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Body-first laparoscopic cholecystectomy: a three-trocar technique for difficult gallbladders
Massimiliano Tuveri1, Augusto Tuveri
1Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari, Italia. massimiliano.tuveri@libero.it
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
|February 27, 2009
Summary
This study shows that a modified three-trocar laparoscopic cholecystectomy (LC) is safe and effective for difficult gallbladder anatomy. The technique avoids extra trocars and has a low conversion rate.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Techniques
Background:
- Laparoscopic cholecystectomy (LC) is standard for gallbladder disease.
- Difficult anatomy at Calot's triangle can complicate LC.
- A modified three-trocar technique was developed to address these challenges.
Purpose of the Study:
- To validate the feasibility, efficacy, and safety of a modified three-trocar LC.
- To assess the technique in cases with difficult Calot's triangle anatomy.
- To determine if additional trocars are necessary.
Main Methods:
- Retrospective analysis of 67 consecutive body-first LCs.
- Evaluation of operative times, conversion rates, complications, and hospital stay.
- Comparison of surgical outcomes based on gallbladder pathology (chronic, acute, interval).
Main Results:
- The modified three-trocar LC was successful in 95.6% of patients.
- Median operative times varied: 32 min (chronic), 53 min (acute), 62 min (interval).
- Significant difference in operative time between chronic and other groups (P < 0.05); no complications or bile duct injuries reported. Average hospital stay was 1 day.
Conclusions:
- The body-first, three-trocar LC is a safe approach for difficult Calot's triangle anatomy.
- This technique achieves a low conversion rate without needing extra trocars.
- Further research is needed to assess long-term outcomes and reliability.