Safety and feasibility of three port procedure in laparoscopic cholecystectomy

Vipin Gupta, Shailendra Pal Singh, Somendra Pal Singh, Anil Kumar Keshari, Anil Kumar Erry, Poonam Gupta, Vikram Singh, Mayank Singh


Background: Laparoscopic cholecystectomy is widely accepted gold standard technique for management of cholelithiasis and has undergone many refinements including decrease in size and number of ports. Many researchers have claimed that three-port laparoscopic cholecystectomy is safe and feasible method for management of cholelithiasis but still it is not performed widely by the surgeons. Objective of our study was to assess the safety and feasibility of three-port laparoscopic cholecystectomy by comparing the various defined parameters with the standard four-port laparoscopic cholecystectomy.

Methods: The study included 100 patients and was divided equally in 2 groups. Patients in Group A underwent laparoscopic cholecystectomy by three-port technique and in Group B were operated by four-port technique. Patients in both the groups were compared in terms of operative time, intra-operative complications, post-operative pain, post-operative complications and cosmesis outcome.

Results: The mean operative time was similar in both groups. Intra-op and post-op complications were also similar. 3 patients in Group A needed fourth port and 1 patient in both group required conversion to open cholecystectomy. Mean pain score and requirement of parentral analgesia was found to be lower in Group A. Duration of hospital was similar in both the groups. Patients in group A had slightly better cosmetic outcome.

Conclusions: Three-port laparoscopic cholecystectomy is a minimally invasive, safe and feasible technique and is not difficult to master than other advanced techniques. In experienced hands, laparoscopy cholecystectomy can be initially started with three-ports and can be converted to four-port if rarely necessary.


Laparoscopic cholecystectomy, Cholelithiasis, Three port cholecystectomy

Full Text:



Shaffer EA: Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21 st century? Curr Gastroenterol Rep. 2005;7(2):132–40.

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

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.

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

Osborne D, Boe B, Rosemurgy AS, Zervos EE Twenty millimetre laparoscopic cholecystectomy: fewer ports results in less pain, shorter hospitalization, and faster recovery. Am Surg. 2005;71(4):298–302.

Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung HY, et al. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17(10):1624–7.

Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg. 2003;90(11):1345–8.

Tagaya N, Kita J, Takagi K, Imada T, Ishikawa K, Kogure H, et al. Experience with three-port laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 1998;5(3):309–11.

Endo S, Souda S, Nezu R, Yoshikawa Y, Hashimoto J, Mori T, et al. A new method of laparoscopic cholecystectomy using three trocars combined with suture retraction of gallbladder. J Laparoendosc Adv Surg Tech A. 2001;11(2):85–8.

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

Leggett PL, Bissell CD, Churchman-Winn R, Ahn C. Three-port microlaparoscopic cholecystectomy in 159 patients. Surg Endosc. 2001;15(3):293–6.

Kumar P, Rana AKS. Three-port versus four-port laparoscopic cholecystectomy: A comparative study at a tertiary care centre in North India. Int Surg J. 2018;5(2):426-32.

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

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

Cerci C, Tarhan OR, Barut I, Bülbül M. Three-port versus four-port laparoscopic cholecystectomy. Hepatogastroenterology. 2007;54(73):15–6.

Sun S, Yang K, Gao M, He X, Tian J, Ma B. Three-port versus four-port laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. World J Surg. 2009;33:1904–8.

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

Sharma PK, Mehta KS. Three Port Versus Standard Four Port Laparoscopic Cholecystectomy-A Prospective Study. JK Sci. 2015;17(1):38-42.

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

Sinha R, Yadav AS, Singh AK. A comparative evaluation of efficacy and safety of 3 port and 4 port laparoscopic cholecystectomy. Global J Res Analysis. 2018;7(5).

Pahuja V, Chand P, Singh G, Kumar V, Singh V. Comparsion of three port laparoscopic cholecystectomy with fundal suturing v/s four port laparoscopic cholecystectomy. J Adv Med Dent Scie Res. 2017;5(5):4952.

Mushtaq C, Shahnawaz A, Munnon da. Is Fourth Port Really Required in Laparoscopic Cholecystectomy? Indian J Surg. 2010;72(5):373-6.

Tuveri M, Tuveri A. Laparoscopic cholecystectomy: Complications and conversions with the 3-trocar technique:10-year review. JSLS. 2007;17:380-4.

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