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WJOLS

Riki Singal et al 10.5005/jp-journals-10033-1294
OriginaL articLe

Comparison of Three-port vs Four-port Laparoscopic

Cholecystectomy in a Medical College in the Periphery

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1 Riki Singal, Pradeep Goyal, Muzzafar Zaman, RK Mishra
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ABSTRACT Keywords: Cholecystectomy, Complications, Incision, Lapa-
roscopy, Ports.
Aims and objectives: To compare three-port laparoscopic
cholecystectomy (LC) with four-port LC in chronic calculous How to cite this article: Singal R, Goyal P, Zaman M, Mishra RK.
cholecystitis patients. We compared the feasibility of the Comparison of Three-port vs Four-port Laparoscopic Chole-
procedure, total operative time, postoperative pain, incidence cystectomy in a Medical College in the Periphery. World J Lap
of complications, and cosmetic results. Surg 2017;10(1):12-16.
Source of support: Nil
Materials and methods: The present study was conducted
in the Department of Surgery at Maharishi Markandeshwar Conflict of interest: None
Institute of Medical Sciences and Research, Mullana, Ambala.
Totally, 200 adult patients of cholelithiasis with chronic chole- INTRODUCTION
cystitis were included in the study. These cases were randomly
divided into two groups (I and II) consisting of 100 cases in The introduction of minimal access surgery for gallblad-
each group. The study was conducted for a period of 1 year der surgery has revolutionized the treatment of gallstones.
from April 2014 to March 2015. Three-port LC was performed
in group I patients and four-port LC was performed in group II. The advantages of laparoscopic procedure are lesser
The cosmetic results, incidence of postoperative complications, postoperative pain, lesser incidence of surgical site infec-
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and operative time were noted in both the groups. tion and shorter hospital stay. Abdominal incision has
The present study is being undertaken to compare the been reduced to four (or more) small stab incisions. This
various merits and demerits of three-port LC vs four-port LC
performed by the same surgical team in the same scenario, in approach significantly causes less postoperative pain, less
terms of parameters mentioned subsequently and assess the bleeding, short hospital stay, and a good cosmetic outcome.
feasibility of both the procedures in our setup in a medical college. The benefits were assessed very soon afterward: Less post-
Results: Gallstone disease is found to be more common in the operative pain, shortened hospital stay, rapid recovery, and
4th and 5th decades. Mean age of presentation was 41 years. better cosmetic results. As the technique became a routine
Three-port LC is difficult in cases of dense adhesions. There procedure, modifications were made in order to make it
were significant differences in operative time (93.16 minutes 1
for three-port LC and 50.66 minutes for four-port LC). There less invasive and more cosmetic. Later, technical advances
was no significant difference due to type of operation. Cosmetic introduced the 5-mm laparoscope and the 5-mm clip appli-
appearances for both the procedures were comparable. ers, thus decreasing the port size, and later, the newer 2- or
Conclusion: We concluded that both three-port and four-port 3-mm instruments allowed the surgeons to make smaller
cholecystectomies are equally good procedures in the hands incisions. The use of a working channel laparoscope made
of experienced laparoscopic surgeons. The complications, it possible to use only two ports, along with transdermal
operative time, hospital stay, cosmesis, and disability days were sutures and needles, for an easier manipulation of the gall-
comparable in both groups. The four-port technique should be
accepted and adopted only by beginners in minimal access bladder. Natural orifice transluminal endoscopic surgery
surgery. The operator who performs three-port LC should be (NOTES) has been shown to offer further improvements
prepared for placement of an additional port or conversion to in advantages of laparoscopic cholecystectomy (LC), i.e.,
open laparotomy whenever complication arises.
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decreased pain, early ambulation, and better cosmesis.
Gallstone disease has been known since long as far as
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1 Professor, Associate Professor, Assistant Professor, Chief the 5th century when Greek physician Trallianus wrote
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about gallstones. Nowadays, LC is the gold standard for
1,3 Department of Surgery, Maharishi Markandeshwar Institute of
Medical Sciences and Research, Ambala, Haryana, India the treatment of symptomatic gallstones.
Gallstones are remarkably common, especially in
2 Department of Surgery, Maharishi Markandeshwar University female population, and are a major expensive health
Solan, Himachal Pradesh, India
problem. Its prevalence has become more apparent since
4 World Laparoscopy Hospital, Gurugram, Haryana, India the introduction of ultrasonography. The incidence of
Corresponding Author: Muzzafar Zaman, Assistant Professor cholelithiasis in the United States is reported to be 10%.
Department of Surgery, Maharishi Markandeshwar Institute of In addition to these 20,000,000 people with documented
Medical Sciences and Research, Ambala, Haryana, India, Phone: cholelithiasis, another 800,000 new cases are diagnosed
+918059931554, e-mail: muzzafarzaman@yahoo.com
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annually and 500,000 cholecystectomies are being
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