Twenty-Millimeter Laparoscopic Cholecystectomy: Fewer Ports Results in Less Pain, Shorter Hospitalization, and Faster Recovery

Abstract

Improvements in technology offer the ability to refine operations without compromising safety. In this study, we determine whether a modified method of laparoscopic cholecystectomy using three ports and an aggregate incision length of 20 mm offers any advantage or poses increased risk. Using a 5-mm, 30° laparoscope, clip applier, and dissector, the gall bladder is removed through an extended umbilical incision. Standard safety principles were followed: achieving the “critical view,” lateral retraction of the fundus, double ligation of the proximal structures, and maintaining sterility for specimen removal. Forty-one consecutive standard laparoscopic cholecystectomies were used as a control group to compare complications, length of stay and surgery, pain scores, and return to work. Sixty patients have undergone the modified technique. There were no differences between the modified and standard technique with regard to cost or complications. Length of surgery was significantly shorter, as was length of stay, narcotics use, and return to work for the modified group versus the control. A modified technique for laparoscopic cholecystectomy poses no increased risk to patients but offers potential for shorter surgery and hospital stays, less need for narcotic analgesia, and faster recovery.

A comparative evaluation of three port versus standard four port laparoscopic cholecystectomy in SGRRIMHS and SMIH Dehradun

“…4,18 The use of the fourth trocar which is generally used for fundus retraction in the American technique seemed unnecessary by some surgeon. 19,20 Many researchers have proved that reducing the number and size of port incisions have more favorable results. [7][8][9][10][11][12] The results comparing both groups in our study were similar to standard literature in terms of age, sex, USG findings, operating time, conversion to open LC, need for 4th port in 3 ports LC, complications and mean hospital stay.…”

A comparative study of two-port versus three-port laparoscopic cholecystectomy

“…[ 10 11 ] Reducing the number and size of ports further enhanced the advantages of laparoscopic over open cholecystectomy. [ 4 ] These modifications actually reduced the pain and analgesia requirement. [ 6 ] Poon et al .…”

“…The value of the lateral (fourth) trocar in the American technique used to hold the gall bladder fundus has been challenged. [ 14 15 ] Recently published data[ 4 16 ] showed that the three-port technique did not compromise the procedure's safety.…”

“…[ 3 ] With increasing surgeon experience, LC has undergone many refinements including reduction in port size. [ 4 ] Three trocars and even two trocars have been used to perform LC,[ 4 5 ] as were mini-instruments; the authors of these new techniques claimed that these techniques took similar time to perform and caused less postoperative pain than the standard LC. [ 6 7 ] Two-port LC has been reported in the international literature to be safe and feasible.…”

Single-Incision Laparoscopic Cholecystectomy Using Conventional Laparoscopic Instruments and Comparison with Three-Port Cholecystectomy

“…Laparoscopic cholecystectomy is the procedure of choice in gallbladder diseases. Reducing the number of ports in the procedure does not affect the safety of procedure but further enhances the advantages of laparoscopy over open cholecystectomy [1]. A number of studies have described the advantages of three-port surgery and have challenged the value of fourth trocar [2].…”