# Minilap-assisted modified single-incision vs. traditional single-incision laparoscopic cholecystectomy: a retrospective cohort study on instrument conflict and operative efficiency

## TL;DR

A new surgical technique for gallbladder removal reduces tool conflicts and improves efficiency, especially in patients with high BMI, while keeping similar cosmetic results.

## Contribution

Introduces minilap-assisted modified single-incision laparoscopic cholecystectomy (MSILC) to reduce instrument conflicts and improve efficiency.

## Key findings

- MSILC reduced instrument conflicts by 38.5% and improved operator comfort by 50% compared to traditional SILC.
- In high BMI patients, MSILC decreased operation time by 17.5% and gallbladder triangle separation time by 50%.
- Cosmetic outcomes were comparable between MSILC and traditional SILC, but MSILC had higher consumables and hospitalization costs.

## Abstract

The single-incision laparoscopic cholecystectomy (SILC) achieves a scarless appearance through a single umbilical approach. However, the restricted surgical field of view, frequent instrument collisions limit its clinical applicability. This study introduces minilap-assisted modified single-incision laparoscopic cholecystectomy (MSILC), incorporating two adjacent trocars at the umbilicus, combined with a 2-mm auxiliary hole created beneath the right costal margin, to mitigate these limitations while preserving aesthetic outcomes.

To explore the clinical value of MSILC compared with traditional SILC (TSILC) in reducing instrument conflict, shortening operation time, improving operator efficiency and cosmetic effects, and providing a basis for the selection of surgical procedures for patients with high body mass index (BMI).

A total of 51 patients with benign gallbladder diseases who underwent MSILC or TSILC between December 2021 and April 2025 at our institution were retrospectively enrolled and categorized into the MSILC (n = 25) or TSILC (n = 26) groups, respectively. For MSILC, a double-channel trocar was deployed at the umbilicus, combined with a 2-mm auxiliary hole layout placed beneath the right costal margin; TSILC comprised a single umbilical incision. The primary endpoint was the number of intraoperative instrument conflicts, while the secondary endpoints included operation time, Surgical difficulty score, operator comfort, and cosmetic satisfaction regarding the incision.

In the MSILC group, the number of instrument conflicts was reduced by 38.5% (median 16 vs. 26, P < 0.001), while the operator comfort score improved by 50% (median 3 vs. 2, P < 0.001) compared with the TSILC group. In the high BMI subgroup (≥ 24 kg/m2), the operation time was decreased by 17.5% (83.43 ± 17.24 vs. 101.13 ± 18.12 minutes, P = 0.012), and the gallbladder triangle separation time was reduced by 50% (median 1 vs. 2 minutes, P = 0.029) for MSILC. No cases in eith er group required conversion to laparotomy or experienced severe complications. No significant differences were observed in the 24-hour postoperative pain score (median visual analog scale score 2 vs. 2, P = 0.982) and cosmetic satisfaction regarding the incision 1 month after surgery (median 5 vs. 4, P = 0.221) between the MSILC and TSILC groups. However, consumables cost and total hospitalization costs in the MSILC group increased by 34.7% (P < 0.001) and 14.4% (P = 0.042), respectively.

MSILC significantly improves intraoperative efficiency by optimizing the trocar layout, especially in patients with high BMI, while maintaining safety and cosmetic outcomes comparable with those of TSILC. However, cost increases due to the use of microdevices should be taken into consideration.