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Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the following
conditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. At
present, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopic
cholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operative
time in SILC procedure.
Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease who
underwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ records
were reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomes
were perioperative and 3-month postoperative adverse outcomes.
Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median
(interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative time
of difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (body
mass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009).
Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitis
were also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007).
Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder were
preoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors are
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