Conventional Versus Two Ports Plus One Puncture Laparoscopic Cholecystectomy: A Clinical Trial

Background: The gold standard treatment for calculus cholecystitis is laparoscopic cholecystectomy (LC). In the conventional laparoscopic cholecystectomy (CLC), three instruments are most useful in ensuring the critical view of safety. The two ports plus one puncture laparoscopic cholecystectomy (TPPOP LC) assisted needle grasper approach upholds the laparoscopic triangulation principles and allows an accessible critical view of safety. This technique successfully reduces port numbers while maintaining equivalent surgical outcomes. Method: The main objective is to compare clinical outcomes of conventional and two ports plus one puncture laparoscopic cholecystectomy. This is a single-center hospital based interventional double-blinded randomized controlled trial that included 98 patients undergoing laparoscopic cholecystectomy at No. (1) Military Hospital (700 bedded) from 01/12/2019 to 31/07/2021. The patients were randomized into group A (CLC) (n = 49) and group B (TPPOP LC) (n = 49). This trial was registered in the ISRCTN registry with the registration number ISRCTN50339464. Results: Among total of 98 patients, 46.9% were male patients and 53.1% were female patients. Mean age in group A was 49.86 ± 7.77 years and in group B was 49.33 ± 7.69 years. Mean operation time in group A was 57.9 ± 6.7 minutes and in group B was 58.5 ± 7.1 minutes, with no significant difference (p = 0.66). Although 4.1% of patients in CLC group and 12.2% in TPPOP LC group experienced bile spillage, no other major intraoperative complications were noted. A significant difference was observed at 36 and 48 hours postoperatively (VAS: 2.69 ± 1.16 in group A and 1.94 ± 0.83 in group B at 36 hours; p = 0.005 and VAS: 1.69 ± 0.92 in group A and 1.33 ± 0.63 in group B at 48 hours; p = 0.002). Postoperative minor wound infection was detected 6.1% in group A and 4.1% in group B (p = 0.64). The mean duration of the postoperative hospital stay was 5.24 ± 1.01 days in group A and 4.98 ± 0.92 days in group B (p = 0.17). Conclusion: This clinical trial concludes that two ports plus one puncture laparoscopic cholecystectomy is as effective and safe as conventional four-port laparoscopic cholecystectomy.