A prospective, randomized, controlled trial of three-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: is the fourth port really required?

Background: Since the advent of four-port laparoscopic cholecystectomy (LC), many modifications have been made that aimed to improve cosmesis and patient prognosis. Here we compared a variety of surgical outcomes such as quality of life three months after surgery between three-port LC and conventional four-port LC. Methods: This study presents an analysis of 245 patients with cholelithiasis who were between 31 and 78 years of age and who underwent elective LC between May 2013 and December 2014. Patients were randomized to undergo either the three-port LC or four-port LC surgery. Operation and hospitalization details were collected. Cosmetic outcome and quality of life of patients were assessed by the validated Patient Scar Questionnaire and MOS-24 questionnaire, respectively, 3 months after surgery. Results: 245 patients were included, and a complete followup was possible for 216 patients (88%). The average length of hospital stay, as well as time needed for return to normal activity and work, was significantly shorter in the three-port group than in the four-port group. No significant differences were observed for operating time and bleeding volume. The average hospitalization cost was lower, and, more importantly, patients had a significantly better cosmetic outcome and quality of life scores at 3 months in the three-port group. Conclusion: Three-port LC was as effective as the conventional four-port LC, and it shortened hospital stay, reduced hospitalization cost, and accelerated patient recovery. Moreover, the cosmetic outcome and quality of life were better.