A narrative review of technical developments for the laparoscopic cholecystectomy

Background and Objective: Laparoscopic cholecystectomy (LC) is a surgical procedure frequently performed in benign gallbladder diseases since its description and has become the gold standard surpassing open cholecystectomy due to its numerous advantages. Like any new technique, adaptation problems were experienced in the early days of its application and complication rates were relatively high. In subsequent years, the evolution of minimally invasive surgery and the growing experience of surgeons have facilitated the application of LC and led to various modifications. This article aims to explore the evolution of cholecystectomy techniques, focusing on standard LC and over 50 modified techniques documented in the medical literature. Methods: We searched original papers, reviews and meta-analyses published about the technical development of laparoscopic surgery in the management of benign gallbladder diseases using PubMed. The study evaluates the impact of modifications on early-stage complications, procedure duration, postoperative pain, and hospital stay, comparing standard LC with various modified approaches. Key Content and Findings: These modifications include reducing the number of ports, changing port entry locations, and altering port sizes. The comparison includes four-port, three-port, two-port, single-incision, needlescopic, robot-assisted, and natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy techniques. Early-stage complication rates among different techniques were examined, and procedure time, postoperative pain, and hospital stay were compared between standard and modified LC methods. Conclusions: The standard LC procedure, with its meticulous steps and adherence to the “Critical View of Safety”, remains the cornerstone of gallbladder surgery. Although modified LC techniques offer advantages in certain aspects, debates continue about the superiority of modified techniques in obtaining better postoperative and cosmetic results. A balanced approach is needed in LC, in which improved cosmetic results should be perfectly harmonized with the most important principle of ensuring patient safety. However, acknowledging the precedence of patient safety over cosmetic and others considerations, the significance of experienced surgeons and meticulous patient selection becomes crucial when opting for modified techniques.