A good view of Calot's triangle is not possible without some form of upward retraction. I would question the motivation in saving a 5mm port site. One less 5mm cut is not a good reason to make the operation more difficult, more time consuming and potentially increase the risk of complication for the patient.

In my opinion, this is feasible. I generally do my cholecystectomies in single-incision technique. You can easily retract the gallbladder using an extra instrument through the umbilical port.

The critical view is mandatory, no matter how many ports you use:

erho P, Sallinen V, Lampela H, Harju J, Koskenvuo L, Mentula P. The critical view of safety and bile duct injuries in laparoscopic cholecystectomy: a photo evaluation study on 1532 patients. HPB (Oxford). 2021:S1365-182X(21)00117-9.

Alternatives for gallbladder retraction have been described, including an extra percutaneous mini instrument, magnets, sutures, etc. Some other ideas:

Funamizu N, Okamoto T, Kumamoto T, Kazama T, Watanabe A, Fujioka S, Yanaga K. Effective method of gallbladder retraction for single-incision laparoscopic cholecystectomy. Asian J Endosc Surg. 2019 Apr;12(2):222-226. doi: 10.1111/ases.12614

Joseph RA, Salas NA, Donovan MA, Reardon PR, Bass BL, Dunkin BJ. Single-site laparoscopic (SSL) cholecystectomy in human cadavers using a novel percutaneous instrument platform and a magnetic anchoring and guidance system (MAGS): reestablishing the "critical view". Surg Endosc. 2012;26:149-53.

This is feasible but I prefer 4 port technique (1 more trocar of 5 mm allows better vision without aesthetic problems)

If you can do a cholecystectomy with 3 ports with great safety do it but if in any way you are going to sacrifice safety please use another one .

it is feasible for simple and selected cases , in good hand.

but for inflamed or difficult cases it could be extremally dangerous .

the 4 port technique (you can add 1 more trocar of 5 or 3 mm) should be use as the stander of care

This is possible, but we prefer a technique with 4 ports (another 1 trocar of 5 mm allows you to improve your vision without aesthetic problems), the question of aesthetics is the direction of the skin incisions (transverse). And instead of 4 ports (5 mm), percutaneous fixation of the gallbladder with a ligature was used.... But 4 ports are still more convenient ...

Recently i have trouble with my left shoulder ..reason behind is struggling with few number of ports. Doing daily surgery as profession i changed mind to use 4 port for lap cholecystectomy. Posture of surgeon including retraction and bed height adjustment according to pt obesity will be going to make surgeon easy and less stress so that stress free surgery with focused on calot`s probably decrease injury scale.

Feasoble but not logic, may be dangerus

Yes it's feasible but only in selected group of patients that also when u have attained sufficient experience in four port lap chole otherwise it can increase the complication rates .

Surgeons’ preference based on training/experience/comfort.

Adding a fourth trocar intraop or converting to open is never considered a failure.

True 👍

Claire L Stevens Stefano Rossi thats true. But seen many surgeons they just showoff with 3 port LCs.

Yes feasible and with clear Calot's triangle you can go ahead, but advantage is very minimal compared to 4 port.

Si es factible i no implica dificultats tecnique endevant. Per contra es mes còmoda la visió del triangle de Calot amb 4 trocars, mes segur i per tant mes pragmatic. La estetica de 0,5 cm de ferida es minima i no implica cap problema estectic.

Seguretat devant de virtuisisme estetic !!!

Feasible? Yes! Does it make a difference? I think not!

Can be done in very straightforward cases. But there never is an "easy" cholecystectomy. If still one wants to avoid a 5mm port, a transabodminal wall suture can be used to hold up the fundus of the gallbladded.

3ports is factibil

Single-port, 2-port or 3-port cholecystectomy are all feasible. However the most important issue is not the number or size of trocars but the safety of the surgery. Laparoscopic cholecystectomy is superior to the open counterpart due to the use of the CO2 pneumoperitoneum which reduces by itself the inflammatory response.

The scars are just scars. If this is an important issue for the patient, you can use two 2mm trocars (pediatric instruments which leaves no visible scars), one 5 mm trocar (epigastric) and one 10 mm umbilical trocar that results in just one 5 mm epigastric scar, keeping the traction, visibility of the Calot triangle and the safety of this procedure.

I agree with Dr Marcel Autran It is a matter of safety

Even with 1 port the operation is possible, but need special equipment.

Владимир Иванович Батюк we all know we are not talking about single port surgery. please give relevent answer acording to the question.

Lo más importante es la seguridad de la cirugía. Existen técnicas de tracción para la vesícula que pueden hacer ahorrar un puerto y minitrócares, lo cual que es discutible pues 1 puerto de 5 mms tiene escasas complicaciones.

Realizar una colecistectomia laparoscópica con 3 puertos es posible. Pero es más seguro usar un 4° acceso para de esta manera exponer bien el triangulo de calor y evitar iatrogenias

Yes feasible in few simple cases in experienced hand .it's better not to struggle in difficult cases .5mm port hardly makes any differnce

I am strongly convinced that single-port laparoscopic surgery (including chole, colon, gynecologic, appendix) is both feasible and safe, if a rigorous previous selection of patients was made. However, feasible and safe does not mean "advocable". I usually discourage the routine use of single-port, miniaturized instrumentations, and any other solution driven by the market and by the patients requests, rather than by a clinical real advantage.

I agree with Dr Marcel Autran and Dr Sergio Sotelo. Safety first of all. It's better use 4 trocar: a good view of Calot's triangle with little scars.

Speaking through personal experience (been doing 3 port for about 4 years now, used 4 ports for few years before that) it comes down to one factor, surgeon's experience. Adequate traction can be maintained with 3 port technique as well allowing safe surgery. And wherever difficulty is encountered, a 4th port can be inserted at any time. Additional advantage with 3 ports, a second assistant is not required

It depends on the gall bladder at first glance, If any doubt no hesitation for the 4th port should remain. Safety is more important than just a single 5-mm incision less or more.

Experience and training matters.

3 port with use of icg is safe

Laparoscopy has become a gimmickry. Everyone is trying their best to score points for one-man-up-ship. Yes, everything is possible with a tag of experience and experience comes by mistakes. Go ahead. Good luck.

safety is more important than a 5mm port

Nobody can forget safety " Primum non nocere " is the first item of our practice

Cholecystectomy is possible with three ports (or rather removing a gallbladder), but the real question that will need to be asked is: is a three port cholecystectomy safe?

I think No, because it is impossible to achieve (The critical view of safety) with three ports.

Yes, it is very much possible.