Abstract
Background
There have been many changes in number and place of trocars that have been described, since the first laparoscopic cholecystectomy (LC), but, in fact, all authors agree that laparoscopic procedure is accepted as gold standard. However, four trocars use in standard laparoscopic cholecystectomy, it has been argued that the fourth port is not necessary for grasping fundus of gallbladder so as to expose Calot’s triangle. The aim of this study is to establish the safety of three-trocar LC in symptomatic gallbladder disease and also to determine the ratio of technical requirements of the fourth trocar.
Methods
Between August 2010 and January 2016, 291 cases were operated in Kocaeli Derince Education and Research Hospital, department of general surgery for symptomatic gallbladder disease with three-port LC, and their records were examined retrospectively.
Results
Two hundred and twenty patients were female (75.6 %) and seventy one (24.4 %) were male. Two hundred and eighteen of two hundred and ninety-one cases (74.92 %) were operated with three- port LC in a secure way. In seventy-three cases (25.08 %), one more port was needed to use. Mean operative time was 33.76 ± 11:18 min. (15–90 min). In these cases, major complications, such as main bile duct injury or bile leakage, that may increase the mortality and morbidity, did not occur. Only in one case (0.34 %) postoperative bleeding was seen from the liver bed, which was required exploration.
Conclusion
We concluded that in experienced hand, LC with three ports is safe and feasible technique if it is not endanger the course of the surgery.
Similar content being viewed by others
References
Hardy KJ (1993) Carl Langenbuch and the Lazarus Hospital: events and circumstances surrounding the first cholecystectomy. Aust N Z J Surg 63:56–64. doi:10.1111/j.1445-2197.1993.tb00035.x
Dubois F, Icard P, Berthelot G et al (1990) Coelioscopic cholecystectomy: premilary report of 36 cases. Ann Surg 211:60–62. doi:10.1097/00000658-199001000-00010
Mouret P (1996) How i developed laparoscopic cholecystectomy. Ann Acad Med Singap 25:744–747
Trichak S (2003) Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endosc 17:1434–1436. doi:10.1007/s00464-002-8713-1
Chalkoo M, Ahangar S, Durrani AM (2010) Is fourth port really required in laparoscopic cholecystectomy? Indian J Surg 72:373–376. doi:10.1007/s12262-010-0154-9
Al-Azawi D, Houssein N, Rayis AB et al (2007) Three-port versus four-port laparoscopic cholecystectomy in acute and chronic cholecystitis. BMC Surg. doi:10.1186/1471-2482-7-8
Kumar M, Agrawal CS, Gupta RK (2007) Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS 11:358–362
Sun S, Yang K, Gao M et al (2009) Three-port versus four-port laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. World J Surg 33:1904–1908. doi:10.1007/s00268-009-0108-1
Sulu B, Diken T, Altun H et al (2014) A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture. Ulus Cer Derg 30:192–196. doi:10.5152/UCD.2014.2717
Justo-Janeiro J, Vincent GT, Lara FV et al (2014) One, two, or three ports in laparoscopic cholecystectomy? Int Surg 99:739–744. doi:10.9738/INTSURG-D-13-00234.1
Harsha HS, Gunjiganvi M, Singh C et al (2013) A study of three-port versus four-port laparoscopic cholecystectomy. J Med Soc 27:208–211. doi:10.4103/0972-4958.127395
Sakran N, Goitein D, Raziel A et al (2014) Advantages of minimal incision laparoscopic cholecystectomy. IMAJ 16:363–366
Gurusamy KS, Vaughan J, Rossi M et al (2014) Fewer-than-four ports versus four ports for laparoscopic cholecystectomy. Cochrane Database of Syst Rev. doi:10.1002/14651858.CD007109.pub2 (Art. No.: CD007109)
Gurusamy KS, Samraj K, Ramamoorthy R et al (2010) Miniport versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006804.pub3
Frilling A, Li J, Weber F et al (2004) Major bile duct injuries after laparoscopic cholecystectomy: a tertiary center experience. J Gastrointest Surg 8:679–685. doi:10.1016/j.gassur.2004.04.005
Haribhakti SP, Mistry JH (2015) Techniques of laparoscopic cholecystectomy: nomenclature and selection. J Min Access Surg 11:113–118. doi:10.4103/0972-9941.140220
Kaushik R (2010) Bleeding complications in laparoscopic cholecystectomy: incidence, mechanisms, prevention and management. J Minim Access Surg 6:59–65. doi:10.4103/0972-9941.68579
Cerci C, Tarhan OR, Barut I et al (2007) Three-port versus four-port laparoscopic cholecystectomy. Hepatogastroenterology 54:15–16
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest. This study was designed as retrospective research, so that informed consent was obtained from all individual participants included in the study, but we have no ethical approval for this article. However, this article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Ciftci, A., Yazicioglu, M.B., Tiryaki, C. et al. Is the fourth port routinely required for laparoscopic cholecystectomy? Our three-port laparoscopic cholecystectomy experience. Ir J Med Sci 185, 909–912 (2016). https://doi.org/10.1007/s11845-016-1493-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-016-1493-8