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


  • Pradeep Singhal Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India
  • Amulya Aggarwal Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India
  • Syed Altamash Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India
  • Ajay Kumar Verma Department of General Surgery, SGRRIMHS and SMIH, Dehradun, Uttarakhand, India




Laparoscopic cholecystectomy, 3 port, 4 port, Lap chole


Background: Cholelithiasis is one of most common condition requiring surgical intervention specially in females in Indo-Gangetic belt. Techniques of cholecystectomy have evolved from open to laparoscopic procedures. Efforts have been made to perform it with lesser ports for better operative outcomes like less complications and better cosmetic appearance. This study aims to compare the postoperative outcomes of 4 port versus 3 port laparoscopic cholecystectomy.

Methods: This is a prospective comparative study. 104 patients for 4 port laparoscopic cholecystectomy and 110 patients for 3 port cholecystectomy were allocated randomly. Preoperative assessment was done in both the groups and Informed consent was taken. Intra operative parameters like duration of surgery, blood loss, surgical complications were assessed. Postoperative follow up was done at 1 week, and scar assessment at 2 weeks. Findings were entered in Microsoft Excel and analyzed using SPSS by applying t-test and chi-square test.

Results: Female: male ratio was 14:1 and age varied between 32-51 years. The mean operative time was in 3 port was 64.6 min and 56.42 min in 4 port (p<0.05). Complications like conversion to open procedure, bleeding from liver bed, cystic artery bleeding and port site infections were comparable in both groups. Analgesic requirement was significantly less after 24 hours in 3 port (p=0.02).

Conclusions: 3 ports cholecystectomy is better in terms of lesser postoperative pain, cosmetic outcome, hospital stay, lesser assistance. The authors recommend 3 ports LC as a routine procedure in gallstone diseases.


Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, Guckin MM. Indications and outcomes of cholecystectomy- a comparison of pre and post laparoscopic era. Ann Surg. 1998;227(3):343-50.

The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO). 1988;8(4):904-6.

Litynski GS. Highlights in the History of Laparoscopy. Frankfurt, Germany: Barbara Bernert Verlag; 1996:165–168.

Litynski GS. Profiles in laparoscopy:Mouret, Dubois, and Perissat:the laparoscopic breakthrough in Europe (1987-1988). JSLS. 1999;3(2):163–7.

Olsen DO. Laparoscopic cholecystectomy. Am J Surg. 1991;161:339-44.

Berci G. Laparoscopic cholecystectomy using fine – caliber instruments:smaller is not necessarily better. Surg Endosc. 1998;12:197.

Cala Z. Laparoscopic cholecystectomy using three trocars. Surg Endosc. 1994;8:476.

Ramachandran CS and Arora V. Two – port laparoscopic cholecystectomy:an innovative new method for gallbladders removed. J Laparoendosc Adv Surg Tech A. 1998;8:303–8.

Yu SC, Yuan RF, Chen SC, Lee WJ. Combined use of mini–laparoscope and conventional laparoscope in laparoscopic cholecystectomy: Preservation of minimal invasiveness. J Laparoendosc Adv Surg Tech A. 1999;(1):57–62.

Leggett PL, Churchman – Winn R, Miller G. Minimizing ports to improve laparoscopic cholecystectomy. Surg Endosc. 2000;14:32-6.

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;90:1345–8.

Trichak S. Three port versus standard four port laparoscopic cholecystectomy. Surg Endosc. 2003;17:1434–6.

Utpal De. Evolution of cholecystectomy:a tribute to Carl August Langenbuch. Ind J Surg. 2004;66(2):97-100.

Beal JM. Historical perspective of gall stone disease. Surg Gynecol Obstet. 1984;158(2):181-9.

Subhas, P and Kochar SK. Minilap cholecystectomy: modified approach. Med J Armed Forces India. 2000;56 (1):7-9.

Rozsos I, Jooko G. Microlaparotomy cholecystectomy. Ann Surg. 1995;222:762-3.

Helmy AHI, Abbas M, EL–Sebai S, Mohey–EL-Dien A, AL–Kholy B. Is modified open microcholecystectomy still valid in the era of laparoscopic surgery? Egyptian J Surg. 2003;22:37-44.

Chitre VV, Studley. JGN. Audit of Methods of Laparoscopic cholecystectomy. Br J Surg. 1999:86(2):185-8.

Osbome D, Boe B, Rosemurgy AS, Zervos EE. Twenty-Millimeter 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, Lee KW. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17(10):1624-7.

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.

Nafeh Md AI, Abbas MM, Youssef MYF, Helmy MAHI, Frcsed. One Surgeon Show Laparoscopic Cholecystectomy Through Three Ports. Ejs. 2005;24(2):95.

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.

Chalkoo M, Ahangar S, Durrani AM. Is Fourth Port Really Required in Laparoscopic Cholecystectomy? Indian J Surg. 2010;72(5):373–6.






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