To evaluate the safety and efficacy of three-port laparoscopic cholecystectomy (LC) via the umbilical approach.

Clinical data of 10 000 patients with benign gallbladder diseases who received three-port LC via the umbilical approach in Songjiang Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 2007 to May 2025 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 3 786 patients were male and 6 214 were female, aged from 18 to 94 years, with a median age of 65 years. 9 160 patients underwent elective surgery and 840 received emergency surgery. Conventional laparoscopic instruments were used in all cases. A 5-mm auxiliary port was created under the xiphoid process for those with anatomical difficulties. The operation time, intraoperative blood loss, postoperative pain intensity assessed by numerical rating scale (NRS) score and postoperative complications were recorded. The operation time, intraoperative blood loss and postoperative NRS score between male and female patients were compared by t-test. The surgical learning curve was delineated to analyze the quantitative relationship of learning process.

All patients successfully completed LC. In male patients, the operation time was (25±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.12). In female counterparts, the operation time was (26±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.10). No significant differences were noted between male and female patients (t=-1.371, 0.946, -0.001; all P>0.05). The length of postoperative hospital stay was (2.0-4.0) d, with a median of 3.2 d. 43 patients developed postoperative complications. 3 cases experienced intraoperative bile duct injury, which were repaired by laparoscopy. 1 case of cross-sectional injury of common bile duct was converted to open surgery for end-to-end anastomosis of common bile duct. 1 case of cross-sectional injury of common hepatic duct was converted to open cholangioenterostomy. 1 case of massive hemorrhage was converted to open surgery for hemostasis. 4 cases of postoperative abdominal bleeding and 2 cases of postoperative bile leakage underwent unplanned laparoscopic surgery. 3 cases of incisional hernia received surgical repair. 3 cases of postoperative choledocholithiasis were treated by ERCP. 12 cases of bile leakage and 10 cases of incisional infection were cured by conservative treatment. No death was reported. Follow-up ranged from 2 to 60 months. The scars were hidden and the cosmetic effect was favorable. The learning curve showed that systematic training of approximately 100 cases was the key to realize technical maturity.

Three-port LC via the umbilical approach is suitable for elective and emergency surgeries, which is safe, feasible and yields favorable cosmetic effect. However, it should be carried out on the premise of ensuring the safety of patients and clear surgical field. Systematic training of approximately 100 cases was the key to realize technical maturity.