Comparison between Two-port Laparoscopic Cholecystectomy and Four-port Laparoscopic Cholecystectomy

Abstract

Summary L aparoscopic cholecystectomy is considered the gold standard for treatment of cholelithiasis. Short length of hospital stay, immediate regaining of physical activity, low prevalence of postoperative pain, morbidity and mortality, and good cosmetic outcomes contribute to the benefits of laparoscopic cholecystectomy (Sari et al., 2005). In the era of NOTES, minimally invasive surgery was a challenge to reduce number of ports and penetrating abdominal wall. In this era, single-port laparoscopic cholecystectomy (SILC) is a feasible option but with some difficulties and needs special instruments making it quite expensive and very good surgical experience. We keen to test the feasibility of two-ports laparoscopic cholecystectomy technique as an alternative to conventional laparoscopic cholecystectomy. Also, we found that few literatures have focused on the two-ports laparoscopic cholecystectomy, so this study was designed to investigate this technique. In our study, sixty patients suffering from chronic calcular cholecystitis underwent laparoscopic cholecystectomy. Thirty patients were subjected to two-ports laparoscopic cholecystectomy and were compared to the other twenty patients who were subjected to multi-incision (conventional) laparoscopic cholecystectomy in terms of feasibility of the technique, operating times and the development of intraoperative complications as biliary injury and early postoperative complications. Pain, pain control and hospital stay were of the important parameters also taken in consideration. The Two-ports technique was found to be quite more challenging than the conventionalapproach with a quite longer operative time but with the use of the right tools,ergonomics improve and the times drop and become comparable to those of theconventional approach. Also, it was found that surgeons with considerablelaparoscopic skills didn’t have to undergo a steep learning curve to get the hang of it.In terms of safety, two-ports technique was found to be safe to perform, as long as the adoptingsurgeon follows the same rules of safety that guides him in the conventionalapproach and has the patience to work in the restrains and limitations of two-ports laparoscopic cholecystectomy. Postoperatively, less pain and decreased use of pain medications have been shownwith two-portslaparoscopic cholecystectomy helping achieve the concept of one-day surgery. No postoperative complications were detected like port-site hernias or wound infections and thepatients were highly satisfied with the aesthetic results of the two-ports approach. However, surgeons should not advocate for slightly improved cosmetic value over safety because we are at the beginning of new minimally invasive revolution and modifications in the technological aspects of these procedures will likely yield better outcomes. Conceptual development will occur ashuman experience grows, and techniques may be described to simplify manoeuvresthat currently seem complicated and more difficult than standard laparoscopicsurgery. More randomized studies comparing two-ports laparoscopic cholecystectomy with traditional laparoscopic cholecystectomy are necessary to evaluate the safety, efficacy, complication rates, and potential benefits, if any, that this innovative technique may provide.