Laparoscopic cholecystectomy: what are the factors determining difficulty?

The experience in laparoscopic cholecystectomy is increasing, more difficult cases are performed even by the junior surgeons. This policy has led the investigators to look for methods to identify potentially difficult laparoscopic cholecystectomy.

A prospective study was performed to find out the factors that determine technical difficulty in laparoscopic cholecystectomy. Two hundred and twenty-seven patients (170 females and 57 males) with symptomatic gallbladder stones were recruited for this study from June 1995 to September 1997. The overall difficulty score as a dependent variable was based on the following operative parameters: duration of surgery, bleeding, dissection of gallbladder wall, adhesions, spillage of bile, spillage of stones and difficulty of gallbladder extraction. Multiple regression analysis was used to assess the significance of the following potential difficulty variables (Independent) in predicting the variation in the overall difficulty score: age, sex, body mass index, gallbladder size, common bile duct diameter, gallbladder wall thickness, liver size and the presence of adhesions.

Gallbladder wall thickness, presence of adhesions, liver size and gallbladder size were found to be significant predictors of the variation in overall difficulty score (Adjusted R2 = 0.48).

We believe that the above-mentioned four difficulty factors are important, however, experience of the surgeon plays a major role in reducing difficult laparoscopic cholecystectomy and consequently decreasing it's complications.