Two-trocar laparoscopic cholecystectomy: a reproducible technique

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• Laparoscopic cholecystectomy is typically performed using a four-trocar technique.
• Minimizing trocar sites in laparoscopic surgery can potentially reduce complications and improve cosmetic outcomes.

Purpose of the Study:

• To evaluate the feasibility, safety, and outcomes of a novel two-trocar laparoscopic cholecystectomy technique.
• To compare the two-trocar technique with the conventional four-trocar method regarding operative time, postoperative pain, hospital stay, and cost-effectiveness.

Main Methods:

• A two-trocar technique was developed involving specific suture placement for gallbladder retraction and exposure of Calot's triangle.
• The procedure included umbilical pneumoperitoneum, insertion of a 30-degree scope and a 5-mm trocar, and retrograde gallbladder dissection.
• Intraoperative cholangiography was performed in select cases, and gallbladder extraction was done through the umbilical port.

Main Results:

• The two-trocar technique was feasible in 84% of patients (25 of 30).
• Mean operative time was 42 minutes, and mean hospital stay was 1.6 days.
• The technique demonstrated comparable safety and operative time to the four-trocar method, with potential benefits in postoperative pain, hospital stay, and cost.

Conclusions:

• The two-trocar laparoscopic cholecystectomy is a safe and effective alternative to the four-trocar technique.
• This approach offers potential advantages including reduced postoperative pain, shorter hospital stays, and improved cost-effectiveness.
• The technique is reproducible and yields favorable cosmetic results.