Background Single-incision laparoscopic cholecystectomy (SILC) might maximize the advantages of laparoscopic cholecystectomy (LC) by reducing postoperative pain and improving cosmesis. However, the safety and feasibility of SILC has not yet been established. This study assesses safety, patient reported outcome measures and feasibility of SILC versus conventional LC. Methods Literature search for RCT's comparing SILC with conventional LC in gallstone-related disease was performed in PubMed and Embase. The conventional LC was defined as two 10-mm and two 5-mm ports. Study selection was done according to predefined criteria. Two reviewers assessed the risk of bias. Pooled outcomes were calculated for adverse events, pain, cosmesis, quality of life and feasibility using fixed-effect and random-effects models. Results Nine RCT's were included with total of 860 patients. No mortality was observed. More mild adverse events (RR 1.55; 95% CI 0.99-2.42) and significantly more serious adverse events (RR 3.00; 95% CI 1.05-8.58) occurred in the SILC group. Postoperative pain (MD -0.46; 95% CI -0.74 to -0.18) and cosmesis (SMD 2.38; 95% CI 1.50-3.26) showed significantly better results for the SILC group, but no differences were observed in quality of life. Operating time (MD 23.12;) and the need for additional ports (RR 11.43; were significantly higher in the SILC group. No difference was observed in conversion to open cholecystectomy or hospital stay longer than 24 h. Conclusions SILC does not provide any clear advantages over conventional LC except for less postoperative pain and improved cosmesis. It is questionable whether these advantages outweigh the higher occurrence of adverse events and shortcomings in feasibility. Considering considerable heterogeneity and low methodological quality of the studies it is advisable to perform well-designed RCT's in the future to address the safety and clinical benefits of SILC.Keywords Laparoscopic cholecystectomy Á Singleincision Á Conventional Á Safety Á Feasibility Cholecystectomy has emerged as the standard surgical treatment for gallstone-related disease [1]. Since laparoscopic cholecystectomy (LC) is associated with reduced post-operative pain, a shorter hospital stay and a quicker convalescence compared to open cholecystectomy, it is accepted as the gold-standard surgical procedure [2]. In conventional LC, a multiport approach is applied, three or four ports are being used, usually four. Traditionally, two ports of 10 mm in size ensure the access of a camera and a clip applier. Manipulation of the gall bladder for adequate exposure of the field of surgery is accomplished with two ports of 5 mm in size [3]. Nowadays, an increasing number of groups use also different sizes of ports, for instance three 5-mm ports and one 10-mm port, using 5-mm clip appliers. Meta-analyses have already compared SILC with LC, but the evidence in these articles is limited. In some of these articles, the control group did not correspond to traditional four-port LC, but included three-port or ...