Is the number of trocars important in laparoscopic cholecystectomy?

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the criterion standard for cholelithiasis. There have been some changes in LC technique, one of which was a reduction in the number of trocars used. The aim of the present study was to explore the feasibility of reducing the number of ports in cases of LC without compromising safety, and to evaluate the benefits associated in terms of pain, recovery, and patient satisfaction.
METHODS: Sixty adults with symptomatic cholelithiasis were enrolled in this study, and patients were divided into 4 equal groups of 15. During the operation, 1- (single incision laparoscopic surgery [SILS]), 2-, 3-, or 4-trocar LC was performed. For the assessment, the following parameters were compared: operating time, success rate, visual analogue pain score, requirement for analgesia (diclofenac), complications, patient satisfaction score with respect to operation and scars, and length of postoperative hospital stay.
RESULTS: There were 45 female (75%) and 15 male (25%) patients with median age of 42.8 years (range: 20-62 years). Demographic data (age, sex, body mass index) were similar in all groups. The 3- and 4-trocar groups had significantly shorter mean operating time than the other groups (SILS: 50±14 minutes; 2-trocar: 36±10 minutes; 3-trocar: 27±10 minutes; 4-trocar: 24±7 minutes; p=0.01). There was no instance of bile duct injury or intra-abdominal collection in any group. One patient in SILS group developed cholangitis, and 1 one patient in 3-trocar group developed wound infection postoperatively that improved with conservative treatment. There was no difference in terms of analgesia requirement, mean overall pain score, overall satisfaction score, or length of hospital stay between the 4 groups. Scar satisfaction score was significantly higher in SILS and 2-trocar groups compared with the others.
DISCUSSION AND CONCLUSION: It appears that SILS and 2-port techniques are as reliable as 3-port and 4-port methods, with no obvious increase in bile duct injury, and although use of these techniques did not reduce need for analgesia, it did increase patient satisfaction.