***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Background : Surgical technique using small-diameter instruments and single-incision laparoscopy are two new options for less invasive laparoscopic cholecystectomy ( LC ) .  In this study , we have compared mini-LC ( MLC ) with single-incision LC ( SILC ) . Material s and Methods : This study is a r and omized clinical trial conducted on the patients diagnosed with symptomatic cholelithiasis who underwent LC . Forty patients were r and omized to two equal groups of MLC and SILC . They were compared in terms of demographic data , operation time , and surgical complications . Results : Baseline characteristics were similar in two groups . Operation time in MLC was significantly shorter than that in SILC ( 45.1 ± 69 min vs 63.75 ± 7.57 min , P-value < 0.001 ) . Also , the total length of the wound in SILC group was shorter than that in MLC group ( P-value < 0.003 ) . Postoperative pain scores were similar in two groups . Hospital stay was shorter in MLC ( 1.2 ± 0.6 days vs 1.6 ± 0.8 days , P < 0.021 ) . There was no difference in postoperative complications in two groups . Conclusion : MLC because of less operation time is preferred than SILC . Also , by subjective measures , it was a more comfortable method compared to SILC Purpose : To estimate the effect of intraperitoneal levobupivacaine on postoperative pain and analgesic requirements , during the first 24 hours after elective laparoscopic cholecystectomy ( LC ) . Material s and Methods : In this prospect i ve , r and omized , placebo-controlled study , 73 consecutive patients scheduled for LC were r and omized into 2 groups . In the local anesthetic group 36 patients received 10 mL of 0.5 % levobupivacaine intraperitoneally at the end of the LC and at 4 hours postoperatively , whereas in the placebo group 37 patients received 10 mL of 0.9 % normal saline .  Visual analog scale pain scores , analgesic consumption , side-effects , and vital signs were recorded for 24 hours postoperatively . Results : In the local anesthetic group lower visual analog scale pain scores were observed postoperatively , both at rest and at movement ( P-values compared with placebo , 0.012 and < 0.001 , respectively ) . Fentanyl consumption was greater in the placebo group ( P-value < 0.001 ) . Conclusions : Intraperitoneal administration of 10 mL 0.5 % levobupivacaine after LC is effective in reducing postoperative pain and decreasing opioid consumption 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 STUDY OBJECTIVE To compare the effects of preoperative intravenous ( IV ) tramadol and preoperative tramadol infiltration of trocar sites on postoperative pain and postoperative nausea and vomiting ( PONV ) after laparoscopic cholecystectomy . DESIGN Prospect i ve , r and omized study . SETTING Operating room , recovery room , and surgical ward . PATIENTS 70 ASA physical status 1 and 2 patients , aged 20 - 70 years , scheduled for elective laparoscopic cholecystectomy . INTERVENTIONS In Group I , patients received IV 2.0 mg/kg of tramadol ; in Group II , trocar insertion points were infiltrated with 2.0 mg/kg of tramadol in 20 mL of 0.9 % NaCl . MEASUREMENTS Pain scores , sedation scores , postoperative analgesic requirement , and PONV were recorded at 0 and 30 minutes and one , three , 6 , 12 , and 24 hours . At 30 minutes and one hour , pain localization ( incisional or diffuse abdominal ) was also recorded . MAIN RESULTS Visual analog scale scores at 30 minutes were significantly lower in Group II [ 3 ( 0 - 7 ) ] than Group I [ 6 ( 3 - 8 ) ] ( P < 0.001 ) . In Group I , 91.4 % of patients received sodium diclofenac , while 68.6 % of Group II patients received sodium diclofenac ( P = 0.002 ) . The time to first analgesic requirement was significantly lower in Group II ( P = 0.004 ) . At the 30-minute measurement time , a significant difference was recorded between the groups in incisional pain ( P < 0.001 ) . There was also a significant difference between groups in the frequency of PONV . CONCLUSIONS Trocar site infiltration of tramadol improves early postoperative pain and decreases PONV UNLABELLED Abstract Background : Postoperative abdominal and shoulder pains after laparoscopic cholecystectomy ( LC ) are the most frequent complaints and are related to delayed recovery . There is a strong correlation between the residual gas volume and the severity of pain following various laparoscopic procedures . We aim ed to investigate the effects of aspiration of residual gas on postoperative outcomes and pain following LC . SUBJECTS AND METHODS Patients were r and omly assigned to either the active gas reduction group ( Group 1 , n=105 ) or the control group ( Group 2 , n=95 ) . After completion of the operative procedures , residual gas was aspirated with a flexible cannula in Group 1 . In Group 2 , gas release from the abdomen was performed using the port site by opening the gas tap only . The demographic data , operation time , insufflated CO2 volume during the operation , hospitalization period , and time to return to daily activities were recorded . Postoperative shoulder and abdominal pain assessment was performed using a numerical pain intensity scale ( NPIS ) at 1 hour , 24 hours , 3 days , and 7 days postoperatively . RESULTS There was no statistically significant difference between the groups in terms of demographic data , operative findings , and clinical outcomes . NPIS scores for shoulder pain at 1 hour and 24 hours were significantly lower in Group 1 ( P=.001 and P=.021 , respectively ) . However , there were no significant differences in the NPIS scores for shoulder and abdominal pain following 24 hours . No differences were found in the hospitalization duration and time to return to daily activities data ( P>.05 ) . CONCLUSIONS Active aspiration of the residual gas just before the removal of the trochars is a simple procedure and leads to a more comfortable hospital stay for patients Purpose : our study compared the effect of fentanyl alone with fentanyl plus intravenous Paracetamol for analgesic efficacy , opioid sparing effects , and opioid-related side effects after laparoscopic cholecystectomy . Material s and Methods : eighty patients undergoing laparoscopic cholecystectomy were r and omized into two groups , who were given either an IV placebo or an IV injection of 1 g paracetamol just before induction . Both groups received fentanyl during induction and IM diclofenac for pain relief every 8 hourly for 24 h after surgery . The postoperative pain relief was evaluated by a visual analog scale ( VAS ) and consumption of fentanyl as rescue analgesic in the postoperative period for 24 h after surgery was measured . The incidence of PONV and sedation scores was also measured in the postoperative period . Results : the mean VAS score in first and second hour after surgery was less in the group receiving IV Paracetamol ( 3.3±0.4 * vs. 5.2±0.9 ; 3.1±0.4 * vs. 4.3±0.3 ) ; the fentanyl consumption over first 24 h was also less in the group receiving IV paracetamol ( 50±14.9 vs. 150±25.8 ) . The time requirement of first dose of rescue analgesic in the postoperative period was also significantly prolonged in the group receiving IV paracetamol ( 76±24.7 vs. 48±15.8 ) . There was no difference in the sedation scores and in the incidence of PONV in the two groups . Conclusion : The study demonstrates the usefulness of intravenous paracetamol as pre-emptive analgesic in the treatment of postoperative pain after laparoscopic cholecystectomy 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  Pain following laparoscopic cholecystectomy ( LC ) is a barrier to early discharge . Some studies have demonstrated that local anaesthetic ( LA ) washed over the liver and gallbladder decreases postoperative pain . In many patients pain is partially of diaphragmatic origin which may not be treated effectively by topical 
    Output:
    
Single‐port incision techniques are not recommended to reduce pain ( GRADE A )