title: Body-first laparoscopic cholecystectomy: a three-trocar technique for difficult gallbladders.
abstract: BACKGROUND
  In this paper, we report on a modified technique of laparoscopic cholecystectomy (LC), using three-trocars in cases of difficult anatomy at the Calot's triangle without the insertion of more additional trocars, in order to validate its feasibility, efficacy, and safety.
  
  
  METHODS
  We retrospectively analyzed 67 consecutive cases of body-first LCs performed for gallbladder disease from January to December 2007. The surgical technique was compared with respect to operative times, conversion to open cholecystectomy, postoperative complications, and length of postoperative stay.
  
  
  RESULTS
  The body-first LC was successful in 64 patients (95.6%). The median operating time was 32 minutes (range, 27-90) for chronic cholecystitis, 53 minutes (range, 41-145) for acute cholecystitis, and 62 minutes (range, 35-170) for interval cholecystectomy. The difference in duration of the surgical procedure between the chronic cholecystitis group and the other two groups was significant (P < 0.05). We did not find any significant difference in the average operating time between the acute cholecystitis group and the interval cholecystectomy. The average postoperative hospital stay was 1 day (range, 1-3). No common bile duct injuries and no complications occurred in the series reported in this paper.
  
  
  CONCLUSIONS
  The body-first three-trocar LC is a safe option when dealing with patients with difficult anatomy at the Calot's triangle. It yields a low conversion rate and avoids the insertion of any additional trocars. Further studies are required on the long-term efficiency and reliability of this technique in order to fully evaluate its value.
authors.affiliation: Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari, Italia. massimiliano.tuveri@libero.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Tuveri
authors.forename: Augusto
authors.initials: A
authors.lastname: Tuveri
mesh_terms: D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome