A flower-shaped cannula for three-incision laparoscopic cholecystectomy

A comparative study of two-port versus three-port laparoscopic cholecystectomy

BACKGROUND:

Conventionally, laparoscopic cholecystectomy (LC) is performed by using three or four ports of various sizes. As cosmesis is an important aspect of LC, the trend is now towards use of fewer ports, thereby resulting in better cosmesis for patients. The aim of this study was to compare three-port against two-port LC techniques and to see whether there is any advantage in using one technique over the other.

SETTINGS AND DESIGN:

The study was conducted in the Department of General Surgery of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) hospital in Northeast India. A prospective comparative type of study was designed. An odd number of patients were operated on by using the three-port technique (Group A), whereas an even number of patients were operated on by the two-port technique (Group B).

MATERIALS AND METHODS:

Sixty patients with symptomatic gallstone disease were included in the study after obtaining informed consent from each of the patients. All patients were operated on under general anaesthesia.

STATISTICAL ANALYSIS USED:

Statistical analysis was done using SPSS software version 22.

RESULTS:

There were 51 female patients and 9 male patients. The mean patient age was 38.67 years. There was less operative time in group A but less postoperative pain in group B. Cosmetic appearance and patient satisfaction for the scar were better in group B.

CONCLUSIONS:

The two-port method appeared to have better acceptability among patients due to lower pain score and better cosmesis.

Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis

BACKGROUND

Several modifications have been introduced to laparoscopic cholecystectomy (LC). The three-port technique has been practiced on a limited scale. Our aim was to compare the three-port and four-port LC in acute (AC) and chronic cholecystitis (CC).

METHODS

The medical records of 495 patients who underwent LC between September 1999 and September 2003 were reviewed. Variables such as complications, operating time, conversion to open procedure, hospital stay, and analgesia requirements were compared.

RESULTS

Two hundred and eighty-three patients underwent three-port LC and 212 patients underwent four-port LC. In total, 163 (32.9%) patients were diagnosed with AC and 332 (67.1%) with CC by histology. There was no statistical difference between the three and four-port groups in terms of complications, conversion to open procedure (p = 0.6), and operating time (p = 0.4). Patients who underwent three-port LC required less opiate analgesia (pethidine) than those who underwent four-port LC (p = 0.0001). The hospital stay was found to be related to the amount of opiates consumed (p = 0.0001) and was significantly shorter in the three-port LC group (p = 0.005).

CONCLUSION

Three-port LC is a safe procedure for AC and CC in expert hands. The procedure offers considerable advantages over the traditional four-port technique in the reduction of analgesia requirements and length of hospital stay.

Three-port vs standard four-port laparoscopic cholecystectomy

BACKGROUND

Since the first laparoscopic cholecystectomy (LC) was reported in 1990, it has met with widespread acceptance as a standard procedure using four trocars. The fourth (lateral) trocar is used to grasp the fundus of the gallbladder so as to expose Calot's triangle. It has been argued that the fourth trocar is not necessary in most cases. Therefore, the aim of this study was to compare the three-port vs the four-port technique.

METHODS

Between 1998 and 2000, 200 consecutive patients undergoing elective LC for gallstone disease were randomized to be treated via either the three- or four-port technique.

RESULTS

There was no difference between the two groups in age, sex, or weight. In terms of outcome, there was no difference between the two groups in success rate, operating time, number of oral analgesic tablets (paracetamol), visual analogue score, or postoperative hospital stay; however, the three-port group required fewer analgesic injections (nalbuphine) (0.4 vs 0.77, p = 0.024).

CONCLUSION

The three-port technique is as safe as the standard four-port one for LC. The main advantages of the three-port technique are that it causes less pain, is less expensive, and leaves fewer scars.