Three-portal technique for laparoscopic cholecystectomy

Abstract

Abstract:We devised special maneuvers and techniques, which we refer to as "the three-portal technique," for the performance of laparoscopic cholecystectomy. With this technique, the primary surgeon operates from the right side of the patient, beginning dissection at the posterior surface of the gallbladder and advancing until the neck of the gallbladder is sufficiently separated from the hepatic bed. The particular advantages of our technique are that the quadrate lobe of the liver does not obstruct the operative field, because of the direction of the dissecting forceps controlled by the operator's right hand, and there is less contact between the various instruments. Sixteen patients with gallstones were successfully treated with this new technique, and no morbidity was attributable to the procedure.

A new technique for two-trocar laparoscopic cholecystectomy

“…Recently, numerous attempts [1,2,6,7,8] have been made to perform LC with fewer trocarsÐnamely, three or two trocarsÐto reduce die trauma of access. However, if fewer trocars are used without any other devices, the surgeon is not able to expose Carot's triangle, and dissection of the cystic duct becomes more dicult and unsafe [5] because it is not mandatory to hold the gallbladder with two grasping forceps, which serve dierent purposes complementary to each other.…”

“…New techniques for laparoscopic cholecystectomy (LC) that use just one to three trocars [1,2,6,7,8] or thin instruments measuring only 2 or 3 mm in diameter have been devised to further minimize surgical invasiveness. However, it is dicult to lift up an in¯amed gallbladder securely and to expose Carot's triangle distinctly during these operative procedures.…”