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Laparoscopic cholecystectomy: An original three-trocar technique

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Abstract

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three-trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p<0.01). Twenty-six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the “classic” four-trocar technique. Moreover, this technique is less expensive and allows one less scar.

Résumé

Actuellement, la cholécystectomie laparoscopique est le traitement de choix de la lithiase vésiculaire. La technique la plus connue comporte l'insertion de quatre trocars. Nous rapportons les résultats d'une technique qui n'utilise que trois trocars. Un quatrième trocar a été nécessaire chez 55 patients (8%). Parmi les 56 cas de cholécystite aiguë, cependant, un quatrième trocar a été nécessaire chez 14 patients (25%) (p<0.01). Vingt six laparoscopies ont du être converties (3.6%). On a observé quatre lésions de la voie biliaire principale (0.5%) deux parmi les 655 interventions à trois trocars, deux aussi après l'ajout d'un quatrième trocar en raison des difficultés de dissection. Nos résultats avec trois trocars sont comparables à ceux de la technique à quatre trocars.

Resumen

En la actualidad la colecistectomía laparoscópica representa el tratamiento de escogencia para la coletitiasis. La técnica operatoria descrita por la mayoría de los autores incluye el uso de 4 trócares. En el presente artículo informamos sobre un grupo de 710 pacientes consecutivos tratados mediante una técnica de 3 trócares. En nuestra experiencia el uso del cuarto trócar fue necesario en sólo 55 casos (7%). Sin embargo, entre los 56 casos de colecistitis aguda de nuestra serie el uso del trócar fue necesario en 14 (25%) (p<0.01). Veintiséis laparoscopias fueron convertidas a procedimiento abierto (3.6%). Se registraron 4 lesiones del colédoco (0.5%): 2 de ellas entre las 655 operaciones con tres trócares (0.3%) y 2 luego de la aplicación del cuarto trócar al comienzo del procedimiento, debido a dificultades en la disección. Neustros resultados son similares a los de la técnica “clásica” de cuatro trócares. Por lo demás, la técnica aquí descrita ahorra gastos y evita una cicatriz.

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Slim, K., Pezet, D., Stencl, J. et al. Laparoscopic cholecystectomy: An original three-trocar technique. World J. Surg. 19, 394–397 (1995). https://doi.org/10.1007/BF00299168

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