Should subcostal and lateral trocars be used in laparoscopic cholecystectomy? A randomized, prospective study

Abstract

Background: Three to four trocars are commonly used when performing laparoscopic cholecystectomy (LC). Subcostal and lateral trocars are used for the grasper to retract the gallbladder. These graspers are seldom extracted or exchanged with other instruments. Based on this, it seems that the subcostal and lateral trocars are of minimal importance. The aim of this study was to evaluate the validity and benefits of performing LC without subcostal and lateral trocars (LCWSL).

Methods: From June 2006 to June 2007, 60 patients diagnosed with gallbladder disease were enrolled in this randomized, controlled trial to compare the result of LCWSL to conventional LC (CLC). Operation time, complication, pain scale, cosmetic effect, and hospital cost were compared.

Results: There were no differences in operation time and intra- or postoperative morbidity. Total blood loss, pain, duration until resumption of oral diet, and duration of hospital stay were similar. Total cost of LCWSL was cheaper than CLC by $397 USD (P < 0.05), and total incision length was smaller than CLC by 11 mm.

Conclusions: LCWSL seems to be an acceptable procedure, having the same morbidity and better economic and cosmetic outcome, as compared to CLC.