{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:46:11Z","timestamp":1781624771646,"version":"3.54.5"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2022,3,31]],"date-time":"2022-03-31T00:00:00Z","timestamp":1648684800000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The four-port laparoscopic technique is the standard approach for cholecystectomy. A three-port technique has been described, but there is no consensus over the outcomes and efficacy of this approach. The aim was to perform a systematic review and meta-analysis to compare the three- and four-port techniques in laparoscopic cholecystectomy for benign diseases of the gallbladder.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The review was conducted according to a predefined protocol registered on PROSPERO. Two authors independently conducted an electronic database search of CENTRAL, MEDLINE, Embase, CINAHL, WHO International Clinical Trials Registry, and ClinicalTrials.gov. Outcomes are reported as risk ratios (RR), mean difference (m.d.), or standardized mean difference (s.m.d.) with 95 per cent confidence intervals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighteen trials were included with 2085 patients. Length of hospital stay and postoperative analgesia requirement favoured the three-port group (m.d. \u22120.29, 95 per cent c.i. \u22120.43 to \u22120.16 (P\u2009&amp;lt;\u20090.001); and s.m.d. \u22120.68, 95 per cent c.i. \u22121.03 to \u22120.33 (P\u2009&amp;lt;\u20090.001), respectively). There were no differences in length of procedure or success rate between the two groups (m.d. 0.90, 95 per cent c.i. \u22123.78 to 5.58 (P\u2009=\u20090.71) and RR 0.99, 95 per cent c.i. 0.97 to 1.01 (P\u2009=\u20090.17), respectively). There were no differences in adverse events. The overall quality of evidence was low.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The three-port technique for laparoscopic cholecystectomy is an option for appropriately trained surgeons who perform it regularly. However, the decision to use three ports should not be at the expense of safe dissection of Calot\u2019s triangle.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrac013","type":"journal-article","created":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T04:17:01Z","timestamp":1643170621000},"source":"Crossref","is-referenced-by-count":15,"title":["Three-port <i>versus<\/i> four-port technique for laparoscopic cholecystectomy: systematic review and meta-analysis"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5816-7151","authenticated-orcid":false,"given":"Lawrence","family":"Nip","sequence":"first","affiliation":[{"name":"Department of General Surgery, University Hospital Lewisham , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kin-Seng","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Queen Alexandra Hospital , Portsmouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia M.","family":"Borg","sequence":"additional","affiliation":[{"name":"Department of General Surgery, University Hospital Lewisham , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,31]]},"reference":[{"key":"2023020211363588900_zrac013-B1","volume-title":"Commissioning Guide: Gallstone Disease","author":"Association of Upper Gastrointestinal Surgeons (AUGIS)"},{"key":"2023020211363588900_zrac013-B2","article-title":"Commissioning Guide: Emergency General Surgery (Acute Abdominal Pain)","author":"Royal College of Surgeons of England (RCSEng) and Association of Surgeons of Great Britain and Ireland (ASGBI)"},{"key":"2023020211363588900_zrac013-B3","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1001\/jama.1993.03500080066034","article-title":"NIH Consensus Development Panel on Gallstones and Laparoscopic Cholecystectomy","volume":"269","year":"1993","journal-title":"JAMA"},{"key":"2023020211363588900_zrac013-B4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/0972-9941.140220","article-title":"Techniques of laparoscopic cholecystectomy: nomenclature and selection","volume":"11","author":"Haribhakti","year":"2015","journal-title":"J Minim Access Surg"},{"key":"2023020211363588900_zrac013-B5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1007\/s005340050051","article-title":"Experience with three-port laparoscopic cholecystectomy","volume":"5","author":"Tagaya","year":"1998","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"2023020211363588900_zrac013-B6","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.amjsurg.2005.07.029","article-title":"Three-port laparoscopic cholecystectomy by harmonic dissection without cystic duct and artery clipping","volume":"191","author":"Tebala","year":"2006","journal-title":"Am J Surg"},{"key":"2023020211363588900_zrac013-B7","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1007\/BF00299168","article-title":"Laparoscopic cholecystectomy: an original three-trocar technique","volume":"19","author":"Slim","year":"1995","journal-title":"World J Surg"},{"key":"2023020211363588900_zrac013-B8","doi-asserted-by":"crossref","first-page":"3739","DOI":"10.1007\/s00464-018-6143-y","article-title":"Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials","volume":"32","author":"Arezzo","year":"2018","journal-title":"Surg Endoscop"},{"key":"2023020211363588900_zrac013-B9","article-title":"Three-port technique vs standard four-port technique for laparoscopic cholecystectomy","author":"Nip"},{"key":"2023020211363588900_zrac013-B10","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2023020211363588900_zrac013-B11","article-title":"Collecting data","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.2","author":"Li","year":"2021"},{"key":"2023020211363588900_zrac013-B12","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"2023020211363588900_zrac013-B13","volume-title":"Review Manager (RevMan). 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