Three-port vs standard four-port laparoscopic cholecystectomy - A prospective randomized study

Background: Since the first laparoscopic cholecystectomy (LC) was reported in 1990, it has met with widespread acceptance as a standard procedure using four trocars. The fourth (lateral) trocar is used to grasp the fundus of the gallbladder so as to expose Calot's triangle. It has been argued that the fourth trocar is not necessary in most cases. Therefore, the aim of this study was to compare the three-port vs the four-port technique. Methods: Between 1998 and 2000, 200 consecutive patients undergoing elective LC for gallstone disease were randomized to be treated via either the three- or four-port technique. Results: There was no difference between the two groups in age, sex, or weight. In terms of outcome, there was no difference between the two groups in success rate, operating time, number of oral analgesic tablets (paracetamol), visual analogue score, or postoperative hospital stay; however, the three-port group required fewer analgesic injections (nalbuphine) (0.4 vs 0.77, p = 0.024). Conclusion: The three-port technique is as safe as the standard four-port one for LC. The main advantages of the three-port technique are that it causes less pain, is less expensive, and leaves fewer scars.