A risk score for conversion from laparoscopic to open cholecystectomy

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

“…Early scores have been derived from small, retrospective series using subjective variables and included data from the learning curve of the laparoscopic era. 7,[20][21][22] Recently, Goonawardena et al developed a predictive nomogram from a retrospective series of 732 patients. 1 Similar variables were found to be significant predictors of conversion in this and the present report.…”

“…[1][2][3][4] Common indications for conversion include failure to demonstrate the 'critical view of safety' , 1,2,5,6 or the presence of an intraoperative complication, such as intestinal perforation, haemorrhage or bile duct injury. Several factors increase the risk of conversion to open, including age, 4 male sex, 3,7 obesity, 1,2 cholecystitis 2,3,7 and previous ERCP. 8 Conversion to open surgery usually indicates a difficult procedure, and rather than being considered a complication, the decision to convert should be regarded as a sign of good judgement in the presence of adverse conditions.…”

“…Low risk patients could be identified and appropriately scheduled in an ambulatory care facility, and selected as training cases for surgical trainees, 9 whilst high risk patients should be appropriately counselled and operated by experienced surgeons. The majority of studies that have evaluated risk factors for conversion to open cholecystectomy are small retrospective series or population-based databases [1][2][3][4]6,7,[10][11][12][13][14] (Table 1). Several studies have developed risk scores, but their clinical utility is limited by retrospective data, small sample sizes and/or lack of validation.…”

Role of scoring system in prediction of difficult laparoscopic cholecystectomy

“…In a study by Kama et al, there were six parameters that were considered as risk factors. 8 Those were male gender, tenderness in upper abdomen, more than 60 years and preoperative diagnosis of acute cholecystitis have been found to be significantly associated with the risk of open cholecystectomy. Initially the scoring system developed for laparoscopic cholecystectomy was based on the previously recorded video procedures.…”

An opportunity in difficulty: Japan-Korea-Taiwan expert Delphi consensus on surgical difficulty during laparoscopic cholecystectomy

“…Evidence for factors that might contribute to surgical difficulty during LC are ambiguous despite several existing studies (preoperative radiological findings [4][5][6], the optimal timing for LC [3,7], indications of preoperative interventions such as percutaneous transhepatic gallbladder drainage [8,9], etc). Most of the previous publications have adopted either the duration of surgery [4][5][6] or open conversion rate [10][11][12][13][14] as surrogate markers for surgical difficulty. However, these factors are strongly affected by the skill of each surgeon and center's policy.…”