Imaging

Abstract

Clinicopathological features between patients requiring conversion and those who did not were compared. (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 abreaching 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. Editorial Comment Conversion of laparoscopic to open surgery is not a complication in my view. the patient. This large series of laparoscopic cases demonstrate that the vascular injuries are responsible for the majority of the conversions. The longer the clinical experience the rate of conversion tends to decrease even in being of the patient encouraging novice surgeons to perform it when suited.