COMPARATIVE ANALYSIS OF THE FOUR-PORT AND THE THREE-PORT TROCAR ACCESS AND THE SINGLE PORT ACCESS IN LAPAROSCOPIC CHOLECYSTECTOMY--REVIEW OF THE LITERATURE

Abstract

Introduction: In the last few years, the search for less invasive procedures led to the development of the innovative technologies of SILS (Single incision laparoscopic surgery) and NOTES (Natural orifice translumenal endoscopic surgery). Lately, SILS's popularity increased in the same manner as the laparoscopic cholecystectomy did in the early 90's of the last century.

Aim: The aim of this analysis is to review the studies, focused on the indications for applying the different techniques of the single-port laparoscopic cholecystectomy, their advantages and disadvantages and the future guidelines for the development of the new trocar access surgical techniques. METHODOLOGIES AND MATERIALS: The studies of the decision making process for applying a certain surgical technique of the conventional laparoscopic cholecystectomy and the single-port laparoscopic cholecystectomy were reviewed. The different aspects of both techniques were analyzed and to demonstrate their relevance, have been illustrated by the published by 2012 studies.

Results: The review of the literature spams over 37 articles, which compare the two main techniques for conventional laparoscopic cholecystectomy in the following parameters: age, BMI, safety of the technique, technical parameters of the surgical intervention as access facilitation, surgery duration, blood loss, postoperative pain, the duration of the hospitalization, the time needed for physical recuperation, short-term and long-term cosmetic results, esthetic satisfaction of the patient and medical and social effectiveness. The reviewed studies didn't show a significant advantage of any of those two techniques. In most cases though, the duration of the hospitalization was shorter for patients that underwent single-port laparoscopic cholecystectomy. The single-port laparoscopic cholecystectomy shows better results in postoperative pain and esthetic results as well.