DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20193142

Stitch less, clip less, three ports laparoscopic cholecystectomy: experience of 300 cases

Ritvik Resutra, Neha Mahajan, Rajive Gupta

Abstract


Background: 300 cases of cholelithiasis were operated by stitch less, clip less, three ports laparoscopic cholecystectomy at Maxx lyfe Hospital, near Bathindi morh, Sunjwan road, Jammu with effect from August 2017 to May 2019. The outcome measures in the form of safety of the technique, postoperative pain, need of postoperative analgesia, number of OT assistants needed, duration of hospital stay, recovery and return to routine work, cosmetic satisfaction of the patient were taken into consideration and were found to be better than in conventional four ports technique of laparoscopic cholecystectomy.

Methods: In three port laparoscopic cholecystectomy, first 10 mm umbilical, second 5 mm subxyphoid and third 5 mm subcostal ports are used and telescope is passed into the peritoneal cavity through the umbilical port. Retraction of the gallbladder is done by the long grasping forceps through the 5 mm subcostal port, whereas dissection is accomplished through the subxyphoid port. The gallbladder is retrieved through the subxyphoid port.

Results: Mean operative time was 40 minutes and mean duration of postoperative stay in the hospital was 18 hours. Days to return to normal activity was 4 days at an average.

Conclusions: The 3-port laparoscopic cholecystectomy  technique is safe and has better outcomes in the form of less postoperative pain, less duration of hospital stay, early return to routine work and more cosmetic satisfaction as compared to the conventional 4-port technique, with no obvious increase in bile duct injuries and it can be a viable alternative in the field of minimally invasive surgery.

Keywords


Cholecystectomy, Cholelithiasis, Laparoscopic, Ports, Stitch less, Trocar

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References


Dubois F, Icard P, Berthelot GA, Levard H. Coelioscopic cholecystectomy. Preliminary report of 36 cases. Annals of Surg. 1990;211(1):60.

Litynski GS. Mouret, Dubois, and Perissat: The Laparoscopic Breakthrough in Europe (1987-1988). JSLS: J Soc Laparoendoscop Surg. 1999;3(2):163.

Trichak S. Three-port vs standard four-port laparoscopic cholecystectomy. Surg Endoscop and Other Interven Tech. 2003;17(9):1434-6.

Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung HY, Lee KW. Two-port versus four-port laparoscopic cholecystectomy. Surgical Endoscopy and Other Interventional Techniques. 2003;17(10):1624-7.

Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Randomized clinical trial of laparoscopic cholecystectomy performed with mini‐instruments. British J Surgery. 2003 Nov;90(11):1345-8.

Tagaya N, Kita J, Takagi K, Imada T, Ishikawa K, Kogure H, Ohyama O. Experience with three‐port laparoscopic cholecystectomy. J Hepato‐Biliary‐Pancreatic Surg. 1998;5(3):309-11.

Endo S, Souda S, Nezu R, Yoshikawa Y, Hashimoto J, Mori T, Uchikoshi F. A new method of laparoscopic cholecystectomy using three trocars combined with suture retraction of gallbladder. J Laparoendoscop Adv Surg Tech. 2001;11(2):85-8.

Slim K, Pezet D, Stencl J, Lechner C, Le Roux S, Lointier P, Chipponi J. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg. 1995;19(3):394-7.

Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Pain after microlaparoscopic cholecystectomy. Surg endoscop. 2000;14(4):340-4.

Leggett PL, Bissell CD, Churchman-Winn R, Ahn C. Three-port microlaparoscopic cholecystectomy in 159 patients. Surg endoscop. 2001;15(3):293-6.

Mori T, Ikeda Y, Okamoto K, Sakata K, Ideguchi K, Nakagawa K, Yasumitsu T. A new technique for two-trocar laparoscopic cholecystectomy. Surg endoscop. 2002;16(4):589-91.

Lomanto D, De Angelis L, Ceci V, Dalsasso G, So J, Frattaroli FM, Muthiah R, Speranza V. Two-trocar laparoscopic cholecystectomy: a reproducible technique. Surg Laparoscop Endoscop Percutan Tech. 2001;11(4):248-51.

Ramachandran CS, ARORA V. An Innovative New Method for Gallbladder Removal. J Laparoendoscopic Adv Surg Tech. 1998;8(5):303-8.

Leggett PL, Churchman-Winn R, Miller G. Minimizing ports to improve laparoscopic cholecystectomy. Surg Endosc. 2000; 14 (1): 32–36

Kang KJ, Lim TJ. Tip for microlaparoscopic cholecystectomy: easy removal of the gallbladder after laparoscopic cholecystectomy using the three-port technique. Surg Laparoscop Endoscop Percutan Tech. 2003;13(2):118-20.

Reardon PR, Kamelgard JI, Applebaum B, Rossman L, Brunicardi FC. Feasibility of laparoscopic cholecystectomy with miniaturized instrumentation in 50 consecutive cases. World J surg. 1999;23(2):128-32.

Ng WT. Three-trocar laparoscopic cholecystectomy: a cautionary note. Surg Laparoscop Endoscop Percutan Tech. 1998;8(2):159.

Cala Z, Perko Z, Velnić D. Comparison of the results of laparoscopic cholecystectomy preformed in the usual way and with a lesser number of trocars. Lijecnicki vjesnik. 2000;122(1-2):1-5.

Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Microlaparoscopic vs conventional laparoscopic cholecystectomy. Surgical Endoscopy and Other Interventional Tech. 2002;16(3):458-64.

Huang MT, Wang W, Wei PL, Chen RJ, Lee WJ. Minilaparoscopic & laparoscopic cholecystectomy: a comparative study. Arch Surg. 2003;138 (9):1017-23.

Kagaya T. Laparoscopic cholecystectomy via two ports, using the “Twin‐Port” system. J Hepato‐Biliary‐Pancreatic Surg. 2001;8(1):76-80.