Experience with three-port laparoscopic cholecystectomy

Abstract

After considerable experience with laparoscopic cholecystectomy (LC) using four ports, we began using three-port LC in October 1993 and have performed 130 LCs with this procedure up to May 1996. The procedure was successful in 119 patients. In 6 patients fourth port was used, and in another 5, the procedure was converted to open laparo-tomy. Cooperative manipulation of the surgical instruments between the operator and assistant is very important for this procedure, for exposing Calot's triangle and dissecting the gallbladder from the gallbladder bed. The use of an ultrasonic aspiration system (Sumisonic ME 2400; Sumitomo Bakelite, Tokyo, Japan) made it easier to identify the cystic duct and artery, especially in patients with chronic inflammation or dense adhesions. We encountered no problems with cannulation into the cystic duct for intraoperative cholangiography, and there were no intra- and postoperative complications in this series. We achieved good results, similar to those achieved with the four-port technique. This technique is technically feasible and safe, and it has esthetic and cost advantages compared with the four-port technique. However, the operator who performs three-port LC should not hesitate to add another port, or to convert to open laparotomy, whenever any difficulties occur during this procedure, to prevent critical complications.

Comparative study between 3-ports and 4-ports laparoscopic cholecystectomy for the cases of gall stone disease

“…Previous studies have shown that laparoscopic cholecystectomy using only three ports is a safe method. [21][22] Similar findings have been found in this study. This study has shown that there is no significant difference between the operating time between the 3-ports technique and 4-ports technique.The previous studies have shown many factors causing prolonged operative time in laparoscopic cholecystectomy like age, sex, BMI, ASA score, previous abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography, acute cholecystitis, and surgeon's experience.…”

Microlaparoscopic vs conventional laparoscopic cholecystectomy

“…Several descriptive nonrandomized series have advocated either downsizing the trocars [9,10,11,13,15,17,18,21,22] or reducing the number of trocars [16,20]. Six randomized controlled trials have examined the eects of reducing the size [5,7,12,14,19] or number [6] of laparoscopic trocars in patients undergoing cholecystectomy.…”

Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy

“…In recent years, attempts have been made to minimize the invasiveness, by reducing the size and/or the number of the operating ports and instruments, and even more, the use of a natural orifice as the access port (Natural Orifice Transluminal Endoscopic Surgery-NOTES) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”