Single-incision Laparoscopic Cholecystectomy: Technical Challenges, Clinical Breakthroughs, and a New Chapter for the Future

Single-incision laparoscopic cholecystectomy (SILC) represents a significant direction in the evolution of minimally invasive surgery. Performed through a single umbilical incision, SILC offers the distinct advantage of achieving a "scarless" abdominal wall and significantly improving patient cosmetic satisfaction. However, this technique faces considerable technical challenges, including the "chopstick effect" inherent to coaxial instrument manipulation, limited visual field, and a steep learning curve. These factors may contribute to an elevated risk of complications such as bile duct injury and incisional hernia. Currently, SILC is primarily indicated for carefully selected patients with low-to-moderate surgical complexity benign gallbladder diseases. While it achieves comparable major clinical outcomes to conventional laparoscopic cholecystectomy (LC), debates persist regarding its operative duration, postoperative pain profiles, and health economic implications. To address these technical bottlenecks, innovative modifications such as suspension exposure techniques, magnetic anchor technology, and robotic single-port platforms continue to emerge. This review contends that SILC serves not as a replacement for conventional LC, but as a valuable complement, specifically designed to meet the higher demands for aesthetics and minimal invasiveness in particular patient populations. Future advancement of SILC urgently requires robust high-quality evidence, establishment of standardized training protocols, and systematic progress in instrument innovation and healthcare reimbursement policies. Such developments are essential to steer SILC towards a more precise and personalized surgical paradigm.