Laparoscopic cholecystectomy was adopted rapidly by most surgeons and embraced enthusiastically by the public. Along with the wide spread of it, how to reduce the cost more has been increasingly important. Moreover the minimal invasiveness has
been
one
of the main goals of laparoscopic cholecystectomy. Retrospective data were collected on 240 patients undergoing laparoscopic choleystectomy at St. Vincent Hospital, Catholic University Medical College, from October 1991 until December 1993.
Nearly
all
patients had taken the three-puncture laparoscopic cholecystectomy since 129th case. In this report, we tried to determine whether the three-puncture laparoscopic cholecystectomy could be chosen as an althernative, instead of standard
four-puncture
technique, on selected patients, by comparison of clinical results betweentwo technques. We excluded first 60 cases ot minimize the bias sprung from the learning curve. All the associated clinical factors were evaluated with the outcomes of two
techniques. Between two techniques, there was no significant difference in intraoperative controllable bleeding, postoperative complications, duration of pain complaints, and postoperative hospital stay. Intraoperative gallbladder
perforation(p=0.0184),
operating time(p=0.0001), and days for return to normal activities(p=0.001) were significantly reduced in cases of three-puncture techniques. Values of serially checked liver enzymes - alanine aminotransferase, aspartate aminotransferase, and
alkaline
phosphatase-showed no divergency between two tchniques. Neither biliary tree complication nor spill age of gallbladder stone into common bile duct was appeared. No case ofreoperation due to the operative failure was occurred. Three puncture
technique
had economical and minor practical advantages over the four-puncture technique in our series. It may help to prevent gallbladder stones from slipping into common bile duct. Altered traction methods may lead us to the better way of preventing bile
duct
injuries. At least for qualified laparoscopic surgeons, three-puncture technique may not be inferior to four-puncture technique in case of properly selected patient.
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