Journal of Investigative Surgery, Early Online, 1–8, 2013 Copyright C  2013 Informa Healthcare USA, Inc. ISSN: 0894-1939 print / 1521-0553 online DOI: 10.3109/08941939.2013.856497 ARTICLE A Randomized Clinical Trial Comparing 4-Port, 3-Port, and Single-Incision Laparoscopic Cholecystectomy Zhamak Khorgami, MD, 1,2 Saeed Shoar, MD, 1 Taha Anbara, MD, 1 Ahmadreza Soroush, MD, 1,2 Shirzad Nasiri, MD, 1,2 Ali Movafegh, MD, 3 Ali Aminian, MD 4 1 Department of surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, 2 Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, 3 Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, 4 Department of surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran ABSTRACT Backgrounds: Despite increasing trend in single incision laparoscopic cholecystectomy (SILC), there is still contro- versy regarding its global acceptance as a routine practice. Our study aimed to compare surgical events, early in-hospital and later outcomes of SILC with conventional multiport laparoscopic cholecystectomy (LC). Methods: Through a randomized controlled trial (RCT) between June and December 2011, 90 consecutive patients with doc- umented biliary diseases waiting for LC were equally allocated to 3-port, 4-port, and single incision LC group. Operative time, surgical adverse events, postoperative pain according to visual analogue scale (VAS), total mor- phine administration, length of hospital stay, and cosmetic outcomes were compared between these three groups. Results: A total of 27 males (30%) and 63 females (70%) were enrolled in this study. The average patients’ age and BMI were 42.6 ± 12.1 years and 26.2 ± 2.7 kg/m 2 , respectively. Operative time in SILC group was significantly longer than other groups. Total intraoperative adverse events and postoperative complications did not differ significantly between the three groups. Mean ± SD VAS score at rest was significantly lower (p < 0.05) in SILC group. The average VAS at coughing was significantly lower in SILC group in all time intervals except the first 6 hr (p < 0.05). In addition, total morphine dose showed significantly lower amount in SILC group (p = 0.02). 12-month follow-up did not reveal significant difference between the study groups (p > 0.05). Conclusion: SILC is associated with less postoperative pain in later hours, reduces in-hospital analgesic dosages, has longer procedure time, but does not increase intraoperative and postoperative adverse events It seems that SILC has no obvious advantages in terms of later outcomes. Keywords: single incision laparoscopic surgery; single incision laparoscopic cholecystectomy; outcomes INTRODUCTION Surgery is the most common treatment for benign diseases of the gallbladder (GB) [1], and such tech- niques have evolved over the past few decades [2]. Currently, laparoscopic cholecystectomy (LC) is con- sidered the gold standard surgical treatment for biliary stone-related diseases of the GB [2–4]. Surgeons have started developing less invasive surgical techniques to further enhance the benefits of LC [4, 5]. Therefore, single-incision LC (SILC) has received much attention since it was first reported in 1997 [5], and many authors have reported their experience with SILC to date [6–11]. Received 6 April 2013; accepted 14 October 2013. Address correspondence to Zhamak Khorgami, MD, Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Email: khorgami@tums.ac.ir Several studies have discussed the adverse events of SILC in terms of pain scores and wound complica- tions [12, 13], while numerous other studies have doc- umented the safety and feasibility of SILC [14–19] and highlighted the potential advantages of decreased inci- sional pain [20]. A multicenter randomized controlled trial (RCT) showed that SILC should be considered as an alternative only for patients for whom increased cosmesis is more important than avoiding the more severe postoperative pain and possibly higher rate of wound complications related with this procedure [13]. Despite a growing body of evidence, few high- powered trials have compared the postoperative 1 J Invest Surg Downloaded from informahealthcare.com by Medizinischen Hochschule on 11/17/13 For personal use only.