Three-port versus four-port laparoscopic cholecystectomy: a comparative study at a tertiary care centre in North India

Peeyush Kumar; Anil K. S. Rana

doi:10.18203/2349-2902.isj20180014

Authors

Peeyush Kumar Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
Anil K. S. Rana Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180014

Keywords:

Four-port, Laparoscopic cholecystectomy, Three-port

Abstract

Background: Improvement of Laparoscopic Cholecystectomy (LC) technique in terms of reduction in size and number of ports is being tried to improve patient satisfaction and outcome. Present study was conducted to evaluate and compare the safety outcome and advantages of three-port and four-port LC.

Methods: This prospective study included 90 patients presenting with symptomatic gall stone disease or gall bladder polyp more than 1cm at base. Patients with jaundice and choledocholithiasis were excluded. Patients were divided into two groups: A and B, who underwent three-port and four-port LC respectively. Outcomes of the two groups were assessed and compared in terms of duration of surgery, intra-operative and post-operative variables including rate and nature of complications, conversion rates, post-operative pain, duration of hospital stay, return to work and cosmetic outcome.

Results: Statistically significant difference was found between the two groups in terms of Visual Analogue Score for pain at 6 and 24 hours, analgesic requirement, duration of hospital stay and return to work; all being less in the three- port LC group. Cosmetic outcome as perceived by patients was also better in the three-port group. Results of other variables were comparable in the two groups.

Conclusions: Three-port procedure is safe and appears to be more cost effective than four-port LC. If LC is performed by an experienced surgeon, it can be started with three ports, if required, a fourth port can be inserted.

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Author Biography

Anil K. S. Rana, Department of Surgery, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India

Professor, Department of Surgery

References

Shahedi WH. The biliary system through the ages. Int Surg. 1979;64(6):63-78.

Gadacz TR. US experience with laparoscopic cholecystectomy. Am J Surg. 1993;165(4):450-4.

Shea JA, Berlin JA. Indications and outcome of cholecystectomy: A comparison of pre and post-laparoscopic era. Ann Surg. 1998;227(3):343-50.

Nahrwold DL. Biliary System. In: Sabiston DS, Lyerldy HK, eds. Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 15th Ed. WB Saunders Company, USA; 1997:1117-1148.

Hunter JG, Oddsdottir M. Gallbladder and the extrahepatic biliary system. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Pollock RE, eds. Schwartz’s Principles of Surgery. 8th Ed. Mc Graw Hill, New York; 2005:1187-1218.

Soper NJ, Dunnegan DL. Laparoscopic cholecystectomy: experience of a single surgeon. World J Surg. 1993;17(1):16-20.

Soper NJ, Brunt LM, Kerbl K. Laparoscopic General Surgery. N Engl J Med. 1994;330(6):409-19.

Soper NJ, Stockmann PT, Dunnegan DL. Laparoscopic cholecystectomy. The new 'gold standard'? Arch Surg. 1992 Aug;127(8):917-21.

Mouret P. From the first laparoscopic cholecystectomy to frontiers of laparoscopic surgery; the future perspective. Dig Surg. 1991;8:124-5.

Palanivelu C. History of Laproscopic Surgery. Palanivelu’s Text Book of Surgical Laproscopy. 1st Ed. Gem digestive disease foundation, Coimbatore; 2002:3-6.

Udwadia TE. Laparoscopy in India a personal perspective. J Minim Access Surg. 2005;1(2):51-2.

Haribhakti SP, Mistry JH. Techniques of laparoscopic cholecystectomy: Nomenclature and selection. J Minim Access Surg. 2015;11(2):113-8.

Dubois F. Laparoscopic Cholecystectomy: The French Technique. In: Phillips EH, Rosenthal RJ, eds. Operative Strategies in Laparoscopic Surgery. Springer, Heidelberg; 1995.

Harsha HS, Gunjiganvi M, Singh C, Moirangthem GS. A study of three-port versus four-port laparoscopic cholecystectomy. J Med Soc. 2013;27(3):208-11.

Wilkinson TRV, Mehrotra P, Bansod P, Akhtar M. Three-port versus four-port laparoscopic cholecystectomy- a prospective study. Int J Med Res Rev. 2017;5(3):235-41.

Kumar M, Agrawal CS, Gupta RK. Three-port Versus Standard Four-Port Laparoscopic Cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in Eastern Nepal. JSLS. 2007;11(3):358-62.

Mayir B, Dogan U, Koc U. Safety and effectiveness of three-port laparoscopic cholecystectomy. Int J Clin Exp Med. 2014;7(8):2339-42.

Al-Azawi D, Houssein N, Rayis AB, McMahon D, Hehir DJ. Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis. BMC Surg. 2007;7:8.

Novacek G. Gender and gallstone disease. Wien Med Wochenschr. 2006;156:527-33.

Dubois F, Icard P, Berthelot G. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Ann Surg. 1990;211(1):60-2.

Schirmer BD, Edge SB, Dix J. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg. 1991;213(6):665-76.

Peters JH, Ellison EC, Innes JT. Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. Ann Surg. 1991;213(1):3-12.

Grace PA, Quereshi A, Coleman J. Reduced postoperative hospitalization after laparoscopic cholecystectomy. Br J Surg. 1991;78(2):160-2.

Slim K, Pezet D, Stencl J. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg. 1995;19(3):394-7.

Lee SH, Burhenne HJ. Gallbladder surgery following cholecystlithotripsy: suggested guidelines for treatment. Br J Surg. 1990;77(11):1268-71.

Koscak D, Lovric J. Laparoscopic three trocar cholecystectomy at Bjelovar General Hospital. Acta Clin Croat. 2005;45:51-6.

Rashed A, Nassar A, Ashkar K. Three Vs Four Ports in Laparoscopic Cholecystectomy. Br J Surg. 1995;82:15.

Gupta A, Shrivastava UK, Kumar P. Minilaparoscopic versus laparoscoic cholecystectomy: a randomised controlled trial. Trop Gastroenterol. 2005;26(3):149-51.

Trichak S. Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17(9):1434-6.

Zucker KA, Bailey RW, Gadacz TR. Laparoscopic guided cholecystectomy. Am J Surg. 1991;161(1):36-42.

Perissat J, Collet D, Belliard R. Laparoscopic cholecystectomy: the state of the art. A report on 700 consecutive cases. World J Surg. 1992;16(6):1074-82.