Laparoscopic cholecystectomy: complications and conversions with the 3-trocar technique: a 10-year review

Traditional laparoscopic cholecystectomy (LC) includes the use of 4 trocars. The aim of this study is to show that LC can be performed safely with the 3-trocar technique, thus simplifying a very well-known technique.

We performed a retrospective analysis of 1878 patients (male-to-female ratio was 1:3; median age of 44 y) that underwent 3-trocar LC between May 1994 and December 2004.

Three-trocar LC was successful in 1774 patients (94%) with a postoperative morbidity of 1.5% (0.5% of major complications), which includes 2 minor common bile duct lesions (type D according to Strasberg classification) and 1 right common iliac artery laceration. Mortality was nil. Among 249 cases of acute cholecystitis, the 3-trocar LC was successful in 172 patients (70%). The adoption of a fourth trocar was necessary in only 82 patients (4.3%). Conversion to laparotomy occurred in a total of 67 patient (3.5%), 22 of which directly from the 3-trocar technique. The median operating time of the 3-trocar LC was 40 minutes (range, 16 to 130) for chronic cholecystitis, and 80 minutes (range, 30 to 145) for acute cholecystitis. The difference in duration of the surgical procedure between the 2 groups was significant (P<0.05). Severe adhesions were more commonly the reason for conversion (P<0.05).

The study achieves to conclude that the 3-trocar technique can be safely performed, is not technically demanding, and yields in experienced hands a complication rate comparable with the conventional LC. Furthermore, it is less expensive and has a better cosmetic result.