Meta-analysis and trial sequential analysis of three-port vs four-port laparoscopic cholecystectomy (level 1 evidence)

Three-port versus Four-port Laparoscopic Cholecystectomy

“…In Group 3-port LC, 17 patients (57%) needed more than 80 minutes of surgery. Between the two groups, there is a statistically significant difference in the mean operative time (10) . While in our study it was measured as the time from the skin incision to closure, the variation in operating time between the two studies is attributable to various criteria utilised by surgeons for operative time.…”

“…This result needed factual importance (7) . Comparative discoveries were tracked down by numerous journalists in different examinations (10)(11)(12). Regarding postoperative torment and difficulties, it was found that 3-port LC had altogether lower VAS at 6 hours post-usable (5.76 ± 0.92 versus 6.20 ± 0.99; p= 0.01) and VAS at 24-hour postoperative (2.76 ± 0.91vs.…”

Evidence-based surgery for laparoscopic cholecystectomy

“…Six RCTs and 2 systematic reviews compared 2- and 3-port LC against 4-port LC [ [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] ] ( Table 2 ). Two-incision approach differed slightly between studies: Poon et al used a modified operating telescope through 1 of the ports [ 16 ], Tavassoli et al used two 5-mm ports inserted into the umbilical incision and one 10-mm port in the hypogastrium [ 17 ], and Sreenivas et al used 2 ports and 2 additional needlescopic transabdominal graspers [ 18 ].…”

“…All 4 studies comparing 3-LC and 4-LC demonstrated less postoperative pain and quicker return to work/physiologic baseline among 3-LC patients [ [12] , [13] , [14] , [15] ]. For 2-LC versus 4-LC, Tavassoli and Sreenivas found decreased pain and quicker return to baseline after 2-LC [ 17 , 18 ], whereas Poon did not find improvements in pain [ 16 ].…”

“…No articles, including Hajibandeh's meta-analysis of 2,111 patients [ 14 ] and Gurusamy's meta-analysis of 855 patients, demonstrated increased complications for 2-LC or 3-LC when compared with 4-LC. Several studies had significant statistical issues: Singal et al did not report P values, and [ 13 ] Liu et al did not report power calculations [ 12 ].…”