Feasibility and Safety of Three-Port Laparoscopic Cholecystectomy Compared to Four-Port Laparoscopic Cholecystectomy.

Mohd Yunus Shah,Nitin Wasnik,Trvraju Wilkinson,Umeshraj Somasundaram

doi:10.7759/cureus.19979

Abstract

BackgroundThe standard four-port laparoscopic cholecystectomy (LC) is the gold standard procedure. The various clinical trials and reports in the literature have suggested that the three-port technique LC can be done safely with acceptable results.Still, that the three-port LC offers any added benefits to the patient is a controversial issue especially in view of safety and feasibility. In this study, we report the experience of three-port LC compared to four-port LC technique, its safety, feasibility and outcomes.Materials and methodsA prospective randomized study was conducted between two groups which included 165 cases - 93 patients were included in three-port LC (Group A) and 72 patients in four-port LC (Group B). Operative time, intraoperative complications, postoperative pain, length of hospital stay, analgesics requirement, conversion to open and return to normal activities were parameters of evaluation.ResultsDemographic data was comparable in both the groups. Three-port LC Group A had lesser post-operative pain and analgesics requirements. The mean postoperative pain visual analogue scale (VAS) score on day 1 was (4.16 and 6.24), on day 7 was (1.26 and 1.81) in three-port group and in four-port LC group, respectively. The mean days of analgesics requirement were 2.56 days and 4.21 days among three-port group and four-port group, respectivelyLength of hospital stay was less and returning to work was early in three-port group. There was no statistical difference in operative time. The mean operative time among three-port LC group A and four-port LC group B was 36+/-8.6 minutes (30-68) and 39+/-7 minutes (30-90), respectively. The overall outcomes were comparable to four-port LC.ConclusionThree-port LC is a feasible and safe procedure for LC with satisfactory outcomes like lesser postoperative pain, postoperative stay and less scars, when performed by experienced hands, especially in acute cholecystitis. The use of fourth port should be done when required in a difficult situation.

Highlights

Standard four-port laparoscopic cholecystectomy (LC) is considered to be a gold standard technique for cholecystectomy [1, 2].Various modifications have been done in the four-port laparoscopic cholecystectomy like decreasing the number and size of the ports to reduce the postoperative pain and better cosmetic results [3,4,5,6]
The use of the fourth port has been questioned by many surgeons and several studies in the literature have reported that three-port LC can be performed safely as it is a feasible technique with comparable outcomes [5,7,8,9]
As reported in other studies, the present study showed comparable less postoperative pain, less analgesics requirements, less number of days of hospitalization and early resumption of work in three-port LC as compared to four-port LC [3, 7,8, 18]

Summary

Introduction

Standard four-port laparoscopic cholecystectomy (LC) is considered to be a gold standard technique for cholecystectomy [1, 2].Various modifications have been done in the four-port laparoscopic cholecystectomy like decreasing the number and size of the ports to reduce the postoperative pain and better cosmetic results [3,4,5,6]. Standard four-port laparoscopic cholecystectomy (LC) is considered to be a gold standard technique for cholecystectomy [1, 2]. The use of the fourth port has been questioned by many surgeons and several studies in the literature have reported that three-port LC can be performed safely as it is a feasible technique with comparable outcomes [5,7,8,9]. These studies have mentioned that three-port LC outcomes need to be re-evaluated by other large sample studies. We report the experience of three-port LC compared to four-port LC technique, its safety, feasibility and outcomes

Methods

Results

Discussion

Conclusion