Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-tube Mass Spectrometry.

OBJECTIVE: BACKGROUND:: Breath VOCs have the potential to noninvasively diagnose cancer. METHODS: Exhaled breath samples were collected using 2-L double-layered Nalophan bags, and were analyzed using selected-ion-flow-tube mass-spectrometry. Gold-standard test for comparison was endoscopy for luminal inspection and computed tomography (CT) to confirm cancer recurrence. Three studies were conducted: RESULTS:: CONCLUSION:: This study suggests the association of a single breath biomarker with the primary presence and recurrence of CRCa. Further multicenter validation studies are required to validate these findings.

A Randomized Controlled Study to Evaluate the Impact of Instrument and Laparoscope Length on Performance and Learning Curve in Single-Incision Laparoscopic Surgery.

INTRODUCTION: The proximity of instrumentation in single-incision laparoscopic surgery (SILS) creates ergonomic challenges. An innovative method to reduce external collisions between instruments and handles is to use instruments of different lengths. This study evaluated the impact of instrument and laparoscope length on simulated SILS performance. METHODS: Performance was assessed using peg transfer (PEG) and pattern cutting (CUT) tasks from the Fundamentals of Laparoscopic Surgery (FLS) curriculum. Following baseline testing, surgeons were randomized into 3 trial arms: Control--standard length instruments and standard length laparoscope; group 1--one long instrument, one standard length instrument and standard length laparoscope; and group 2--standard length instruments and long laparoscope. Two phases were undertaken using a validated SILS-modified FLS box trainer: phase 1--25 repetitions of PEG and phase 2--5 repetitions of CUT. FLS scoring parameters measured performance and the Imperial College Surgical Assessment Device (ICSAD) captured motion analysis of hands. RESULTS: Twenty-three surgeons were recruited--control (n = 7), group 1 (n = 9), and group 2 (n = 7). No significant differences were observed in operative experience or baseline skills performance. Phase 1: Peak FLS score was significantly higher in group 1 compared with control (P = .009). Comparison of learning curves revealed learning plateau was significantly higher in group 1 compared with control (P = .010). Phase 2: Group 1 revealed a trend toward higher peak FLS scores over the control (P = .067). No significant differences in motion analysis of hands were demonstrated using ICSAD. CONCLUSIONS: This study demonstrates that using instruments of different lengths can improve simulated SILS performance.

A randomized controlled study to establish the effect of articulating instruments on performance in single-incision laparoscopic surgery.

OBJECTIVE: In single-incision laparoscopic surgery (SILS), operating through 1 incision presents ergonomic challenges. No consensus exists on whether articulating instruments (ARTs) may help. This study evaluated their effect on simulated SILS, hypothesizing that they would affect performance and workload. DESIGN: Surgeons were randomized to 2 straight instruments (STRs), 1 ART and 1 STR, or 2 ARTs. After baseline testing, 25 repetitions of the Fundamentals of Laparoscopic Surgery (FLS) peg-transfer (PEG) task and 5 repetitions of the short-hand for the FLS pattern-cutting task (CIRCLE) were performed. Primary outcomes were maximum FLS PEG scores, CIRCLE times and errors, and Imperial College Surgical Assessment Device hand motion analysis. National Aeronautics and Space Administration (NASA) Raw Task Load Index (RTLX) questionnaires evaluated a secondary outcome--workload. SETTING: The trial took place in a simulated operating theater within the Academic Surgical Unit at St Mary's Hospital, London, UK. PARTICIPANTS: Eligible surgeons had completed at least 5 laparoscopic cases as a primary operator. Surgeons were stratified by laparoscopic experience into intermediate (less than 25 previous procedures as primary operator) or advanced (25 procedures or more). A total of 21 surgeons were recruited and randomized; 7 of them to each instrument combination group. All surgeons completed PEG, and 5 from each group completed CIRCLE. RESULTS: Groups' baseline PEG scores were similar (p = 0.625). STR-ART achieved higher maximum PEG scores than STR or ART did (median = 236 vs 198 vs 193, respectively, p = 0.002). Fastest CIRCLE times were similar (median = 190s vs 130s vs 186s, p = 0.129) as were minimum errors (median = 1 vs 2 vs 3, p = 0.101). For PEG, Imperial College Surgical Assessment Device demonstrated similar total path lengths (median = 12.3m vs 12.3m vs 16.0m, p = 0.545) and total numbers of movements (median = 89.6 vs 86.4 vs 171, p = 0.080). Groups' NASA Raw Task Load Index scores were similar (p = 0.708). CONCLUSIONS: Combining 1 STR and 1 ART improved SILS performance in the PEG task. Therefore, this may be the optimum instrument configuration for use within some clinical SILS applications.

Single-incision versus conventional multiport laparoscopic colorectal surgery-systematic review and pooled analysis.

BACKGROUND: The aim of this pooled analysis is to determine the effect of single-incision laparoscopic colorectal surgery (SILC) on short-term clinical and oncological outcomes compared with conventional multiport laparoscopic colorectal surgery (CLC). METHODS: An electronic search of Embase, Medline, Web of Science, and Cochrane databases was performed. Weighted mean differences (WMD) were calculated for the effect size of SILC on continuous variables and pooled odds ratios (POR) were calculated for discrete variables. RESULTS: No significant differences between the groups were noted for mortality or morbidity including anastomotic leak, reoperation, pneumonia, wound infection, port-site hernia, and operative time. The benefits of a SILC approach included reduction in time to return of bowel function (WMD = -1.11 days; 95 % C.I. -2.11 to -0.13; P = 0.03), and length of hospital stay (WMD = -1.9 days; 95 % C.I. -2.73 to -1.07; P < 0.0001). Oncological surgical quality was also shown for SILC for the treatment of colorectal cancer with a similar average lymph node harvest, proximal and distal resection margin length compared to CLC. CONCLUSIONS: SILC can be performed safely by experienced laparoscopic surgeons with similar short-term clinical and oncological outcomes to CLC. SILC may further enhance some of the benefits of minimally invasive surgery with a reduction in blood loss and length of hospital stay.

Pain, well-being, body image and cosmesis: a comparison of single-port and four-port laparoscopic cholecystectomy.

BACKGROUND: This study aims to compare post-operative pain, well-being, body image and cosmesis in SILS cholecystectomy and four-port laparoscopic cholecystectomy (FPLC). MATERIAL AND METHODS: Forty-two consecutive patients (15 SILS, 27 FPLC) undergoing elective cholecystectomy were included in the study. Peri-operative pain, well-being, body image and cosmesis were evaluated using validated assessment tools. RESULTS: Significantly lower pain scores were reported one week post-operatively in the SILS group (5.6 vs 8.3; p = 0.035). No significant difference was found in analgesic requirements, physical or mental well-being at any time interval. Significantly higher (favourable) body image questionnaire scores were reported in the SILS group at one week (5.4 v 4.5; p < 0.01), two weeks (5.6 vs 4.8; p < 0.01) and one month (5.7 vs 5.0; p < 0.01) post-operatively. CONCLUSION: SILS patients have significantly reduced one-week pain scores and there was no significant difference in well-being between the two groups. Patients who underwent SILS had improved body image and cosmesis. If both techniques are found to be equivalent concerning safety, cost, learning curve and availability, SILS may play a key role in the new era of patient choice.

Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy.

BACKGROUND: Minimally invasive techniques have become an integral part of general surgery with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents the final 1-year results of a prospective, randomized, multicenter, single-blinded trial of SILC vs multiport cholecystectomy (4PLC). STUDY DESIGN: Patients with biliary colic and documented gallstones or polyps or with biliary dyskinesia were randomized to SILC vs 4PLC. Data measures included operative details, adverse events, and conversion to 4PLC or laparotomy. Patients were followed for 12 months. RESULTS: Two hundred patients underwent randomization to SILC (n = 119) or 4PLC (n = 81). Enrollment ranged from 1 to 50 patients with 4 sites enrolling >25 patients. Total adverse events were not significantly different between groups (36% 4PLC vs 45% SILC; p = 0.24), as were severe adverse events (4% 4PLC vs 10% SILC; p = 0.11). Incision-related adverse events were higher after SILC (11.7% vs 4.9%; p = 0.13), but all of these were listed as mild or moderate. Total hernia rates were 1.2% (1 of 81) in 4PLC patients vs 8.4% (10 of 119) in SILC patients (p = 0.03). At 1-year follow-up, cosmesis scores continued to favor SILC (p < 0.0001). CONCLUSIONS: Results of this trial show SILC to be a safe and feasible procedure when compared with 4PLC, with similar total adverse events but with an identified significant increase in hernia formation. Cosmesis scoring and patient preference at 12 months continue to favor SILC, and more than half of the patients were willing to pay more for a single-site surgery over a standard laparoscopic procedure. Additional longer-term population-based studies are needed to clarify if this increased rate of hernia formation as compared with 4PLC will continue to hold true.

A comparison of skill acquisition and transfer in single incision and multi-port laparoscopic surgery.

OBJECTIVES: Single incision laparoscopic surgery (SILS) offers a scar-less approach to cholecystectomy. We conducted a cadaveric randomized crossover study to compare the novice learning curves for multiport laparoscopic cholecystectomy (LC) and single incision laparoscopic cholecystectomy (SILC), and to investigate the acquisition of transferable skills. PARTICIPANTS: Twenty medical students were randomized into SILS or LC groups. METHODS: After baseline assessment and cognitive learning modules, groups completed 5 cadaveric porcine cholecystectomies in their designated modality, followed by one using the other approach. Performance was assessed using a validated surgical assessment device (ICSAD) and by expert video analysis with generic and procedure-specific rating scales [modified global rating scale (mGRS) and procedure-specific rating scales (PSRS)]. RESULTS: Analysis of the first case revealed significant differences between LC and SILS groups for time-taken (median 46.00 vs 68.19 min, p = 0.019), and path length (216 vs 348 m, p = 0.034). Intergroup analysis of the remaining group cases showed no difference for any of the performance metrics. Outlying performance of the 4th case in the LC group rendered learning curve comparison unviable. At crossover, performance of the SILS group on their LC compared with the 5th LC performed by the LC group showed no significant difference. However, comparing the LC group's SILC to the 5th SILC performed by the SILS group showed significant difference for all performance metrics (p < 0.05). CONCLUSIONS: This study suggests that the difference between novice performance for SILC and LC becomes negligible after the first procedure. Furthermore, dedicated SILC training appears to develop competencies for both SILC and LC, therefore its addition to the early surgical curriculum is likely to extend the access of SILC to patients without reducing multiport laparoscopic skill acquisition.

A randomised comparative study evaluating learning curves of novices in a basic single-incision laparoscopic surgery task.

OBJECTIVE: There is currently no objective quantification of the temporal changes in performance associated with a novice surgeon learning single-incision laparoscopic surgery (SILS) operative tasks. Analysing learning curves allows us to objectively quantify performance. The aim was to evaluate if the rate of learning and ultimate proficiency level reached in SILS when using straight or articulating instruments is different to conventional laparoscopy and if training in laparoscopy influences learning or proficiency for SILS. DESIGN AND SETTING: Thirty-six surgically naive medical students were randomised to complete the validated peg transfer task over 50 repetitions using a conventional laparoscopic set-up, SILS set-up with straight instruments or articulated instruments or SILS set-up after having reached proficiency using a conventional laparoscopy. RESULTS: There was a significant increased overall proficiency between the group trained in conventional laparoscopy and all other groups (p < 0.01), with no difference between the other groups. There was no difference in the rate of learning between the groups. There was no difference in the ultimate proficiency level (p = 0.671) or rate of learning (p = 0.63) when using straight or articulating instruments. There was no difference in ultimate proficiency level (p = 0.59) or learning rate (p = 0.219) seen in the SILS group that had prior training on the task with a conventional laparoscopic set-up. CONCLUSIONS: The results of this study indicate that the proficiency reached using a conventional laparoscopic set-up cannot be matched using a SILS configuration for the novice surgeon and that the choice of straight or articulated instruments as well as previous laparoscopic training does not confer an advantage in this basic task.

Current status of single-incision laparoscopic surgery: European experts' views.

Recent advances in minimally invasive surgery have centered on reducing the number of incisions required, which has led to the development of the single-incision laparoscopic technique. A panel of European single-incision laparoscopy experts met to discuss the current status of, and the future expectations for, the technique. The experts reached agreement on a number of statements and recommendations, which will support surgeons in adopting the technique. The panel agreed that the single-incision technique may offer a number of benefits to patients; however, further clinical data need to be published to confirm its value. An ideal training route for surgeons who are adopting the technique was agreed upon, as was the need for a single, large clinical registry of data.

A high fidelity model for single-incision laparoscopic cholecystectomy.

Single-incision laparoscopic surgery (SILS) is a safe approach for cholecystectomy, with the potential to minimise the iatrogenic trauma sustained from the operation. However, a number of reports show SILS to be technically challenging and as such there is expected to be a significant learning curve for expert surgeons adopting the new technique, as well as for junior surgical trainees. There are inherent risks to patient safety associated with practicing and developing new skills in a real-life theatre environment. However, thus far, there have been no realistic SILS training models available. We tested the feasibility of conducting SILS cholecystectomies on a cadaveric porcine model with standard operating equipment, which may provide a platform to facilitate safe training and assessment protocols. In this paper we provide an account of the training model technique, and review the literature surrounding SILS training and performance evaluation.

Patient reported outcomes and their importance in the development of novel surgical techniques.

INTRODUCTION: Although traditional quality measures such as morbidity and mortality outcomes still pay an important role in the assessment of health care quality, greater emphasis is now being placed on patient-reported outcome measures such as patient satisfaction. This area is especially important for novel surgical technologies such as single-incision laparoscopic surgery (SILS) and natural orifice translumenal endoscopic surgery (NOTES). These new innovations are able to minimize or abolish surgical scarring and are likely to have most benefit in the area of patient satisfaction as opposed to traditional outcome measures. Therefore, it is important to gauge the public opinion regarding these new techniques, as continued public interest can help support further research in this up-and-coming field. METHODS: A questionnaire study was carried out with members of the general public. Questions were asked regarding preference for surgical techniques, including open surgery, laparoscopic surgery, NOTES, and SILS, in the situation of acute appendicitis. RESULTS: The questionnaire was completed by 1006 individuals. Results indicated that an established safety profile was necessary before the introduction of these new techniques into general practice. The concept of scarless surgery did appeal to the public, with SILS being the treatment of choice in the scenario of acute appendicitis. DISCUSSION: The patient perspective on health care is an important aspect of health care quality assessment. This is especially important with regard to the development of novel surgical techniques such as SILS and NOTES. With these techniques, the potential benefits are most likely to be found in the realms of reduced scarring and improved patient satisfaction. The findings from this study demonstrate the public's interest in these new techniques and thus give further support to continued research and development in this area.

Does previous laparoscopic experience improve ability to perform single-incision laparoscopic surgery?

BACKGROUND: Single-site laparoscopic surgery (SSLS) has been suggested as a safe and less invasive alternative to standard laparoscopic surgery (LAP). It is not clear whether previous laparoscopic experience influences the ability to perform SSLS. This study aimed to assess the impact of laparoscopic experience on the performance of SSLS. METHODS: For this study, 18 surgeons were recruited including 12 novice surgeons, four experienced laparoscopic surgeons (intermediate) and two experienced SSLS surgeons (expert). All these subjects completed four tasks from the validated Fundamentals of laparoscopic surgery (FLS) curriculum. The tasks were performed using both a LAP and an SSLS approach with a randomized crossover design. Assessment of the tasks was performed with standardized FLS metrics and dexterity analysis using the Imperial college surgical assessment device. RESULTS: The novice group performed two tasks (precision cutting and intracorporeal suture) significantly better with a LAP approach than with an SSLS approach in all parameters (P < 0.05). The two other tasks (peg transfer and endoloop) were performed significantly better with LAP than with SSLS in terms of time and dexterity only (P < 0.05) but not in terms of error score. The intermediate and expert groups demonstrated no significant difference between their LAP and SSLS performances for any of the tasks in any parameter. Intergroup analysis of performance demonstrated construct validity of the SSLS tasks, with significant differences between novice and intermediate performances for three tasks (peg transfer, endoloop, and intracorporeal suture) (P < 0.05) and between novice and expert performances for three tasks (peg transfer, precision cutting, and intracorporeal suture) (P < 0.05). CONCLUSIONS: This study demonstrated that previous laparoscopic experience improves ability to perform SSLS tasks. Some SSLS tasks do not show construct validity due to the complexity of the SSLS technique. It also is implied that current LAP technical skills training curricula are insufficient for teaching SSLS.

Single-center experience in systemic stress and short-term morbidity of single-incision cholecystectomy.

Single-incision laparoscopic surgery (SILS) aims to reduce the number and size of skin incisions. The authors compared systemic stress and perioperative outcome of SILS and laparoscopic (LAP) cholecystectomy. Twenty-nine subjects (8 males and 21 females; mean age = 47 years; mean body mass index = 27) were included in the study. There was no statistical difference in mean operative time (LAP = 89 minutes; SILS = 113 minutes; P = ns), and no intraoperative complications were reported. There were no statistically significant differences observed in white cell count, C-reactive protein, interleukin-6, and tumor necrosis factor-α between SILS and LAP groups. The mean hospital length of stay (LAP = 1.8 days; SILS = 1.4 days) and Visual Analogue Scale scores for pain at 6 hours (LAP = 5.14; SILS = 4.46) and 24 hours (LAP = 3.9; SILS = 2.815) were similar with no perioperative morbidity. These results suggest that the systemic stress response in LAP and SILS cholecystectomy does not appear to be significantly different. SILS cholecystectomy appears safe with no perioperative morbidity or complications encountered in this series.

Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy.

BACKGROUND: Minimally invasive techniques have become an integral part of general surgery, with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents a prospective, randomized, multicenter, single-blind trial of SILC compared with four-port cholecystectomy (4PLC) with the goal of assessing safety, feasibility, and factors predicting outcomes. METHODS: Patients with biliary colic and documented gallstones or polyps or with biliary dyskinesia were randomized to SILC or 4PLC. Data measures included operative details, adverse events, and conversion to 4PLC or laparotomy. Pain, cosmesis, and quality-of-life scores were documented. Patients were followed for 12 months. RESULTS: Two hundred patients were randomized to SILC (n = 117) or 4PLC (n = 80) (3 patients chose not to participate after randomization). Patients were similar except for body mass index (BMI), which was lower in the SILC patients (28.9 vs. 31.0, p = 0.011). One SILC patient required conversion to 4PLC. Operative time was longer for SILC (57 vs. 45 min, p < 0.0001), but outcomes, including total adverse events, were similar (34% vs. 38%, p = 0.55). Cosmesis scores favored SILC (p < 0.002), but pain scores were lower for 4PLC (1 point difference in 10-point scale, p < 0.028) despite equal analgesia use. Wound complications were greater after SILC (10% vs. 3%, p = 0.047), but hernia recurrence was equivalent for both procedures (1.3% vs. 3.4%, p = 0.65). Univariate analysis showed female gender, SILC, and younger age to be predictors for increased pain scores, while SILC was associated with improved cosmesis scores. CONCLUSIONS: In this multicenter randomized controlled trial of SILC versus 4PLC, SILC appears to be safe with a similar biliary complication profile. Pain scores and wound complication rates are higher for SILC; however, cosmesis scores favored SILC. For patients preferring a better cosmetic outcome and willing to accept possible increased postoperative pain, SILC offers a safe alternative to the standard 4PLC. Further follow-up is needed to detail the long-term risk of wound morbidities, including hernia recurrence.

Specialist anatomy: Is the structure of teaching adequate?

BACKGROUND: A knowledge and understanding of specialist anatomy, which includes radiological, laparoscopic, endoscopic and endovascular anatomy is essential for interpretation of imaging and development of procedural skills. METHODS AND MATERIALS: Medical students, specialist trainees and specialists from the London (England, UK) area were surveyed to investigate individual experiences and recommendations for: (1) timing of the introduction of specialist anatomy teaching, and (2) pedagogical methods used. Opinions relating to radiological, laparoscopic, endoscopic and endovascular anatomy were collected. Non-parametric tests were used to investigate differences in recommendations between specialist trainees and specialists. RESULTS: Two hundred and twenty-eight (53%) individuals responded to the survey. Imaging was most commonly used to learn radiological anatomy (94.5%). Procedural observation was most commonly used to learn laparoscopic (89.0%), endoscopic (87.3%) and endovascular anatomy (66.2%). Imaging was the most recommended method to learn radiological anatomy (92.1%). Procedural observation was the most recommended method for learning laparoscopic (80.0%), endoscopic (81.2%) and endovascular anatomy (42.5%). Specialist trainees and specialists recommended introduction of specialist anatomy during undergraduate training. CONCLUSION: Although the methods for specialist anatomy learning are in practice, there is no consensus on timing and structure within the anatomy curriculum. Recommendations from trainees and specialists should be considered so that the existing curriculum can be refined to maximise learning outcomes.

A clinical review of single-incision laparoscopic surgery.

Laparoscopic surgery is one of the most significant surgical advances of the twentieth century. Recently, the focus has been on the development of minimally invasive techniques in the form of single-incision laparoscopic surgery. The single-incision technique provides a less invasive alternative to conventional laparoscopic surgery, requiring only one incision disguised within the umbilical folds in contrast to the three to five incisions in conventional laparoscopic surgery. The availability of a number of specialised ports has aided the development of single-incision laparoscopic surgery, and led to its widespread use. The successful use of single-incision laparoscopic surgery has been reported for a number of surgical procedures, and offers several potential benefits versus conventional laparoscopic surgery, including reduced pain, reduced time to recovery and improved cosmesis. This review of international literature assesses the current status, as well as the experience, of single-incision laparoscopic surgery within general, colorectal, bariatric, metabolic, gynaecological and urological surgery. The challenges faced with single-incision laparoscopic surgery are discussed, as well as the clinical studies that are required in order to establish single-incision surgery as a significant improvement to conventional laparoscopic surgery in terms of reduced pain and improved cosmesis.

Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data.

BACKGROUND: This study presents preliminary data from a prospective randomized multicenter, single-blinded trial of single-incision laparoscopic cholecystectomy (SILC) versus standard laparoscopic cholecystectomy (4PLC). METHODS: Patients with symptomatic gallstones, polyps, or biliary dyskinesia (ejection fraction <30%) were randomized to SILC or 4PLC. Data included operative time, estimated blood loss, length of skin and fascial incisions, complications, pain, satisfaction and cosmetic scoring, and conversion. RESULTS: Operating room time was longer with SILC (n = 50) versus 4PLC (n = 33). No differences were seen in blood loss, complications, or pain scores. Body image scores and cosmetic scores at 1, 2, 4, and 12 weeks were significantly higher for SILC. Satisfaction scores, however, were similar. CONCLUSIONS: Preliminary results from this prospective trial showed SILC to be safe compared with 4PLC although operative times were longer. Cosmetic scores were higher for SILS compared with 4PLC. Satisfaction scores were similar although both groups reported a significantly higher preference towards SILC.

Single-incision laparoscopic surgery for right hemicolectomy.

HYPOTHESIS: Single-incision laparoscopic surgery (SILS) allows surgeons to perform laparoscopic procedures through a single umbilical incision, minimizing surgical trauma. DESIGN: We describe herein our methods of SILS right hemicolectomy using a recent case as an example. SETTING: SILS appendectomy and cholecystectomy have been performed by our surgical team for longer than 1 year among more than 80 patients. Patient  SILS right hemicolectomy was performed in a 38-year-old woman with a history of B-cell lymphoma and ileocecal mass. INTERVENTIONS: The operation was performed using a SILS port and an extracorporeal stapled anastomosis. MAIN OUTCOME MEASURES: Length of stay and postoperative pain and complications. RESULTS: SILS right hemicolectomy took 175 minutes to perform. The patient was discharged on postoperative day 6; a chest infection after surgery had prolonged the length of stay. CONCLUSIONS: SILS is an attractive method to further minimize surgical trauma and can be applied in more complex cases, such as colectomy. Large trials are needed to determine the benefits of this new technique.

Evaluating systemic stress response in single port vs. multi-port laparoscopic cholecystectomy.

BACKGROUND AND AIMS: Acute-phase proteins and inflammatory cytokines mediate measurable responses to surgical trauma, which are proportional to the extent of tissue injury and correlate with post-operative outcome. By comparing systemic stress following multi-port (LC) and single-incision laparoscopic cholecystectomy (SILC), we aim to determine whether reduced incision size induces a reduced stress response. METHODS: Thirty-five consecutive patients were included, 11 underwent SILC (mean ± SEM; age 44.8 ± 3.88 year; BMI 27 ± 1.44 kg/m(2)) and 24 underwent LC (56.17 ± 2.80 year; 31.72 ± 1.07 kg/m(2), p < 0.05). Primary endpoint measures included levels of interleukin-6 and C-reactive protein measured pre- and post-operatively. Length-of-stay (LOS) and postoperative morbidity were secondary endpoints. RESULTS: No statistically significant differences were found between SILC and LC for interleukin-6 and C-reactive protein levels, LOS and duration of surgery. There was also no correlation between systemic stress response and operative parameters. There were no intra-operative complications. CONCLUSION: SILC appears to be a safe, feasible technique with potential advantages of cosmesis, reduced incisional pain, and well-being recommending its use. These data indicate no difference in systemic stress and morbidity between SILC and LC. A larger, multi-centred, randomised prospective trial is warranted to further investigate and confirm this finding.