Comparing 3 port and 4 port laparoscopic cholecystectomy: safety, feasibility, and outcomes

BACKGROUND: Minimally invasive techniques should be the first option for cholecystectomy. 3-port cholecystectomy may be performed securely and with satisfactory outcomes. The potential benefits of 3 or single-port cholecystectomy remain controversial due to concerns regarding patient safety. Our study compared the 3-port cholecystectomy’s safety, feasibility, and outcomes to the traditional 4-port technique.METHODS: Seventy-five laparoscopic cholecystectomy (LC) cases were performed between November 2022 and December 2023 and divided into two groups. 3-port LC with 30 patients and 4-port LC with 45 patients. Duration of surgery, complications, pain scores, length of hospital stay, analgesic requirements, and conversion rates were evaluated.RESULTS: The demographic outcomes were similar between the two groups. In either group, no conversion to open surgery was recorded. The 3-port LC group demonstrated significantly lower postoperative pain and analgesic requirements than the 4-port LC group. The mean score of the visual analog scale (VAS) on postoperative day 1 was similar in both groups, measuring 6.16 and 6.24, respectively. Duration of hospital stay was shorter in 3-port LC (1.16 versus 1.22), and both groups exhibited similar return-to-work timelines. The duration of surgery for the groups was 29±8.6 minutes and 32±8, respectively.CONCLUSIONS: Three-port LC is a secure alternative with satisfactory outcomes, particularly in cases of acute cholecystitis. Patients undergoing the three-port technique experienced reduced postoperative pain, shorter hospital stays, and fewer scars. Experienced surgical hands are crucial for successful implementation, and in challenging situations, the placement of a fourth port remains a viable option.