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

Mohd Yunus Shah; Umeshraj Somasundaram; TRVRaju Wilkinson; Nitin Wasnik

doi:10.7759/cureus.19979

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

Cureus. 2021 Nov 29;13(11):e19979. doi: 10.7759/cureus.19979. eCollection 2021 Nov.

Authors

Mohd Yunus Shah¹, Umeshraj Somasundaram², TRVRaju Wilkinson¹, Nitin Wasnik¹

Affiliations

¹ Department of Surgery, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND.
² Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Chengalpet, IND.

Abstract

Background The 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 methods A 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. Results Demographic 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, respectively Length 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. Conclusion Three-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.

Keywords: cholelithiasis.; four-port technique; laparoscopic cholecystectomy; minimally invasive surgery; three-port technique.