Laparoscopic cholecystectomy

  Laparoscopic cholecystectomy has been clinically used for many years, and I have done many cases, from the classic four-hole method, to the three-hole method, to the two-hole and single-hole, each of which has been tried and each has been experienced.  First, from the safety point of view, four-hole is the most classic one. The skilled cooperation of two people and good operational support make better exposure of the operative field, so that the safety should be ranked the highest among the four.  Second, from the postoperative effect, pain, if all four surgeries are smooth and successful, the postoperative pain scoring is definitely ranked in the top of single-hole and two-hole, after all, the most painful postoperative subxiphoid hole is omitted, but the intraoperative operation is more complicated, longer and less safe than four-hole and three-hole.  Third, from the operation time, the classic four holes is the most done, of course, is also the most skilled, time can be controlled well, but if the assistant is not in, it is best to choose three holes alone, skilled can also achieve a very high speed, good safety results, but compared to four holes or a little hidden, and the extra 5mm hole from the cosmetic point of view also has little impact. But the operation time of single hole will be relatively long.  Fourth, from the point of view of operational difficulties, conservative not to develop, single-hole and two-hole for surgeons is asking for trouble, intraoperative operation is very troublesome, safety risks are great, but everything is difficult at the beginning, with the accumulation of experience and the perfection of the instrument, single-hole may be tomorrow’s classic.  Fifth, from the cosmetic effect, of course, the fewer holes the better, although the less to go only 5 and 10mm poke holes, but for the patient’s psychological acceptance greatly increased.