Two-trocar laparoscopic cholecystectomy - A reproducible technique

Laparoscopic cholecystectomy is usually performed with a four-trocar techni que. From December 1998 to March 1999, 25 of 42 admitted patients underwent a two-trocar laparoscopic cholecystectomy. In our technique, after establi shing umbilical carbon dioxide pneumoperitoneum. a 30 degrees scope was ins erted. and a second 5-mm trocar was positioned below and to the left of the xiphoid process. Then two stitches with nonabsorbable sutures were passed: one at the fundus to pull up the gallbladder, and the second through the n eck of the gallbladder to expose the structure of the Calot triangle. Intra operative cholangiography was performed with a percutaneous catheter in 15 patients. Retrograde cholecystectomy was performed and the gallbladder was extracted through the umbilical port. Scars were closed with glue, and bupi vacaine was injected to reduce pain. The technique was feasible in approxim ately 84% (25 of 30) of patients. The mean operative time was 42 minutes, a nd the mean hospital stay was 1.6 days. We conclude that this method is sim ilar to four-port laparoscopic cholecystectomy in terms of safety and opera tion time. This technique seems to be well reproducible and offers better r esults in terms of postoperative pain, hospital stay without considering be tter cosmetic results, and cost-effectiveness.