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WJOLS

Two Port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique
RESuLTS

There was no incidence of bile duct or vascular injury,
bile leak, iatrogenic injury, intraoperative perforation of
gallbladder, bile spillage, significant procedural blood
loss, significant gas leak or subcutaneous emphysema at
either port site. The mean operating time was 50 minutes
(40-155 minutes).
We have converted 3 cases from the two port tech-
nique to the standard four port technique. One was due
to technical difficulty arising out of bleeding and the
other 2 due to difficult intraoperative findings. These 2
cases had dense adhesions in the Calot’s triangle and gall-
bladder fossa respectively. However, none of them
Fig. 4: Intraoperative photograph demonstrating the right and required conversion to open cholecystectomy.
left hand instruments
Patients were allowed orally as early as 6 hours
following surgery. All patients were routinely discharged
on 2nd postoperative day except for two patients. One had
severe abdominal pain and later developed surgical site
infection, which subsided with wound drainage and the
other patient developed fever in postoperative period. All
the patients were happy and satisfied due to rapid and
comfortable recovery and of course, about their small
wound. Many patients were astonished small incision
used to perform the surgery and hence were curious to
know the procedure details (Fig. 6). Patients were advised
follow-up on 10th day, 3 month and 1 year following
surgery. Out of 25 patients, 23 patients visited the hospital
for 10th day follow-up and were fine at that point of time.
However only 7 have completed 3 months follow-up at
Fig. 5: A schematic diagram of right and left hand instruments
working in close harmony the point of data collection and none of them had any
complications including port site hernia.

dISCuSSIoN

Although laparoscopic cholecystectomy has been prac-
ticed as a day care surgery, it is far from reality in our
set-up as most of the patients are from remote rural and
hilly areas with poor access to healthcare. That is the
reason for patient being discharged routinely on 2nd post
operative day. Secondly, the follow-up of the patients has
remained far from ideal. Many of them, once discharged,
tend to avoid hospital follow-up unless they are unwell.
The geographic and telecommunication barriers are
other factors which has prevented us from reaching out
to them.
Fig. 6: Final appearance of the postoperative wounds Two port laparoscopic cholecystectomy has been
following closure
practiced by many surgeons successfully and has been
as an assembly, with one gras ping/retracting at a short reported to be safe and superior to 4 port cholecystectomy
2,3
distance from the other one (Figs 4 and 5). They move in in terms of pain, cosmesis and patient acceptance.
tandem performing the dissection bit by bit sequentially Various techniques and special instruments like inno-
from Calot’s triangle to the fundus till the point of com- vative extracorporeal knot by Mishra et al, ‘Twin-port’
plete separation of the organ. system (that allows a 5 mm camera and a forceps through
World Journal of Laparoscopic Surgery, September-December 2014;7(3):103-106 105