Elective laparoscopic cholecystectomy for surgical trainees: Predictive factors of operative time

Aim: To determine pre-operative criteria to predict duration and technical difficulty of laparoscopic cholecystectomies that will aid in identifying patients suitable for training lists. Method: A prospective analysis of 835 consecutive patients who underwent laparoscopic cholecystectomies. Data collected included patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (ES), duration of surgery (from skin incision to skin closure), peri-operative and postoperative complications and histological gallbladder wall thickness. Results: Post-operative complications were seen in 3% (n=20). Overall open conversion rate was 2%. The mean duration of surgery was 78.76 ± 1.75 minutes. Age, ERCP and ES were not independent predictors of a long operation time. However, a positive correlation was seen with histological gallbladder wall thickness and duration of surgery (p=0.001). The mean operating time for gallbladder wall thickness < 3mm was 72.1 ±1.62 minutes whereas that for > 3mm thickness was 83.3 ± 2.05 minutes (p=<0.001). Conclusion: Gallbladder wall thickness can be used as an independent predictor of a long operation time.