Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery

Abstract

Aims and objectives:To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, postoperative pain, incidence of complications, and cosmetic results. Materials and methods:The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Totally, 200 adult patients of cholelithiasis with chronic cholecystitis were included in the study. These cases were randomly divided into two groups (I and II) consisting of 100 cases in each group. The study was conducted for a period of 1 year from April 2014 to March 2015. Three-port LC was performed in group I patients and four-port LC was performed in group II. The cosmetic results, incidence of postoperative complications, and operative time were noted in both the groups.The present study is being undertaken to compare the various merits and demerits of three-port LC vs four-port LC performed by the same surgical team in the same scenario, in terms of parameters mentioned subsequently and assess the feasibility of both the procedures in our setup in a medical college.Results: Gallstone disease is found to be more common in the 4th and 5th decades. Mean age of presentation was 41 years. Three-port LC is difficult in cases of dense adhesions. There were significant differences in operative time (93.16 minutes for three-port LC and 50.66 minutes for four-port LC). There was no significant difference due to type of operation. Cosmetic appearances for both the procedures were comparable. Conclusion:We concluded that both three-port and four-port cholecystectomies are equally good procedures in the hands of experienced laparoscopic surgeons. The complications, operative time, hospital stay, cosmesis, and disability days were comparable in both groups. The four-port technique should be accepted and adopted only by beginners in minimal access surgery. The operator who performs three-port LC should be prepared for placement of an additional port or conversion to open laparotomy whenever complication arises.

Evidence-based surgery for laparoscopic cholecystectomy

“…Six RCTs and 2 systematic reviews compared 2- and 3-port LC against 4-port LC [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ] ( Table 2 ). Two-incision approach differed slightly between studies: Poon et al used a modified operating telescope through 1 of the ports [ 16 ], Tavassoli et al used two 5-mm ports inserted into the umbilical incision and one 10-mm port in the hypogastrium [ 17 ], and Sreenivas et al used 2 ports and 2 additional needlescopic transabdominal graspers [ 18 ].…”

“…All 4 studies comparing 3-LC and 4-LC demonstrated less postoperative pain and quicker return to work/physiologic baseline among 3-LC patients [ [12] , [13] , [14] , [15] ]. For 2-LC versus 4-LC, Tavassoli and Sreenivas found decreased pain and quicker return to baseline after 2-LC [ 17 , 18 ], whereas Poon did not find improvements in pain [ 16 ].…”

“…Only Singal et al found increased operative time for reduced-port LC (93.16 min for 3-LC vs 50.66 min for 4-LC), although this study suffered from a lack of P values [ 13 ]. Poon et al even found significantly lower operative time for 2-LC (54.6 min vs 66.0 min, P = .04) [ 16 ].…”

“…The advent of single-incision LC, where up to 4 laparoscopic instruments are inserted via 1 umbilical incision, is representative of a trend to decrease the invasiveness of LC [ 11 ]. Reduced-port LC may result in improved cosmesis and reduced postoperative pain, although potential tradeoffs may include increased operative time [ 12 , 13 ]. Port closure technique, including sutured versus nonsutured fascial closure, must also be considered in the effort to minimize complications; this discussion is addressed in our group's previous publication [ 9 ].…”

Effect of Duration of Surgery on Liver Enzymes After Cholecystectomy: Safety or Duration

“…The introduction of minimal access surgery for gallbladder surgery has revolutionized the treatment of gallstones [1]. Laparoscopic cholecystectomy (LC) has become the gold standard treatment for symptomatic uncomplicated cholelithiasis and replaced the open cholecystectomy (OC).…”