Comparative analysis of the four-port and three-port trocar access of the conventional laparoscopic cholecystectomy--review of the literature.
BACKGROUND
The presented analysis focuses on the first stage in the development of the laparoscopic technique forsurgical removal of the gall-bladder. The scope of the study starts with the period of its introduction in the clinical practice of the laparoscopic cholecystectomy and ends with the recognition of the three-port technique for surgical intervention.


OBJECTIVE
The aim of this analysis is to review the studies, focused on the indications applying different techniques of conventional laparoscopiccholecystectomy, to summarize their advantages and disadvantages and to pinpoint the future guidelinesfor the development of the surgical techniques. METHODOLOGIES AND MATERIALS: The studies of the decision making process for applying a certain surgical technique of the conventional laparoscopic cholecystectomy, the individualized approach in surgical treatment and the risks and complications in different methodologies were reviewed. The different aspects of the process were analyzed and to demonstrate their relevance, have been illustrated by the published by 2011 studies.


RESULTS
The review of the literature spams over 40 articles, which compare the two main techniques for conventional laparoscopic cholecystectomy in the following parameters: safety of the technique, technical parameters of the surgical intervention as access facilitation, the number, the position and the size of the trocars, 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 don't show a significant advantage of any of those two techniques. In terms of safety, the four-port trocar technique is considered better, but in short-term cosmetic results and esthetic satisfaction, the three-port trocar has more merit.


CONCLUSIONS
The comparative analysis of the three-port and four-port trocar access of the conventional laparoscopic cholecystectomy shows a tendency in the development of low invasive techniques. The period this study has covered is limited due to the introduction of the one-port techniques as a new direction in the development of the laparoscopic surgery and the shift in the focus from conventional laparoscopic techniques to techniques with a single access. The new tendencies in the low invasive techniques will be the subject of part 2.
Department of Surgery, Clinic of surgery "Prof Dr. Aleksandar Stanishev" "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria
A
A
Koichev
D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D010149:Postoperative Pain / Q000209:etiology; D016896:Treatment Outcome