The literature on SILS/LESS cholecystectomy has been recently reviewed by Antoniou et al. [6]. They analyzed the results of 29 different articles reporting the realization of a SILC/LESS cholecystectomy with a total of 1166 patients. Among the reported results there is 9.3% of unsuccessful surgery, generally due to a lack of proper identification of Calot’s triangle, along with a cumulative Tipifarnib myeloid intraoperative complication rate of 2.7% (range 0�C20%) with the most common being gallbladder perforation/bile spillage (2.2%) and hemorrhage (0.3%). The most common postoperative complications were wound infection and hematoma in 2.1% of patients [6]. In more recent articles Duron et al. and Mutter et al. reported series of 55 and 58 patients, respectively, who underwent SILC/LESS Cholecystectomy [31, 36].

Duron et al. [36] reported a series of 55 cases performed in a single institution, in which a ��learning curve�� effect was present with regard to shorter operating times and the inclusion of more technically difficult patients as surgeon experience increased [36]. Mutter et al. [31] analyzed the implementation of this type of surgery in a teaching hospital comparing six surgeons (3 senior surgeons and 3 junior surgeons) finding no significant difference between operating times or complication rates, thus advocating the safe implementation of SILC/LESS cholecystectomy in teaching hospitals [31]. These results however, include a limited number of surgeons and are applicable only to patients with programmed cholecystectomies without any foreseeable factors aggravating dissection of Calot’s triangle as out of the 58 patients only 3 were diagnosed with acute cholecystitis, thereby limiting their applicability.

In a matched pair analysis that took place over 26 months, Gangl et al. [20] compared operating time, postoperative pain using the visual analogous scale (VAS) at 24 and 48hrs, use of analgesics, length of hospital stay, and complications [20]. They performed the SILC/LESS patient data gathering prospectively, comparing them to matched controls from a group of 163 LC which were performed in the same time period, with no significant differences in age, gender, BMI, ASA classification, diagnosis of acute cholecystitis, or previous abdominal surgery. They reported a SILC/LESS cholecystectomy completion rate of 85.1%, with conversion to LC in 9 patients and open cholecystectomy in 1 patient due to inadequate visualization of the anatomy, versus a 100% completion rate in the LC group, with no significant difference Drug_discovery with regard to postoperative pain, analgesic use, length of stay or complications. The only significant difference was the length of surgery with a longer operating time in the SILC/LESS cholecystectomy group (75min versus 63min).