Conversions in laparoscopic renal surgery: causes and outcomes.
Objective: We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes.
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 1500 g 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.