Three Port Versus Standard Four Port Laparoscopic Cholecystectomy- A Prospective Study

The first laparoscopic cholecystectomy (LC) was performed in 1987 by Philip Mouret and later established by Dubois, Perissat, Reddick, and others in 1990's (1-3). Since then, there have been many changes and improvements in the technique. Traditional LC is performed using 4 port technique. The fourth (lateral) trocar is used to grasp the fundus of the gall bladder so as to expose the Calot's triangle (1, 3, 4). With increasing surgeon experience, LC has under gone many refinements including reduction in port size and number. It has been argued that the fourth trocar may not be necessary, and laparoscopic cholecystectomy can be performed safely without using it (1, 5-8). In India, first case was performed by T.E.Udwadia in Mumbai in 1991 (9). Laparoscopic Cholecystectomy has become the gold standard for treatment of gallbladder stone disease (10). This is a prospective study over a period of one year of 200 patients, comparing the safety and efficacy in reducing the number of ports from four to three in Laparoscopic Cholecystectomy. Material and Methods This study was conducted in the Department of Surgery of ASCOMS & Hospital, Jammu, India, for one year. Two hundred patients with symptomatic gallstone disease were admitted for elective surgery and randomized into two groups viz. group A (100 pts) subjected to the three port technique and group B (100 pts) subjected to the conventional four port technique. The patients were initially evaluated and worked up in the out-patient department including ultrasound abdomen and then admitted for surgery after taking an informed consent. All patients were screened and those who were Introduction Abstract The current study was undertaken to compare the safety, efficacy, cosmesis, cost effectiveness, complication rates and incidence of conversions. In a period of one year 200 patients with symptomatic GB stone disease were randomly divided into group A (100 patients) for three port technique and group B (100 patients) for standard four port technique. The outcomes were assessed based on duration of surgery, complication rates, postoperative pain, cosmesis, hospital stay and conversion rates.The mean operative time was compared and found to be less in group A. Intraoperative and postoperative complications was similar in both groups. The postoperative pain was less in group A. The mean hospital stay was less in group A (1.27 days) than group B (1.95 days).Better cosmetic results and patient satisfaction was observed in group A. 5 patients of group A required fourth port and 3 patients of group B required conversion to open cholecystectomy. The three port technique is a safe and feasible method in hands of an experienced laparoscopic surgeon. Thus it can be recommended as a safe alternative to conventional four ports laparoscopic Cholecystectomy.