufficient for a fair comparison between SILC and multiport LC. Therefore, we prepared this study to compare SILC and 3-port LC (TPLC) prospectively. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare that there is no conflict of interest. Accepted for publication January 10, 2017. Reprint requests: Mohammed A. Omar, MD, General Surgery Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt 83511. E-mail: mohamed_ali@med.svu.edu.eg. 0039-6060/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.surg.2017.01.006 SURGERY 1 ARTICLE IN PRESS