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Conversion During Laparoscopic Surgery: Frequency, Indications and Risk Factors

2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2008.05.026

1527-3792

Lee Richstone, Casey A. Seideman, Lauren Baldinger, Sompol Permpongkosol, Thomas W. Jarrett, Li-Ming Su, Christian P. Pavlovich, Louis R. Kavoussi,

Hernia repair and management

No AccessJournal of UrologyAdult Urology1 Sep 2008Conversion During Laparoscopic Surgery: Frequency, Indications and Risk Factors Lee Richstone, Casey Seideman, Lauren Baldinger, Sompol Permpongkosol, Thomas W. Jarrett, Li-Ming Su, Christian Pavlovich, and Louis R. Kavoussi Lee RichstoneLee Richstone North Shore-Long Island Jewish Health System, New Hyde Park, New York , Casey SeidemanCasey Seideman North Shore-Long Island Jewish Health System, New Hyde Park, New York , Lauren BaldingerLauren Baldinger North Shore-Long Island Jewish Health System, New Hyde Park, New York , Sompol PermpongkosolSompol Permpongkosol Department of Urology, Ramathibodi Hospital, Bangkok, Thailand , Thomas W. JarrettThomas W. Jarrett George Washington University Hospital, Washington, D. C. , Li-Ming SuLi-Ming Su The Brady Urological Institute, Baltimore, Maryland , Christian PavlovichChristian Pavlovich The Brady Urological Institute, Baltimore, Maryland , and Louis R. KavoussiLouis R. Kavoussi North Shore-Long Island Jewish Health System, New Hyde Park, New York View All Author Informationhttps://doi.org/10.1016/j.juro.2008.05.026AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There are limited data on the indications for open conversion during laparoscopic surgery. The frequency of conversion for various procedures is poorly quantified and the degree to which this changes with time is not well understood. Risk factors for conversion are not defined. We addressed these issues in a large series of laparoscopic operations. Materials and Methods: We reviewed our database of 2,128 laparoscopic operations performed between 1993 and 2005, including radical nephrectomy in 549 patients, simple nephrectomy in 186, partial nephrectomy in 347, donor nephrectomy in 553, pyeloplasty in 301, nephroureterectomy in 106 and retroperitoneal lymph node dissection in 86. Open conversions were identified and the frequency of conversion for the total cohort and specific procedures was determined. Trends in conversion with time were assessed and indications analyzed. Clinicopathological features between patients requiring conversion and those who did not were compared. Results: We identified 68 patients (3.3%) who underwent conversion to open surgery (group 1) and 2,011 (96.7%) who did not (group 2). The frequency of conversion was greatest during nephroureterectomy (8.49%), followed by simple nephrectomy (5.91%), retroperitoneal lymph node dissection (4.65%), partial nephrectomy (4.32%), radical nephrectomy (2.91%), donor nephrectomy (2.53%) and pyeloplasty (0.33%). The absolute number of conversions and conversions/cases performed per year decreased significantly with time, reaching a nadir of less than 1% per year. Conversion was inversely related to case volume and cumulative experience. Indications included vascular injury in 38.5% of cases, concern with margins in 13.5%, bowel injury in 13.5%, failure to progress in 11.5%, adhesions in 9.6%, diaphragmatic injury in 1.9% and other in 11.5%. The distribution of indications remained similar with time. There were no differences in patient age, gender, surgical history, American Society of Anesthesiologists score or tumor stage between groups 1 and 2. In groups 1 and 2 mean operative time was 304 vs 219 minutes and estimated blood loss was 904 vs 255 cc (each p <0.0001). Conclusions: The rate of conversion during laparoscopic surgery is not uniform across procedures and it is important for patient counseling. The most common indication for conversion is vascular injury. Importantly the frequency of conversion is dynamic and likely related to case volume and cumulative experience. References 1 : Complications of laparoscopic nephrectomy: the Mayo Clinic experience. J Urol2004; 171: 1447. 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Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byAutorino R, Kaouk J, Yakoubi R, Rha K, Stein R, White W, Stolzenburg J, Cindolo L, Liatsikos E, Rais-Bahrami S, Volpe A, Han D, Derweesh I, Lee S, Abdel-Karim A, Branco A, Greco F, Allaf M, Sotelo R, Kallidonis P, Jeong B, Best S, Bazzi W, Pierorazio P, Elsalmy S, Rane A, Han W, Yang B, Schips L, Molina W, Fornara P, Terrone C, Giedelman C, Lee J, Crouzet S, Haber G, Richstone L, Yinghao S, Kim F and Cadeddu J (2012) Urological Laparoendoscopic Single Site Surgery: Multi-Institutional Analysis of Risk Factors for Conversion and Postoperative ComplicationsJournal of Urology, VOL. 187, NO. 6, (1989-1994), Online publication date: 1-Jun-2012.Rowley M and Wolf J (2011) Risk Factors for Conversion to Hand Assisted Laparoscopy or Open Surgery During Laparoscopic Renal SurgeryJournal of Urology, VOL. 185, NO. 3, (940-944), Online publication date: 1-Mar-2011. Volume 180Issue 3September 2008Page: 855-859 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordskidneynephrectomylaparoscopylaparotomyintraoperative complicationsMetrics Author Information Lee Richstone North Shore-Long Island Jewish Health System, New Hyde Park, New York More articles by this author Casey Seideman North Shore-Long Island Jewish Health System, New Hyde Park, New York More articles by this author Lauren Baldinger North Shore-Long Island Jewish Health System, New Hyde Park, New York More articles by this author Sompol Permpongkosol Department of Urology, Ramathibodi Hospital, Bangkok, Thailand More articles by this author Thomas W. Jarrett George Washington University Hospital, Washington, D. C. More articles by this author Li-Ming Su The Brady Urological Institute, Baltimore, Maryland More articles by this author Christian Pavlovich The Brady Urological Institute, Baltimore, Maryland More articles by this author Louis R. Kavoussi North Shore-Long Island Jewish Health System, New Hyde Park, New York More articles by this author Expand All Advertisement PDF downloadLoading ...