Comparative study of three-port vs four-port laparoscopic cholecystectomy in a cohort study: a surgical task load survey

Abstract

The three-port laparoscopic cholecystectomy (LC) approach is gaining attention for its perceived benefits, although it is not widely accepted outside of clinical trials. The present investigation aims to compare the outcomes of three-port LC (3PLC) and four-port LC (4PLC) methods, focusing on their safety, efficacy, and workload. This multicenter investigation was performed between March 2021 and April 2022. Demographic data, procedural outcomes, visual analog scale regarding postoperative pain, and the level of satisfaction were collected and compared. In addition, the Surgery-TLX and Borg's CR10 tools were utilized to assess the surgeon's workload. Of 169 patients who enrolled in the study, 84 individuals underwent 3PLC, and 85 cases had 4PLC. The three-port LC indicated a significantly shorter duration of operation compared to the four-port (63.55 vs. 69.08 min respectively, p = 0.001). The hospital length of stay and the mean pain score on day 1 were also lower in the 3PLC (1.14 days vs. 1.79 days, p < 0.001 and 1.85 vs. 2.52, p = 0.004, respectively). The mean level of satisfaction on day 7 was higher in the 3PLC. The Borg's CR10 scale showed that surgeons experienced more physical discomfort and pain in the left shoulder, left forearm, and trunk after 4PLC. The surgery-TLX scale in our study indicated increased mental demands and distraction, but less situational awareness in the surgeons after 4PLC. The 3PLC technique could serve as a safe and feasible laparoscopic technique and does not cause more complications than the conventional 4PLC.