The article by S. Trichak regarding three-port laparoscopic cholecystectomy (lap chole) was of particular interest to myself [2]. Starting in 1996, I have routinely utilized the three-port approach to perform a lap chole except when the operative laparoscopic findings contraindicated or required additional port sites and trocar placement for exposure, retraction, and dissection [1]. These three-port patients may be elective, urgent, or emergent patients in need of cholecystectomy. A great majority of these patients are operated electively at a remote surgicenter 7 miles from the nearest hospital and discharged home 2 h postoperatively. If the patients are seen in the hospital, they are similarly operated with a three-port system. We regularly use an open technique to place the first port periumbilically, but when previous surgical adhesions preclude this approach, an open substernal approach is used. In these cases, three ports may be the only laparoscopic option. We have felt the patients had less discomfort and certainly saved the cost of an additional port trocar. The scarring (5 mm) is generally of little concern.

The author should be congratulated for his efforts to demonstrate the wisdom of a three-port procedure