Laparoscopic cholecystectomy with three trocars: 10 years experience

Area of Science:

• Surgical Innovation
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Laparoscopic cholecystectomy is the standard surgical procedure for gallbladder removal.
• Most surgeons utilize a 4-trocar technique for laparoscopic cholecystectomy.
• The use of fewer trocars may offer advantages in terms of cost and cosmesis.

Purpose of the Study:

• To evaluate the feasibility, safety, and effectiveness of a 3-trocar laparoscopic cholecystectomy technique.
• To compare the outcomes of the 3-trocar technique with the traditional 4-trocar method.
• To assess the benefits of a reduced-port approach in terms of economic and cosmetic outcomes.

Main Methods:

• A retrospective analysis of 1,243 laparoscopic cholecystectomies performed between 1992 and 2002 using a 3-trocar technique (two 10 mm, one 5 mm).
• Documentation of overall conversion rates and reasons for using a fourth trocar.
• Inclusion of cases with anatomical difficulties, intraoperative cholangiography, sclerotic cholecystitis, and emergency operations.

Main Results:

• A total of 1,243 cholecystectomies were performed with the 3-trocar technique over 10 years.
• The overall conversion rate to open surgery was low at 0.75%.
• A fourth trocar was used in 5.7% of cases to manage anatomical challenges or for cholangiography, with all interventions proving technically feasible.

Conclusions:

• The 3-trocar laparoscopic cholecystectomy is a safe, effective, and technically feasible technique.
• This approach offers economic advantages and improved cosmetic results for patients.
• The technique is suitable for routine use, including complex cases like sclerotic cholecystitis and emergency procedures.