American position gives the advantage that the gallblader and Calot's triagle are in front ot the surgeon, also when performed by 2 surgeons, the operator can hold the camera witl left hand and dissect with right hand, witch is very difficult when standing between the legs of the patient. French position is more ergonomic for 3 port cholecystectomies. 

French position is in my opnion the best regarding ergonomics. The assistant moves more freely and his/her hands and arms won't collide with the surgeons'. The angle is also preferable, you can easier visualize both sides of the structures in Calot.

I'm used to french position that I find satisfactory in term of ergonomics. I suppose that it is iust a matter of habit, because once You deal with laparoscopic colon surgery ,You get used to different position with no much difference regarding the technical performance

Regarding ergonomics, I  prefer the American position.

It depends on whether you ask an American or French? In ergonomic terms depends on your muscle constitution and BMI. In general it is best to know what you're doing and do it. Do not forget, laparoscopy requires good physical condition.

What really improves ergonomics, is the use of a camera holder, and with a four port procedure a holder for the liver retractor as well. This relieves the assistant from the static, and uncomfortable task of holding the camera steady.

It also gives more room to the surgeon to stand in the most optimal manner, not hampered by the assistant.

Article Camera and Instrument Holders and Their Clinical Value in Mi...

= By 1989, I never used an assistant. I had a camera holder, anchored my fundal retracting forceps to the drape  with an Allis or Gilpie, paid attention to the habitus, and trained the left or right handed resident in all possible positions so that they can be craftsmen and not just provincial technicians delimiting  their surgical skill. The approach should be adapted to the patient  by the surgeon and not vice versa.

= The difference between you and the physician  is that you can transmit your thoughts to your fingers.  Surgery is not only a science, it is also an art. 

That depend of your aim:

If you dont want to perform peroperative cholangiography, french poisition is the best for the surgeon who is in front the field

If you want to perform peroperative cholangiography, american position is best

i my idea ,both procedure is practical and ergonomic and depend on surgeon habit.

but i prefer french ones.

I believe that the French position has advantage if the common bile duct exploration is planned. It favours the right-hand´s suture movements, specially when transfixing the most medial part of the duct. On the other hand, this position is worst for the camera assistant.  I agree with Yonko Georgiev when he states that the American position is suitable for the procedure performed by two surgeons.

I think it is a matter of personal ease and comfort.It depends upon which method one uses while learning. Lap Chole. can be done with ease by both the techniques. For easy ones the American technique is undoubtedly superior.

For me, French position is better. 

Better ergonomics and you have three hands working, better for difficult cases (acute, sub-acute and CBD explorations)

 It depends on the surgeon (and the patient) at the end of the day the best technique is the one the surgeon does best. I do the American every time and to change to French would really upset the feng shui. Also to change your technique for the hard ones is probably going to make the operation a bit harder, as you won't be used to the position. 

Harsha

American position is suitable

For  me the american position is better.

Undoubtedly, french position is ergonomically the best. Since all over the globe lot of experience has been published, the same benefits can be accomplished with american position. DVT is definitely less with american position. For CBD exploration and for SILS, french position is ergonomically ideal. 

I was trained to do laparoscopic cholecystecomies in the American position during my residency. Then when i was working in France i learned doing them in the French position. I have been using exclusively the French position ever since.

Here's a list of the pros and cons of each position (in my humble opinion):

French

pros (+)

Best ergonomics and most comfortable for the surgeon who is positioned in front of the operative field. Possibility to dissect the cystic duct from the left and the right.

Facilitates bi-manual operative technique where the left hand creates counter-traction and exposes.

Can be performed with an inexperienced assistant.

Best position for CBD exploration.

cons (-)

Not ergonomic for the assistant whose position is not so comfortable holding the camera with the left hand and being immobile for the whole operation.

Crossing of the surgeon's right arm with the assistant's left.

A bit tricky when performing an intraoperative cholangiogram.

American

pros (+)

Best for starting experience with laparoscopic surgery. Only the surgeon's right hand operates.

More interesting for the assistant who retracts and exposes using both hands. It's a good entry level exercise for laparoscopic surgery.

The assistant's position is more comfortable and no arm crossing occurs.

Easier to do an intraoperative cholangiogram.

cons (-)

The cystic duct can be approached only from the left side.

The surgeon holds the camera with his left hand and thus cannot use both hands to dissect.

Dependence on a trained and competent assistant.

Needs two monitors: one for the surgeon and one for the assistant.

I hope this list of thoughts helps.

Hello to everyone:

I have to agree with most of the previous answers to this topic. I too had most of the times performed multi-port laparoscopic cholecystectomy using the American position (more than 5,000 cases). I use one 12-mm umbilical port (Hasson) and three 5-mm subcostal ports.

However, the reason I prefer the American position is Operating Room time economy, and obviously the cost for it.

My experience with the French position comes from my early Nissen operations and my early bariatric cases. I started doing my first 25 gastric bypass cases standing between the patient's legs. And then I noticed that just positioning and fixing the patient to the table took us in average 15 to 25 min. Therefore I started to operate all my bariatric cases standing on the right side of my patients. From there I switched all my Nissen fundoplications also to an American position and decreased my operating time by 20 min at least.

Now, in regards to laparoscopic cholecystectomy, as I said before, I do almost all of them in the American position. However, when I have to do a Nissen and a Cholecystectomy in the same patient, I start operating from the patient's right side and my 5 ports distribution is as follows:

1) 12-mm umbilical port (Hasson)

2) 5-mm right subcostal port (just lateral to the mid-clavicular line)

3) 5-mm subxyphoidal port  

4) 5-mm left subcostal port (just lateral to the mid-clavicular line)

5) 5-mm left subcostal port (between the anterior and middle axillary lines)

Then, when I finished the Nissen, I shift my position to the patient's left side and use the umbilical port for the camera man, the subxiphoidal port for my assistant in retracting the gallbladder fundus upwards and I use the two paramedian ports for most of the operation - like the French technique. Nonetheless, my patient is in the American position. Taking advantage of the best of both worlds. 

I hope that this rather elaborated answer contributes to this well nourished forum.