Analysis Of Influencing Factors Of Prolonged Operation Time Of Single Incision Laparoscopic Cholecystectomy

Objective:Along with the development of surgical minimally invasive concept and technology,the gallbladder underwent laparotomy surgery way to the evolution of laparoscopic,in recent years by the umbilical single incision laparoscopic cholecystectomy in can be done smoothly on the basis of the gallbladder excision with small trauma,rapid recovery and the advantages of the cosmetic effect is good by hospitals to carry out,for the treatment of benign gallbladder diseases operation method provides a new choice,However,the operation of single incision laparoscopic cholecystectomy is more difficult and the average operation time is longer than that of standard laparoscopic cholecystectomy due to the technical difficulties such as small operation space,mutual interference of instruments,"chopsticks effect" and the need for good cooperation between assistants and surgeons.Studies have found that prolonged laparoscopic surgery will lead to an increase in the incidence of complications,so it is of great significance to clarify the related influencing factors of prolonged single incision laparoscopic cholecystectomy to improve surgical safety.The purpose of this study was to analyze the influencing factors of prolonged operative time of single incision laparoscopic cholecystectomy and the relationship between prolonged operative time and complications,and to explore how to improve surgical safety by controlling the influencing factors during perioperative period,in order to provide guidance for clinical work.Methods:The clinical data of 556 patients with single incision laparoscopic cholecystectomy performed by the same group of surgeons in the department of hepatobiliary and pancreatic surgery,the first hospital of shanxi medical university from April 2018 to June 2021 were retrospectively analyzed.Based on the upper quartile of operation time distribution,about 80min,they were divided into the extended operation time group(n=139)and the non-extended operation time group(n=417).The clinical data of the two groups were statistically analyzed,including gender,age,Body Mass Index(BMI),diabetes,hypertension,gallbladder wall thickness,presence or absence of gallstones and neck incarceration,previous upper abdominal surgery,gallbladder atrophy,acute cholecystitis,white blood cell level and complications.Results:The 556 patients included in this study successfully completed single incision laparoscopic cholecystectomy,with the operation time ranging from 26 to 175min,(62±22)min on average.There were statistically significant differences between the extended group of operation time and the unextended group in BMI,upper abdominal surgery history,acute inflammatory stage,gallbladder wall thickness over 3mm,gallbladder atrophy and complications(P<0.05).Multivariate Logistic regression analysis showed that BMI(P<0.05,OR=1.729),upper abdominal surgery history(P<0.05,OR=6.201),gallbladder wall thickness over 3mm(P<0.05,OR=5.142),acute inflammation stage(P<0.05,OR=6.033),gallbladder atrophy(P<0.05,OR=2.417)were independent risk factors for prolonged operative time for single incision laparoscopic cholecystectomy.Conclusion:The main factors leading to the prolonged operation time of single incision laparoscopic cholecystectomy were BMI,upper abdominal operation history,acute inflammatory stage of gallbladder,gallbladder wall thickness over 3mm,atrophic cholecystitis.Preoperative evaluation of the above factors can help clinicians predict the difficulty of surgery.Calm analysis,careful identification and standard treatment during operation can improve surgical safety and reduce the occurrence of surgical complications.Single incision laparoscopic cholecystectomy has outstanding cosmetic effect and wide application population,which is worthy of popularization and application in clinical work.