Comparison of Ergonomics of Epigastric Port Placement in Relation to the Falciform Ligament in Laparoscopic Cholecystectomy

Background: Epigastric port placement during laparoscopic cholecystectomy affects instrument triangulation and working ergonomics. The optimal position in relation to the falciform ligament remains variable. Aim: To compare ergonomic measurements and selected perioperative outcomes between epigastric port placement to the left and right of the falciform ligament. Methods: This comparative study included 40 adults undergoing standard four-port laparoscopic cholecystectomy at Government Medical College and Associated Group of Hospitals, Kota, Rajasthan, between October 2023 and December 2024. Twenty patients underwent left-of-falciform placement and 20 underwent right-of-falciform placement. Outcomes included manipulation and azimuth angles, port-to-port and port-to-target distances, port insertion time, operative time and hospital stay. Results: Mean manipulation angle was 60.0° (SD 0) in the left-sided group and 105.5° (SD 6.05) in the right-sided group (reported p<0.001). Mean azimuth angle 1 was 30.0° (SD 0) versus 80.25° (SD 7.34; p<0.001); azimuth angle 2 was 30.0° versus 32.0° (p=0.095). Mean epigastric port insertion time was 33.5 versus 37.5 seconds (p=0.023). Operative time (92.5 versus 100.5 minutes; p=0.219) and hospital stay (3.65 versus 3.85 days; p=0.651) did not differ significantly. Conclusion: Left-of-falciform placement was associated with a manipulation angle of 60°, more symmetrical reported azimuth angles and shorter port insertion time. No statistically significant differences were observed in operative time or hospital stay. The findings should be interpreted cautiously pending verification against the original dataset.