Experience of initial 200 cases of two-port laparoscopic cholecystectomy

Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. At laparoscopy hospital New Delhi we have performed 200 cases of laparoscopic cholecystectomy within 5 years. Fist two port laparoscopic cholecystectomy was performed by Dr. R.K. Mishra in November 2002 at Laparoscopy Hospital, New Delhi. Laparoscopic two port cholecystectomy offers additional advantages over four port cholecystectomy or not remains controversial. During five year time we compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Two-port laparoscopic cholecystectomy resulted in less port-site pain and similar clinical outcomes as four port cholecystectomy. Two port laparoscopic cholecystectomy also offer fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.

We have sent this trial to get published in World Journal of Laparoscopic Surgery. We report a prospective randomized controlled trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. In many previous study of the world Laparoctor were used perform two port cholecysctectomy and retraction of gallbladder was done by the long grasping forceps through the operating telescope, whereas dissection was accomplished through the 5-mm subxyphoid port. Additional 5-mm sub costal ports was used when it was found necessary.

The cystic duct and cystic artery were clipped by a 5-mm multiple clip applicator in previous studies. In our study we have used specially designed Mishra knot to perform two port cholecystectomy. The detail of this technique of performing two port can be seen at http://www.laparoscopyhospital.com/two_port_cholecystectomy.htm . Most of our patients reported high satisfaction for the surgery of two port laparoscopic cholecystectomy and the surgical scars was very much satisfactory. Compared to four port cholecystectomy there was a higher observed satisfaction score for the two-port laparoscopic cholecystectomy group, although this did not reach statistical significance? In the era of laparoscopic surgery, less postoperative pain and early recovery are major goals in order to achieve better patient care and cost-effectiveness. Several studies demonstrated that less postoperative pain was associated with reduction in either size or number of ports.

To conclude, we demonstrated in this study that two-port laparoscopic cholecystectomy is safe and has similar clinical outcomes compared to the conventional four-port laparoscopic cholecystectomy in selective cases. Since two-port laparoscopic cholecystectomy has less surgical scars, it can be recommended as a routine technique.

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