THREE - PORT APPROACH TO LAPAROSCOPIC CHOLECYSTECTOMY: ANALYSIS OF SELF EXPERIENCE

Abstract

Background Laparoscopic cholecystectomy is now regarded as the gold standard method of cholecystectomy all over the world. Four-port approach is the standard method used by the majority of laparoscopic surgeons. In recent years, many attempts have been made to further improve the established technique of laparoscopic cholecystectomy. The goal has been to minimize the invasiveness of this procedure by either reducing the number or size of the operating ports and instruments.Objective This study is an analysis of self experience of laparoscopic cholecystectomy utilizing three ports, highlighting its feasibility, safety and efficacy in comparing with the standard four – port approach. Patients and Methods This study was held in Al-Jumhori Teaching Hospital during the period from January 2002 to December 2005. Patients with acute or chronic cholecystitis were included in this study. An initial three – port approach was attempted in all patients. Insertion of the fourth port mainly for fundal retraction was decided whenever there is difficulty completing the operation with three ports. Results This study was conducted on 247 consecutive patients who underwent laparoscopic cholecystectomy by one surgeon. In 111 patients (45%) the surgery was successfully performed through three ports. In 133 patients (55%) insertion of fourth port was required to complete the operation. Conversion to open cholecystectomy was needed in 3 patients (1.2% conversion rate). The mean operative time was (38) minutes in three-port approach vs (51) minutes in the standard four- port approach. Regarding intraoperative complications, there was a report of intraperitoneal firing in one patient. Hopefully It was momentary and confined to the vicinity of epigastric port and caused no ill effects to surrounding tissues. Postoperative biliary peritonitis was reported in one female patient, which was attributed to leakage from accessory bile duct. She was managed by re-laproscopy. Another female patient underwent laparotomy 2 months later for missed stone in the stump of cyst duct. Port hernia were detected in 3 patients (1.2%); 1 patient of the three-port group (0.9%), and 2 patients of the four-port group (1.5). One male patient of the four – port group, aged 75 years died 12 hours after the operation from MI.Conclusion These data from our study suggests that a more minimal invasion to laparoscopic cholecystectomy can be accomplished at our teaching institution with equal efficacy and safety as the more conventional technique.