***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: 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 Background : Two-port laparoscopic cholecystectomy has been reported to be safe and feasible . However , whether it offers any additional advantages remains controversial . This study reports a r and omized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy . Methods : One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were r and omized to receive either the two-port or the four-port technique . All patients were blinded to the type of operation they underwent . Four surgical tapes were applied to st and ard four-port sites in both groups at the end of the operation . All dressings were kept intact until the first follow-up 1 week after surgery . Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale ( VAS ) . Other outcome measures included analgesia requirements , length and difficulty of the operation , postoperative stay , and patient satisfaction score on surgery and scars . Results : Demographic data were comparable for both groups . Patients in the two-port group had shorter mean operative time ( 54.6 ± 24.7 min vs 66.9 ± 33.1 min for the four-post group ; p = 0.03 ) and less pain at individual subcostal port sites [ mean score using 10-cm unscaled VAS : 1.5 vs 2.8 ( p = 0.01 ) at the midsubcostal port site and 1.3 vs 2.3 ( p = 0.02 ) at the lateral subcostal port site ] . Overall pain score , analgesia requirements , hospital stay , and patient satisfaction score on surgery and scars were similar between the two groups . Conclusion : Two-port laparoscopic cholecystectomy result ed in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy . Thus , it can be recommended as a routine procedure in elective laparoscopic cholecystectomy 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 : 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 Although laparoscopic cholecystectomy has rapidly developed in the treatment of gall bladder disease in the absence of controlled clinical trial data its outcome parameters compared with open cholecystectomy remain unclear . A prospect i ve audit of the introduction of laparoscopic cholecystectomy in the west of Scotl and over a two year period was carried out to attempt to assess this new procedure . A total of 45 surgeons in 19 hospitals performing laparoscopic cholecystectomy su bmi tted prospect i ve data from September 1990 - 1992 . A total of 2285 cholecystectomies were audited ( a completed data collection rate of 99 % ) . Laparoscopic cholecystectomy was attempted in 1683 ( 74 % ) patients and completed in 1448 patients ( median conversion rate to the open procedure 17 % ) . The median operation time in the completed laparoscopic cholecystectomy patients was 100 minutes ( range 30 - 330 ) and overall hospital stay three days ( 1 - 33 ) . There were nine deaths ( 0.5 % ) after laparoscopic cholecystectomy although only two were directly attributable to the laparoscopic procedure . In the laparoscopic cholecystectomy group there were 99 complications ( 5.9 % ) , 53 ( 3 % ) of these were major requiring further invasive intervention . Forty patients ( 2.4 % ) required early or delayed laparotomy for major complications such as bleeding or bile duct injuries . There were 11 ( 0.7 % ) bile duct injuries in the laparoscopic cholecystectomy series , five were noted during the initial procedure and six were recognised later result ing from jaundice or bile leaks . Ductal injuries occurred after a median of 20 laparoscopic cholecystectomies . In conclusion laparoscopic cholecystectomy has rapidly replaced open cholecystectomy in the treatment of gall bladder disease . Although the overall death and complication rate associated with laparoscopic cholecystectomy is similar to open cholecystectomy , the bile duct injury rate is higher The main objectives of minisite cholecystectomy ( MC ) are to have smaller incisions , better cosmetic results , less trauma , and a lower morbidity rate . This prospect i ve r and omized study compares MC with conventional laparoscopic cholecystectomy ( CLC ) in terms of surgical trauma and cosmetic results in 44 patients . Conversion from MC to CLC was required in five patients . No conversion to open surgery was needed in the CLC group . The average operating time was slightly longer in the MC group , but the difference was not statistically significant ( 81 minutes versus 72 minutes , p=0.22 ) . The population characteristics , postoperative respiratory function measurements , pain scores , and analgesic requirements were similar in the two groups . The average score for scar tissue was significantly lower in the MC group ( 0.73 versus 1.93 , p=0.0045 ) . Only the cosmetic results of MC were superior to CLC . This technique could be a feasible alternative procedure in patients seeking better cosmetic results . However , further studies with larger sample sizes are needed to evaluate the postoperative morbidity of MC.RésuméLes objectifs principaux de la cholécystectomie laparoscopique minime ( CM ) ( par mini-trocars ) sont de réaliser de plus petites incisions , d’obtenir un meilleur résultat esthétique , de provoquer moins de trauma et d’avoir un taux plus bas de morbidité que la cholécystectomie par laparoscopic classique . Cette étude prospect i ve r and omisée a comparé la CM à la cholécystectomie par laparoscopic ( CL ) traditionnelle en termes de traumatisme chirurgical et de résultat esthétique chez 44 patients . On a du convertir la CM en CL chez cinq patients . Aucune conversion vers la chirurgie ouverte n’a été nécessaire dans le groupe de CL traditionnelle . Le temps moyen d’intervention a été plus long dans le groupe CM mais cette différence n’était pas statistiquement significative ( 81 min vs. 72 min , p=0.22 ) . Les caractéristiques de la population , les fonctions respiratoires , les scores de la douleur et les besoins en analgésiques étaient similaires dans les deux groupes . Les scores moyens d’évaluation de la cicatrice ont été significativement plus bas dans le groupe CM ( 0.73 vs. 1.93 , p=0.0045 ) . Seuls les résultats esthétiques de la CM étaient supérieurs à la CL . Cette technique pourrait être une alternative valable chez les patients cherchant une amélioration des résultats esthétiques . Cependant , d’autres études avec des échantillons plus larges sont nécessaires pour évaluer la morbidité postopératoire de la CM.ResumenEl propósito principal de la colecistectomía de invasión mínima ( CIM ) es lograr una cicatriz pequeña , mejor apariencia estética , menos trauma y morbilidad reducida . El présente estudio prospect i ve y aleatorizado compara la CIM con la coleciste 
    Output:
    
There is very low quality evidence that is insufficient to determine whether there is any significant clinical benefit in using fewer-than-four-ports laparoscopic cholecystectomy compared with four-port laparoscopic cholecystectomy .