Feasibility and safety of laparoscopic 3-port cholecystectomy using the LiVac retractor: a prospective cohort study

Background: Laparoscopic cholecystectomy (LC) is a highly standardized procedure, which is usually performed using 4 ports. LC in reduced 3-port technique with the internal vacuum-based LiVac retractor has hardly been investigated so far. The aim of our study was to evaluate the 3-port cholecystectomy using the LiVac retractor with focus on surgical feasibility and patient safety. Methods: Treatment data from 25 patients undergoing LC using the 3-port technique with the LiVac retractor (group 1) were prospectively collected. Postoperative complications (Clavien-Dindo classification) were defined as the primary outcome. Pain scores, laboratory values and surgical handling of the LiVac system were the secondary outcome. Surgical handling was evaluated using a standardized questionnaire (grading from 1-6; 1= very good, 6= absolutely insufficient). Data of the prospective LiVac cohort were compared with a retrospective reference cohort of 50 patients with 4-port cholecystectomy of the same time period (group 2). Results: The rate of postoperative complications did not differ significantly (all grades; group 1: 16% vs. group 2: 10%; P= 0.451). Patients in group 1 had significantly prolonged operative time ( group 1: 99 minutes vs. group 2: 75 minutes; P=0.008). An additional fourth port had to be inserted in 60% of all LiVac cholecystectomies; 54% of surgeons reported relevant problems with LiVac use. Conclusions: The use of the LiVac retractor in laparoscopic 3-port cholecystectomy was found to be feasible. However, it was associated with a prolonged operation time, limited exposure of the operative field, and only moderate user satisfaction. The 3-port procedure using the LiVac retractor did not result in any patient benefits compared to conventional 4-port cholecystectomy. Thus, LC using 4 ports should be preferred. However, a prospective randomized comparative study would be needed for final evaluation.