Reduced-Port Laparoscopic Cholecystectomy Using a Port-Free Organ Retractor: A Comparative Study with Conventional Four-Port Technique

Abstract

Background:

Reduced-port surgery can eliminate the need for a skilled surgical assistant and enable solo surgery with a nonsurgeon camera assistant, potentially addressing surgeon shortages. However, single-incision laparoscopic cholecystectomy has limitations, including instrument collision and prolonged operative time. This study evaluated free jaw (FJ) clip-assisted reduced-port laparoscopic cholecystectomy (RPLC) as a solo-surgery technique.

Methods:

Between January 2022 and December 2025, 14 patients underwent FJ clip-assisted RPLC (three-incision, n = 6; two-incision, n = 8) performed by a single surgeon with a camera assistant who did not manipulate instruments, and 25 patients underwent four-port conventional laparoscopic cholecystectomy (CLC). The primary outcomes were operative time and the learning curve. The secondary outcomes included blood loss, complications, and postoperative hospital stay. The learning curve was evaluated using cumulative sum (CUSUM) analysis.

Results:

The CUSUM analysis demonstrated a turning point at case 6, indicating completion of the learning curve. The median operative times were comparable between the RPLC and CLC groups (85.5 versus 90.0 minutes, P = .121). Estimated blood loss was significantly lower in the RPLC group (1 versus 5 mL, P = .013). No complications related to intercostal puncture or FJ clip-induced gallbladder damage were observed. No postoperative complications (Clavien–Dindo ≥II) were observed in either group.

Conclusions:

FJ clip-assisted RPLC is a feasible solo-surgery technique with a short learning curve. This technique achieved safety comparable to CLC with minimal additional cost, potentially addressing surgeon shortages while maintaining surgical quality.