Conversions in laparoscopic renal surgery: Causes and outcomes

Bert S. Ivey, Steven M. Lucas, Carl A. Meyer, Tyler E. Emley, Aaron Bey, Thomas Gardner, Chandru Sundaram

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes. Patients and Methods: A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications. Results: 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05). Conclusions: Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.

Original languageEnglish
Pages (from-to)1167-1173
Number of pages7
JournalJournal of Endourology
Volume25
Issue number7
DOIs
StatePublished - Jul 1 2011

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Laparoscopy
Kidney
Hand
Conversion to Open Surgery
Autosomal Dominant Polycystic Kidney
Intraoperative Complications
Operative Time
Nephrectomy
Length of Stay
Anatomy
Thrombosis
Tissue Donors
Hemorrhage
Morbidity
Neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Conversions in laparoscopic renal surgery : Causes and outcomes. / Ivey, Bert S.; Lucas, Steven M.; Meyer, Carl A.; Emley, Tyler E.; Bey, Aaron; Gardner, Thomas; Sundaram, Chandru.

In: Journal of Endourology, Vol. 25, No. 7, 01.07.2011, p. 1167-1173.

Research output: Contribution to journalArticle

Ivey, Bert S. ; Lucas, Steven M. ; Meyer, Carl A. ; Emley, Tyler E. ; Bey, Aaron ; Gardner, Thomas ; Sundaram, Chandru. / Conversions in laparoscopic renal surgery : Causes and outcomes. In: Journal of Endourology. 2011 ; Vol. 25, No. 7. pp. 1167-1173.
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abstract = "Purpose: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes. Patients and Methods: A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications. Results: 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0{\%} and 12.2{\%}, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1{\%}, 6.9{\%}, 13.2{\%}, and 1.8{\%}, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13{\%}), while nephroureterectomy had the highest rate of complications (40{\%}). Cases in which there were large specimens weighing over 1500g were converted in 40{\%} of cases vs 8.2{\%} for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9{\%} without vs 9.3{\%} with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05). Conclusions: Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.",
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N2 - Purpose: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes. Patients and Methods: A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications. Results: 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05). Conclusions: Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.

AB - Purpose: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes. Patients and Methods: A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications. Results: 399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05). Conclusions: Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.

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