title: Is the fourth port routinely required for laparoscopic cholecystectomy? Our three-port laparoscopic cholecystectomy experience.
abstract: BACKGROUND
  There have been many changes in number and place of trocars that have been described, since the first laparoscopic cholecystectomy (LC), but, in fact, all authors agree that laparoscopic procedure is accepted as gold standard. However, four trocars use in standard laparoscopic cholecystectomy, it has been argued that the fourth port is not necessary for grasping fundus of gallbladder so as to expose Calot's triangle. The aim of this study is to establish the safety of three-trocar LC in symptomatic gallbladder disease and also to determine the ratio of technical requirements of the fourth trocar.
  
  
  METHODS
  Between August 2010 and January 2016, 291 cases were operated in Kocaeli Derince Education and Research Hospital, department of general surgery for symptomatic gallbladder disease with three-port LC, and their records were examined retrospectively.
  
  
  RESULTS
  Two hundred and twenty patients were female (75.6 %) and seventy one (24.4 %) were male. Two hundred and eighteen of two hundred and ninety-one cases (74.92 %) were operated with three- port LC in a secure way. In seventy-three cases (25.08 %), one more port was needed to use. Mean operative time was 33.76 ± 11:18 min. (15-90 min). In these cases, major complications, such as main bile duct injury or bile leakage, that may increase the mortality and morbidity, did not occur. Only in one case (0.34 %) postoperative bleeding was seen from the liver bed, which was required exploration.
  
  
  CONCLUSIONS
  We concluded that in experienced hand, LC with three ports is safe and feasible technique if it is not endanger the course of the surgery.
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey. draliciftci@hotmail.com.
authors: A
authors: A
authors: Ciftci
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: M B
authors: MB
authors: Yazicioglu
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: C
authors: C
authors: Tiryaki
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: H T
authors: HT
authors: Turgut
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: O
authors: O
authors: Subasi
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: M
authors: M
authors: Ilgoz
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: O
authors: O
authors: Civil
authors: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
authors: S Y
authors: SY
authors: Yildiz
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000293:injuries; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Surgical technique; Three-port LC