***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Single-port laparoscopic cholecystectomy ( LC ) has been compared with 3- or 4-port LC . To our knowledge , there are no studies comparing the 3- , 2- , and 1-port techniques . Patients were r and omized into 3 groups : LC 1-port using SILS , LC 2-port using a laparoscope with a working channel , and LC 3-port using the st and ard ports .  Pain was evaluated at recovery , 4 hours , 24 hours , day 5 , and day 8 , using an analog visual scale .  Homogenous groups in their demographic characteristics ; all confirmed gallbladder lithiasis . At recovery , there was less pain in group 1 ( P = 0.002 ) ; at 4 hours pain was similar in all groups ( P = 0.899 ) ; at 24 hours there was less pain in groups 2 and 3 ( P = 0.031 ) ; and at days 5 and 8 there was marginal ( P = 0.053 ) and significant ( P = 0.003 ) relevance . In terms of pain perception , LC performed through 1 port does not offer advantages when compared with 2 or 3 ports . More clinical trials are needed to confirm these data Introduction . Laparoendoscopic single-site surgery ( LESS ) uses a multiple-entry portal in a single 3.0- to 4.0-cm incision in a natural scar , the umbilicus . The present study aim ed to compare the inflammatory impact of classic video laparoscopic cholecystectomy ( LC ) versus LESS cholecystectomy . Methods . A prospect i ve r and omized controlled study was conducted from January to June 2011 at 2 university hospitals in Rio de Janeiro , Brazil . Fifty-seven patients ( 53 women , 4 men ; mean age = 48.7 years ) were r and omly assigned to receive LC ( n = 29 ) or LESS ( n = 28 ) cholecystectomy .  C-reactive protein ( CRP ) and interleukin 6 ( IL-6 ) were measured from blood sample s collected during induction of anesthesia and at 3 and 24 hours postoperatively . Results . Median IL-6 levels in the LESS and LC groups , respectively , were 2.96 and 4.5 pg/mL preoperatively , 11.6 and 28.05 pg/mL at 3 hours postoperatively ( P = .029 ) , and 13.18 and 15.1 pg/mL at 24 hours postoperatively ( P = .52 ) . Median CRP levels in the LESS and LC groups , respectively , were 0.33 and 0.44 mg/mL preoperatively , 0.40 and 0.45 mg/mL ( P = .73 ) at 3 hours postoperatively , and 1.7 and 1.82 mg/mL ( P = .84 ) at 24 hours postoperatively . We did not find a significant association between IL-6 ( and CRP ) and body mass index in the LESS group . Conclusions . LESS cholecystectomy requires a larger size incision than LC . We found a tendency of less postoperative pain following LESS cholecystectomy than LC . There was also a tendency toward lower early inflammatory impact following LESS cholecystectomy versus LC Purpose : To evaluate the safety and feasibility of single-incision laparoscopic cholecystectomy ( SILS-C ) compared with conventional laparoscopic cholecystectomy ( CLC ) . Methods : Sixty-five patients ( SILS-C : 35 , CLC : 30 ) were prospect ively enrolled and operated with conventional straight instruments . The postoperative pain scores at 6 , 24 hours , and 1 week , nausea , vomiting , commencement of oral intake , hospital stay , resumption of normal activities and work and satisfaction levels were noted . Results : Twenty-eight percent ( 10/35 ) SILS-C patients required introduction of additional trocars to complete the procedure . No patient required conversion to open . All the morbidity parameters were similar in both the groups , except that the seroma formation in the wound was significantly higher in the SILS-C group [ SILS-C : 17 % (6/35)/CLC : 0 % , P=0.038 ] . One patient in SILS-C had a major bile duct injury . Conclusions : SILS-C is safe and feasible with conventional instruments . However , caution needs to be exercised in view of a major bile duct injury and a higher rate of seroma formation in the wound Objective : To compare short-term surgical outcomes and quality of life ( QOL ) between single-port laparoscopic cholecystectomy ( SPLC ) and classic 4-port laparoscopic cholecystectomy ( CLC ) . Background : There is significant interest in further reducing the trauma associated with surgical procedures . Although a number of observational studies have suggested that SPLC is a feasible alternative to CLC , there is a lack of data from r and omized studies validating any benefit over CLC . Methods : Eligible patients were r and omized to receive SPLC or CLC .  Operative and perioperative outcomes , including cosmesis and QOL were analyzed . Results : Forty-three patients were r and omized to SPLC ( n = 21 ) or CLC ( n = 22 ) . There were no significant differences between groups for most preoperative demographics , American Society of Anesthesiology score , gallstone characteristics , local inflammation , blood loss , or length of stay .  Patients undergoing SPLC were older than those receiving CLC  ( 57.3 years vs. 45.8 years , P < 0.05 ) . Operative times for SPLC were greater than CLC ( 88.5 minutes vs. 44.8 minutes , P < 0.05 ) . Overall and cosmetic satisfaction , QOL as determined by the SF-36 survey , postoperative complications , and post-operative pain scores between discharge and 2-week postoperative visit were not significantly different between groups . Wound infection rates were similar in both groups . The SPLC group contained 1 retained bile duct stone , 1-port site hernia , and 1 postoperative port site hemorrhage . Conclusions : SPLC procedure time was longer and incurred more complications than CLC without significant benefits in patient satisfaction , postoperative pain and QOL .  SPLC may be offered in carefully selected patients . Larger r and omized trials performed later in the learning curve with SPLC may identify more subtle advantages of one method over another Purpose Laparoscopic techniques have allowed surgeons to perform complicated intra-abdominal surgery with minimal trauma . Single incision laparoscopic surgery ( SILS ) was developed with the aim of reducing the invasiveness of conventional laparoscopy . In this study we aim ed to compare results of SILS cholecystectomy and three port conventional laparoscopic ( TPCL ) cholecystectomy prospect ively . Methods In this prospect i ve study , 100 patients who underwent laparoscopic cholecystectomy for gallbladder disease were r and omly allocated to  SILS cholecystectomy ( group 1 ) or  TPCL cholecystectomy  ( group 2 ) . Demographics , pathologic diagnosis , operating time , blood loss , length of hospital stay , complications , pain score , conversion rate , and satisfaction of cosmetic outcome were recorded . Results Forty-four SILS cholesystectomies ( 88 % ) and 42 TPCL cholecystectomies ( 84 % ) were completed successfully . Conversion to open surgery was required for 4 cases in group 1 and 6 cases in group 2 . Operating time was significantly longer in group 1 compared with group 2 ( 73 minutes vs. 48 minutes ; P < 0.05 ) . Higher pain scores were observed in group 1 versus group 2 in postoperative day 1 ( P < 0.05 ) . There was higher cosmetic satisfaction in group 1 ( P < 0.05 ) . Conclusion SILS cholecystectomy performed by experienced surgeons is at least as successful , feasible , effective and safe as a TPCL cholecystectomy . Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious , gra date d approach to attempt the various procedures . Prospect i ve r and omized studies comparing single access versus conventional multiport laparoscopic cholecystectomy , with large volumes and long-term follow-up , are needed to confirm our initial experience . ( Clinical Trials.gov Identifier : NCT01772745 . Background Laparoendoscopic single-site ( LESS ) surgery is an evolution of laparoscopic surgery aim ing at decreasing the patient ’s parietal trauma associated with abdominal operations . LESS has been found so far to be efficient and have the same good results as the st and ard four-port laparoscopic cholecystectomy . α-Defensins are antimicrobial peptides of the organism . They are the first cell components against pathogens . Cytokines are also mediators in the response to trauma . The aim of this study was to compare the inflammatory reaction in LESS and four-port laparoscopic cholecystectomy . Methods Forty patients with noncomplicated cholelithiasis were r and omly assigned into one of two groups . Group A included the patients who would undergo four-port laparoscopic cholecystectomy and group B included the patients who would undergo LESS cholecystectomy . These patients had a BMI < 30 , were ASA I or II , and had no previous upper-GI surgery . Blood was taken preoperatively and 6 and 24 h postoperatively . hsCRP ( with automated analyzer ) and α-defensins ( using ELISA ) were calculated for each sample . The same postoperative protocol was followed for both groups . Mann-Whitney U test was used to analyze the results . Pain was calculated with a visual analog scale ( VAS ) for shoulder and abdomen at 6 and 24 h. Hospital stay , nausea , and pain medication needed was noted . Results The α-defensins value was statistically significantly higher in the 24-h sample s ( P < 0.001 ) for LESS cholecystectomy . No statistically significant difference was shown for hsCRP , even though P = 0.05 for the 24-h sample s with the values of LESS higher . No LESS was converted to a classical laparoscopic cholecystectomy , and none of the patients of either group needed conversion to open cholecystectomy . Pain was statistically significantly less for the LESS group at the 24-h interval ( P < 0.0001 ) . Less medication was needed for LESS patients after the 6th postoperative hour ( P = 0.007 ) . Conclusion Higher inflammatory reaction in LESS cholecystectomy could be the result of greater tension on the tissues . More studies are needed to conclude if this has a significant clinical expression Purpose : We report the outcomes of a r and omized clinical trial of single-port laparoscopic cholecystectomy ( SPLC ) and multiport laparoscopic cholecystectomy ( MPLC ) . Methods : Fifty-four patients ( 27 in each group ) were r and omized . A visual analog scale was used with a 10-point scale for an objective assessment of incisional pain and incisional cosmesis on postoperative days 1 , 3 , and 14 . Results : The mean operating time was significantly longer in the SPLC . The mean cosmesis scores on postoperative days 3 ( 9.7 vs. 8.9 , P=0.01 ) and 14 ( 9.9 vs. 9.2 , P<0.01 ) were significantly greater in the SPLC group than in the MPLC group . The group ’s mean visual analog scale scores for incisional pain , and their requirements for analgesics , did not differ significantly . Conclusions : Although SPLC takes longer than MPLC , experienced laparoscopic surgeons can perform SPLC safely with results comparable with those for MPLC . SPLC is superior to MPLC in terms of short-term cosmetic outcomes Background Natural orifice transumbilical endoscopic surgery ( NOTES ) is a technique still in experimental development that requires clinical trials to assess its safety and efficacy . We present a pilot prospect i ve , r and omized , three-arm clinical trial of 1-year duration that was conducted as a noninferiority trial comparing single-incision laparoscopic surgery ( SILS ) and flexible single-incision surgery ( FSIS ) with conventional laparoscopy for elective cholecystectomy ( NCT01558414 ) . Methods Sixty patients between aged 18 and 65 years who were eligible for elective cholecystectomy were r and omly assigned in a 1:1:1 ratio ( n = 20 per group ) : group A ( SILS ) , single-incision endoscopic surgery using a transumbilical SILS ™ device ; group B ( FSIS ) , single-incision transumbilical surgery using a flexible endoscope ; and group C ( CL ) , conventional laparoscopy . The main outcome variable of the study was “ parietal complications ” ( wound infection , bleeding , and ventral hernia ) . The analysis was by intention to treat and attritions were not replaced . Results Cholecystectomy was performed in 100 % of the cases ; perioperative complications occurred in only 1.6 % of the cases , and umbilical surgical wound infection in 3.33 % , with no differences between groups . After a minimum follow-up of 1 year , no differences were noted in the frequency of parietal complications and no ventral hernias occurred . Postoperative pain , hospital length of stay , and downtime from work 
    Output:
    
ConclusionS ingle-incision laparoscopic cholecystectomy with curved instruments may be associated with an increased level of operative difficulty , as reflected by the need for auxiliary measures for exposure and increased operative time as compared to the use of linear instruments .