title: A new method of laparoscopic cholecystectomy using three trocars combined with suture retraction of gallbladder.
abstract: OBJECTIVE
  Since the establishment of laparoscopic cholecystectomy (LC) for benign gallbladder lesions, the four-trocar method has been the standard procedure. However, the fourth trocar generally is used just for fundic retraction of the gallbladder. We have developed a three-trocar method for LC and performed it in 132 patients.
  
  
  METHODS
  After the creation of the pneumoperitoneum, the first 10-mm trocar sheath was inserted in the subumbilicus for the endoscope, the second 5-mm trocar in the epigastric paramedian point for the working port, and the third 5-mm trocar in the subcostal area for grasping forceps. Monofilament nylon with a straight needle was inserted through the right 7th intercostal space in the anterior axillary line, and the seromuscular layer of the gallbladder fundus was punctured and retracted toward the anterior abdominal wall. After that, usual cholecystectomy was performed.
  
  
  RESULTS
  Among the 132 patients who underwent the three-trocar method, 10 cases (8%) needed a fourth trocar. No patient was converted to open cholecystectomy. There were no significant differences in the operating time, the length of hospital stay after the operation, or the use of analgesics between the three-trocar and the four-trocar methods. No major complication was recognized.
  
  
  CONCLUSIONS
  This method also has cosmetic advantages. Therefore, we believe this method might be recommended for LC.
authors.affiliation: Department of General Thoracic Surgery, Kure National Hospital, Hiroshima, Japan. ShunjiEndo@aol.com
authors.forename: S
authors.initials: S
authors.lastname: Endo
authors.forename: S
authors.initials: S
authors.lastname: Souda
authors.forename: R
authors.initials: R
authors.lastname: Nezu
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: J
authors.initials: J
authors.lastname: Hashimoto
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.forename: F
authors.initials: F
authors.lastname: Uchikoshi
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D004954:Esthetics; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D016896:Treatment Outcome