title: Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy.
abstract: OBJECTIVE
  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/m(2) as well as the 4-channel SILC.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea.
authors.forename: Seong Uk
authors.initials: SU
authors.lastname: Cheon
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea.
authors.forename: Ju Ik
authors.initials: JI
authors.lastname: Moon
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University School of Medicine, Daejeon, Korea.
authors.forename: In Seok
authors.initials: IS
authors.lastname: Choi
keywords: Cholecystectomy; Laparoscopy; Operative time; Risk factors; Single incision