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KMID : 0371420150890050247
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Annals of Surgical Treatment and Research
2015 Volume.89 No. 5 p.247 ~ p.253
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Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy
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Cheon Seong-Uk
Moon Ju-Ik
Choi In-Seok
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Abstract
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Purpose: We performed 3-channel single incision laparoscopic cholecystectomy (SILC) in earlier period of this study and modified our method to 4-channel SILC using a snake retractor for better operative field in later period. This study has been designed to evaluate the risk factors for prolonged operative time in SILC.
Methods: From April 2010 to August 2014, 323 cases of 3-channel SILC (Konyang standard method [KSM] group) and 399 cases of 4-channel SILC (modified KSM [mKSM] group) using a snake retractor were performed.
Results: The clinical characteristics were not significantly different between KSM and mKSM group except preoperative percutaneous transhepatic gallbladder drainage (PTGBD) treatment (9.6% vs. 16.5%, P < 0.007). The mean operation time was longer in mKSM group than KSM group (55.8 ± 19.7 minutes vs. 51.7 ± 20.1 minutes, P = 0.006). The estimated blood loss of KSM group was more than mKSM group (24.6 ± 54.1 mL vs. 16.9 ± 27.0 mL, P = 0.013). According to the histopathologic findings, acute cholecystitis or empyema were confirmed more in mKSM group as compared with KSM group (28% vs. 14.0%, P = 0.025). In multivariate analysis, the risk factors for prolonged operation time were drainage insertion, histopathologic findings (acute cholecystitis or empyema), surgeons' technical expertise, body mass index > 30 kg/m2 as well as the 4-channel SILC.
Conclusion: Among patients with these risk factors, conventional laparoscopic cholecystectomy could be considered as well although SILC might be safe and feasible modality for benign gallbladder disease.
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KEYWORD
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Operative time, Risk factors, Cholecystectomy, Laparoscopy, Single incision
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