Cause Of Conversion Research Articles

A PROSPECTIVE STUDY OF LAPAROSCOPIC CHOLECYSTECTOMY WITH PARTICULAR REFERENCE TO CONVERSION RATE

Background: Laparoscopic Cholecystectomy is established as the primary procedure for the vast majority of patients with benign gall bladder disease .1st laparoscopic cholecystectomy record in medical literature was performed in March 1987 by Phillip Mouret, in France and in 1992 accepted as new gold standard procedure across world despite of few complications.
 Aims and Objectives: To determine the causes of conversion of laparoscopic cholecystectomy to open cholecystectomy.
 Material and methods: From September 2018 to September 2019, total 85 patients were diagnosed as cholelithiasis admitted in respective unit postings of SVBP hospital Meerut and 53 cases selected for study of laparoscopic cholecystectomy. Workup of patients done with proper history, clinical examination, blood investigations and ultrasonography abdomen.
 Observations and Results: We performed laparoscopic cholecystectomy in 53 cases with male: female ratio of 1:4.9.Conversion rate was 7.5% .Most common cause of conversion was frozen calot’s with adhesions ,several other factors aid in conversion like age more than 45 years, male gender and acute phase of cholecystitis.
 Conclusion: In our study, we found that laparoscopic cholecystectomy when performed in properly selected patients is very much effective in treatment of symptomatic gall stone disease in term of less complication, less duration of operation and anaesthesia related complication ,cost effectiveness ,early return on work and daily routine activity .Thus laparoscopic cholecystectomy is gold standard procedure for gall stone disease despite of few complications and unavoidable conversion.
 Keywords: Cccl, BMI

Intraoperative conversion from laparoscopic gastrectomy to an open procedure: a decade of experience in a Japanese high-volume center.

Although laparoscopic gastrectomy (LG) is a widely accepted treatment for gastric cancer, conversion to laparotomy is sometimes required. The current study aimed to review the time trends of intraoperative conversions to open procedures during the decade in which the LG procedure was being developed. Cases in which LG was attempted at the Cancer Institute Hospital from 2005 to 2018 were retrospectively reviewed, and the details regarding conversions to open surgery were examined. Twenty-two (0.63%) of 3,498 patients required conversion to open surgery due to technical difficulties. The major reasons for conversions were difficulties in reconstruction (seven patients; 0.20%) and intraoperative bleeding (six patients; 0.17%). All conversions due to difficulties in reconstruction occurred in the introduction period of LG during the performance of esophagojejunostomy or esophagogastrostomy in laparoscopic total gastrectomy or proximal gastrectomy using a circular stapler. Five (71.4%) of the seven patients in whom conversion was performed due to difficulties in reconstruction developed postoperative severe complications. No conversions due to difficulties in reconstruction have been experienced since 2011, possibly due to the decrease in the number of laparoscopic total gastrectomy procedures and the introduction of the use of a linear stapler in esophagojejunostomy. To manage intraoperative bleeding in LG, hemostatic procedures were systematized and conversions were considered if visualization was not maintained following the procedures. None of the six patients who required laparotomy due to intraoperative bleeding required surgical or radiological intervention postoperatively. Over a decade of experience and procedural changes have markedly decreased the incidence of conversion to open surgery in LG. The main causes of conversion during the early period of LG introduction were difficulties in reconstruction and intraoperative bleeding; the incidences of these complications have been decreased by employing the appropriate procedures for LG.

Abstract No. 441 Eventual outcomes of patients undergoing peritoneal dialysis catheter by interventional radiologist: a large single-institution 2-year observational study

Patients with end-stage renal disease may use peritoneal dialysis (PD) for convenience and flexibility. However, PD catheters may have associated adverse outcomes, including discomfort, inadequate dialysis, malfunction, and infection. Some of them may transition to Hemodialysis or possibly get a kidney transplant during their lifetime. Our study sought to determine the outcomes of patients who had PD catheters placed by Interventional radiologists over a 2-year period. A database was generated of patients who had received PD catheters over a 2-year period. Demographic and pre-PD catheter placement data was collected, including ESRD etiology, preexisting RRT modality, and baseline creatinine. Outcome data was gathered through clinical record review, including infection incidence, time to HD conversion (if applicable), and time to transplant. Patients who had inconsistent records or were lost to follow-up were excluded from analysis. A total of 80 patients who received PD catheters from March 1, 2014, to December 21, 2016, were included in analysis. Approximately 36.3% (29/80) patients had preexisting RRT with HD prior to PD catheter placement. 25% (20/80) patients had at least one episode of PD catheter-associated infection, with peritonitis accounting for 85% (17/20) of infection. All reported cases of infection occurred after 30 days of PD catheter placement, with a median time-to-infection of 11.6 months. Approximately 42.5% (34/80) of PD patients transitioned to HD, with tunneled catheter placement accounting for the most common post-PD RRT modality. Infection and PD failure accounted for the first and second most cited reasons for PD catheter removal at 29.7% and 27.0%, respectively. 25% of patients underwent eventual successful renal transplant. PD catheter related infection, most specifically peritonitis, remains a serious complication of PD, leads to hospitalization, PD catheter removal, or possible conversion to HD. Infection remains the most common cause of PD catheter removal (excluding transplant). All cases of infection occurred 30 days post-PD catheter placement, suggesting that infection is not related to IR procedure but remains an important cause for conversion to HD.

Conversion Rate from Laparoscopic to open Cholecystectomy in AL-kindy Teaching Hospital, Baghdad

Background: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common.
 Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among patient suffering from gall bladder disease, and to explore the most common causes of conversion from laparoscopic to open cholecystectomy.
 Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, history of previous abdominal scar, common bile duct stone, ERCP, duration of symptom was included in our study.
 Results: Seven hundreds twenty –seven patients 74.48% were females and 191 26.52% were males. The mean age of patient presented with gall bladder disease was 40.43 years. Thirty –eight patients were converted to open cholecystectomy. The most common cause of conversation was dense adhesions 42.1% - followed by bleeding 30.1%. Other common causes of conversion were biliary anomalous anatomy 10.5%, common bile injury 5%, visceral injury and technical failure 7%.
 Conclusion: The main perioperative cause for OC was dense adhesion around gall bladder and the male gender, increasing age, history of common bile duct stone removed by previous ERCP, history of previous surgery, are independent risk factors of difficult laparoscopic cholecystectomy.

Risk Factors and Impact of Conversion to Thoracotomy From 20,565 Cases of Thoracoscopic Lung Surgery

Intraoperative conversion to thoracotomy from video-assisted thoracoscopic surgery is a major concern and can be associated with increased adverse outcomes. Therefore, this study was conducted to identify any possible clinical risk factors and related outcomes. This monocentric retrospective study was conducted between January 2016 and December 2018 and included 20,565 consecutive patients who were undergoing thoracoscopic lung operations. Planned thoracotomy, complete pneumonectomies, angioplastic or bronchoplastic or chest wall resections, bilateral lung resections, or cases with missing data were excluded. Univariate and multivariate analyses were performed to identify risk factors for conversion to thoracotomy. A 1:1 propensity score matching analysis was conducted to verify postoperative outcomes. The overall incidence of conversion to thoracotomy was 1.0% (205 of 20,565). The most common cause of conversion was vascular injury, found in 60 patients (29.3%). Multivariable logistic regression analysis identified age older than 60 years, male sex, preoperative chemotherapy, lesion diameter of 1.4 cm or larger, clinical nodal involvement, lymph node calcification, pleural adhesions, type of resection, location of resection, ipsilateral reoperation, and lower surgical experience as independent risk factors of conversion. Among patients who underwent conversion to thoracotomy and who had any complications, the percentages of pulmonary complications, chest tube duration, intensive care unit stay, and hospital length of stay were higher. Within the conversion groups, emergency (37 of 205; 18%) and nonemergency (168 of 205; 82%) conversion groups were similar for overall postoperative complications. The study identified 11 potential risk factors of conversion to thoracotomy, which was associated with increased postoperative complications. The findings may be important for operative planning, preoperative patient counseling and risk adjustment, and eventually reducing conversion rates and related outcomes.

НАШ ОПЫТ 4360 ЛАПАРОСКОПИЧЕСКИХ ХОЛЕЦИСТЭКТОМИЙ ПРИ ЖЁЛЧНОКАМЕННОЙ БОЛЕЗНИ

Objective: Analysis of our own experience in performing laparoscopic cholecystectomy (LCE) for cholelithiasis (CHL). Methods: The study is based on the results of 4360 LCE in patients with cholelithiasis. Among the patients, women predominated – 3732 (85.6%), the average age of patients was 52.0±3.5 years. The structure of nosologies: chronic calculous cholecystitis – 3310 (75.9%), acute calculous cholecystitis – 1050 (24.1%). The operations were performed under general endotracheal anaesthesia with carbon dioxide insufflations; the location of the operating team was of the «American» type. Results: LCE was performed in 96.5% of patients, access conversion to open surgery was required in 3.5% of cases. The most common causes of conversion were the presence of a massive adhesive process (59.6%) and destructive changes in the walls of the gallbladder (9.93%). In the ICU, the operated patients were observed on average for 4±2.5 hours, the postoperative stay of patients in the hospital ward was 1.7±1.2 days. Immediate postoperative complications were noted in 1.63% of cases, mortality was 0.13%. Conclusions: Based on their own experience, the authors agree with the postulate that the LCE is the «gold standard» in gallbladder surgery in patients with gallstone disease. At the same time, purposeful preoperative preparation, careful selection of patients, high qualification of the surgeon, as well as adequate postoperative management of patients are the main factors in achieving good outcome. The complexity of surgical techniques can be reduced by collectively addressing complex situations of general somatic status by the active involvement of associated professionals. Keywords: Gallstone disease, laparoscopic cholecystectomy, conversion, early postoperative complications.

Major Ambulatory Surgery in Breast Diseases

IntroductionThe use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. MethodsA retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The number of patients, exclusion reasons, the type of surgical procedures, the evolution of substitution rate (SI), the rate and the causes of conversion to admission, the post-operatory complications, the motives of not including in the ambulatory program and the satisfaction rate of the patients operated with ambulatory surgery have been studied. This has been compared with a 2013 group. ResultsIn 2017, 396 procedures for BP were performed. 170 operations were carried out for benign and 226 for malignant. The SI for the global mammary pathology is 72.8%. The SI for benign pathology was 93.4%. The SI for malignant pathology was 57.2%, which has increased in the last years from 45.4% in 2013. The index of unexpected admission (TI) of the malignant pathology was 14.1%, while the TI in the benign pathology was 0.6%. Patients hospitalized for malignant pathology presented higher complications (17%) than ambulatory ones (8.5%) and benign (6.5%). ConclusionsAt the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

International expert consensus on the management of bleeding during VATS lung surgery.

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.

Characterization of Patients with Minimally Invasive Surgery Converted in a Pediatric Hospital.

Introduction: Minimally invasive surgery (MIS) in pediatric surgery is now the standard of care for various surgical conditions. We have seen an increase in MIS with some of the procedures requiring intraoperative conversion to open surgery. Materials and Methods: This is a single-institution retrospective study of patients who underwent MIS between 2009 and 2017 requiring conversion to open surgery. Preoperative characteristics, cause of conversion, and postoperative factors were recorded. Results: A total of 154 patients had converted to MIS, 89.6% underwent laparoscopic procedures. Mean age was 8.5 years, 53.9% were male. Primary cause leading to surgery was not oncologic (89.6%), dirty contaminated wound was found in 49.35%, inflammatory response markers were altered, and 38.9% of our patients were American Society of Anesthesiologists physical status classification 3. Principal causes of conversion were failure in progression (53.25%) and loss of anatomic reference (24.5%). A total of 44.16% of the patients required postoperative pediatric intensive care unit admission, 29.2% required reintervention, and mortality rate was 0.65%. We detailed data regarding thoracoscopic, appendectomy, and laparoscopic procedures. Conclusion: Conversion to MIS is a decision the surgeon must make in different scenarios. This study allowed us to characterize our population regarding converted MIS procedures. Male gender, age group, altered inflammatory markers, not oncologic pathology, and dirty wound were frequently found, but we cannot establish any of them as risk factors. Main cause for conversion to open surgery was failure in the progression of the procedure in our study according to reported literature. We intend to develop further studies to determine risk factors.

Feasibility and safety of reduced-port video-assisted thoracoscopic surgery using a needle scope for pulmonary lobectomy- retrospective study.

BackgroundThis study aimed to determine the usefulness and limitations of videoassisted thoracoscopic (VATS) lobectomy using one-window and puncture method (1WPM).MethodsThis study involved 14 patients who underwent lobectomy using the 1WPM at our institute from 2008 to 2017.ResultsThe study patients comprised of 3 men and 11 women with a median age of 10.5 years (range, 0-72 years). There were eight cases in children younger than 18 years old and the youngest patient was 9 days old. The diagnoses were congenital pulmonary cystic disease (n = 7), primary lung cancer (n = 4), metastatic lung tumor (n = 1), and others (n = 2). The 1WPM was successful in 9 of 14 patients (64.3%) and, in 5 cases (35.7%), needed conversion to either two-window method (TWM) using additional port (n = 3) or open thoracotomy (n = 2). The causes for conversion were need for additional bronchoplasty or lymph node dissection (n = 3), failure of one-lung ventilation (n = 1), and presence of a small thoracic cavity that made the procedure extremely difficult (n = 1). In the group that was successfully treated with 1WPM, the median values were as follows: operation time, 193 min (range, 112-480 min); blood loss, 0 ml (range, 0-90 ml); drainage duration, 1 day (range, 1-4 days); and postoperative hospital stay, 7 days (range, 4-13 days).ConclusionsLobectomy by 1WPM can be safely performed and has good postoperative course and this procedure can be applicable and effective in small infants.

Fast-track care with intraoperative blood salvage in laparoscopic splenectomy

Fast-track surgery is claimed to reduce medical morbidity, eliminate the hospitalization needs, and shorten the convalescence period. Intraoperative bleeding as the main complication is also the primary cause of conversion from laparoscopic to open splenectomy. Intraoperative blood salvage can reduce transfusion requirements, decrease the conversion rate to open, and promote fast-tracking in laparoscopic splenectomy (LS). From November 2007 through December 2016 we collected medical data of 115 LS patients. There were three groups: 54 patients receiving routine care (we marks them as Group RT), 33 patients with fast-track care (Group FT), and 28 receiving fast-track care receiving intraoperative splenic blood salvage and autotransfusion (Group FT + ISBS). These medical data are comprised of included three phases (pre-, intra-, and postoperative). There were significant differences (P < 0.05) between RT, FT, and FT + ISBS groups. The hemoglobin level in Group FT + ISBS was significantly higher than in Group RT and Group FT. Comparing the duration of hospital stay of 3 groups, Group RT stayed for a significantly longer time than Group FT and Group FT + ISBS, Group FT + ISBSmuch shorter than Group FT. Comparing the hospitalization expense, GroupFT + ISBS significantly expended less than Group RT and Group FT. Our study shows that laparoscopic splenectomy with fast-track care is feasible, effective, and safe for patients who require splenectomy. Fast-tracking with intraoperative blood salvage improved the fast-track laparoscopic splenectomy procedure.

Is early conversion of laparoscopic to open cholecystectomy helpful in preventing iatrogenic injuries: a retrospective study from a single unit of a tertiary care centre

Background: Gall stone disease is the commonest hepatobiliary problem which is tackled by either laparoscopic or open technique. Since the advent of laparoscopic cholecystectomy by Eric Muhne in 1985, it has become gold standard for gall bladder removal. But a surgeon must be competent enough to convert it into open procedure, provided there are on table complications. Moreover, since laparoscopic surgery has a learning curve, open procedure for any surgery is must for safety of the patient as well as the surgeon.Methods: A retrospective study is done over a period of 4 years (January, 2015 to December, 2018) and data of 469 patients undergoing laparoscopic cholecystectomy in a single unit of Safdarjung Hospital, New Delhi, India has been collected and evaluated for conversion to open procedure on the basis of intraoperative findings. The complications noted and the intraoperative findings and the reasons of conversion to open cholecystectomy have been compared to the previous studies done.Results: Out of total 469 cases, M:F ratio was 1:3.51. Total 40 underwent conversion to open cholecystectomy (8.54%) with M:F ratio of 1:2.07. Most common cause of conversion was dense adhesions in Calot’s triangle along with omentum and bowel. Single patient had agenesis of gall bladder. There was no iatrogenic injury to common bile duct, common hepatic duct and there were no postoperative mortalities.Conclusions: Early conversion to open cholecystectomy is associated with lower intraoperative iatrogenic injuries and hence, lowers postoperative morbidity.

Prevention and treatment of hemorrhagic complications in the laparoscopic radical gastrectomy

Intraoperative hemorrhage is the most common complication of laparoscopic radical gastrectomy, which is also the main cause of conversion to open surgery. With the popularization of laparoscopic surgery technology worldwide, how to complete high-quality surgery and effectively avoid intra-operative or postoperative complications is the goal pursued by all surgeons. Intraoperative hemorrhage in the laparoscopic radical gastrectomy is mainly divided into parenchymal hemorrhage, perigastric vascular injury-induced hemorrhage, lymph node hemorrhage and anastomotic bleeding. Compression, electrocoagulation, vascular clipping and vascular suture repair are the most common treatments for intraoperative hemorrhage. It is necessary to use above methods in clinical work. Proficiency in laparoscopic operation skills, familiarity with perigastric vascular anatomy and variation, and improved teamwork to reduce complications are the key to laparoscopic surgery for gastric cancer. Combined with literature reports, the authors summarize experience in laparoscopic surgery for gastric cancer, discuss the prevention and treatment of hemorrhagic complica-tions during laparoscopic radical gastrectomy. Key words: Gastric neoplasms; Gastric cancer; Hemorrhage; Complication; Laparoscopy

Management of intraoperative bleeding in the video-assisted thoracoscopic surgeries

Minimally invasive approach using video-assisted thoracoscopic (VATS) to lung and esophageal cancer resection offers enormous benefits over open surgery. Yet, the intraoperative bleeding is still a primary cause of conversion to open surgery as well as a major risk for VATS surgery. We present two cases of intraoperative bleeding during thoracoscopic lobectomy and esophagectomy. Ethical approval was obtained from the institutional ethics board. Thoracoscopic management of intraoperative bleeding was demonstrated in different operations. Calm maintenance of a clear thoracoscopic view and prompt establishment of bleeding control, may allow for suture repair of injured vessels. Despite intraoperative bleeding remains the most challenging risk factor, proper management renders minimal invasive approach safe and effective for vasculature repair.

Incidence of conversion from laparoscopic to open cholecystectomy and its associated factors

Background: Laparoscopic cholecystectomy has replaced open cholecystectomy as standard procedure for the treatment of Symptomatic cholelithiasis. Nonetheless, conversion from laparoscopic cholecystectomy to open one is still required in many circumstances. The aim of this study was to determine the main causes of conversion to open in laparoscopic cholecystectomy.Methods: From 1st of January 2010 until the 1st of January 2011 one hundred and fifty patients who had laparoscopic cholecystectomy were prospectively followed at the time of surgery by obtaining a data for the patient’s age, sex, time from the introduction of laparoscopic ports till decision of conversion and the cause of conversion if present.Results: Put of the 150 laparoscopic cholecystectomy 9 conversions occurred (the percentage of conversion was 6%). The most common causes were: vascular injuries: 2 patients, empyema of the gall bladder: 2 patients, severe obesity: 1 patient, abnormal position of gall bladder: 1 patient, and dense adhesions and disturbed anatomy: 3 patients. Three patients of conversions are males from 25 male patients underwent laparoscopic cholecystectomy, 6 cases are females from 125 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 12% while for female patients is 4.8%.Conclusions: The overall conversion rate in this study was 6% and the most common cause for conversion is dense adhesions, followed by empyema of GB. and severe bleeding that need conversion, and the rate for conversion was higher in male patients.

Comparison of Outcome Between Low Pressure and Standard Pressure Pneumoperitoneum in Laparoscopic Living Donor Nephrectomy

Nowadays, kidney transplantation is done through laparoscopic living donor nephrectomy performed by insufflating CO2 gas into intraperitoneum space using standard pressure (12–15 mmHg). However, it is also hypothesized that with lower pressure (8–10 mmHg) could be used for laparoscopic living donor nephrectomy related with lower postoperative pain and side effects. This was a prospective comparative study done in Department of Urology, Cipto Mangunkusumo General Hospital from November 2015 to August 2016. All subjects underwent laparoscopic living donor nephrectomy (LLDN). In this period, the subjects received a low pressure pneumoperitoneum procedure. This group was later compared randomly to a standard pressure pneumoperitoneum procedure group who underwent previous LLDN procedure. Out of 85, subjects underwent LLDN with low and standard pressure were 41 and 44, respectively. Despite nonsignificant difference of post op pain and duration of operation, the side effect in low pressure was lower than standard (p = 0.033 for epigastric pain, p = 0.024 for nausea, and p = 0.018 for vomiting). However, 22% subjects with low pressure need to be converted to standard pressure. Based on stratified analysis, the cause of conversion was higher BMI (p &lt; 0.001). In conclusion, LLDN using low pressure pneumoperitoneum is proven to be as effective as LLDN using standard pressure pneumoperitoneum in providing good intraoperative and postoperative outcomes. Thus, this study suggests the use of low pressure pneumoperitoneum as an alternative procedure in LLDN surgeries. Further studies, however, are needed to assess the adverse outcomes of LLDN procedure using low pressure, as well as to assess the risk of conversion to standard pressure, i.e., BMI.

Determinants of conversion during laparoscopic cholecystectomy among a sample of Iraqi patients

Background: Laparoscopic cholecystectomy has become a standard technique for gall bladder surgery of symptomatic cholelithiasis. However, conversion to open cholecystectomy is sometimes necessary. The aim of the present study was to assess the predictive factors that increase the possibility of conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: A total of 621 laparoscopic cholecystectomies were attempted at AL-Mawanee General Hospital and AL-Sader Teaching Hospital in Basrah, IRAQ from June 2012 till June 2016.Of these,43 had to be converted to open cholecystectomies. Patients assessed according to different factors, including age, sex, acute cholecystitis, adhesions of gallbladder and calot's triangle, obesity, previous abdominal surgery, anatomical variation of gallbladder and Calot's triangle and intraoperative complications (bleeding, bile duct injury, visceral injury).Results: Conversion to open cholecystectomy was performed in 43 patients (6.92%). The significant factors for conversions were adhesions of gallbladder and Calot's triangle(39.53%) followed by acute cholecystitis(34.88%). Rate of conversion in other factors are as the following i.e., isolated male gender (0%), age (0%), previous abdominal surgery (9.3%), obesity (2.33%), anatomical variations of gall bladder and calot's triangle (2.33%), intra operative complications including bleeding (4.65%), bile duct injury (4.65%), visceral injury (2.33%) were insignificant factors for conversion.Conclusions: Adhesions of gallbladder and calot's triangle is the most common predictive factor and cause for conversion from laparoscopic cholecystectomy to open cholecystectomy. Acute cholecystitis found to be the strongest factor for conversion despite its incidence is lower than adhesions of gall bladder and calots triangle. Male gender and age more than fifty years are not direct predictive factors for conversions.

Postoperative pulmonary complications and hospital stay after lung resection surgery: A meta-analysis comparing nonintubated and intubated anesthesia.

Since postoperative pulmonary complications are one of the main causes of morbidity and mortality in patients undergoing lung resection surgery, we performed a meta-analysis to compare the incidence of postoperative pulmonary complications and hospital death, and the length of hospital stay in patients who received nonintubated or intubated anesthesia during thoracoscopic surgery for lung resection and further explore the tricks in nonintubated anesthesia. PubMed, Embase, and Cochrane Library were searched from inception to September 2017. We included eligible research comparing nonintubated anesthesia with intubated anesthesia in thoracoscopic surgery for lung resection. The primary outcomes involved postoperative pulmonary complications, hospital death, and hospital stay. The rates and causes of conversion from nonintubated anesthesia to intubated anesthesia were also analyzed. After screening through 754 potentially relevant articles, we included 3 randomized controlled trials and 7 observational studies with 1138 patients. There was no perioperative mortality in 2 groups. The nonintubated group revealed comparable postoperative pulmonary complications (OR = 0.57; P = .07; P for heterogeneity = .49, I = 0%) and shorter hospital stay (WMD = -1.10; P < .00001; P for heterogeneity = .84, I = 0%) in overall findings with little heterogeneity. Nonintubated anesthesia in thoracoscopic surgery for lung resection shortened the length of hospital stay compared with intubated anesthesia. However, the incidence of postoperative pulmonary complications was comparable between nonintubated and intubated group. Given the potential perioperative emergencies, such as persistent hypoxemia, carbon dioxide retention, or extensive pleural adhesions, nonintubated anesthesia in lung resection surgery requires extra vigilance to ensure the safety of the patients and the success of the surgery. Powerful randomized controlled trials in the future are essential to provide more certainty and address long-term effectiveness. Only when anesthesiologists and surgeons make efforts together can better clinical outcomes in lung resection surgery be achieved.

Causes and incidence of laparoscopic cholecystectomy conversion to open cholecystectomy in Al Karama teaching hospital

Background: There is no doubt that laparoscopic cholecystectomy replaced open cholecystectomy as standard procedure for the treatment of symptomatic cholelithiasis. Conversion from laparoscopic cholecystectomy to open cholecystectomy is still required in many circumstance, this study aimed at exploring causes and incidence of conversion. Methods: This is a prospective study of 200 cases of laparoscopic cholecystectomy cases were performed in ALKARAMA Teaching Hospital from January2009 to January 2011. All cases were followed at the time of surgery by obtaining data sheet for the patient’s age, sex, time from the introduction of ports till decision of conversion and the cause of conversion if present.Results: Out of 200 laparoscopic cholecystectomy, 12 cases were converted into open cholecystectomy (6%). The major causes were : dense adhesions (4), bleeding (2), anatomical difficulties (2), impacted stone in Hartmann pauch (2), dilated cystic duct (1) and sever inflammation (1). Two of the conversions are males from 45 male patients underwent laparoscopic cholecystectomy, 10 cases are females from 155 female patients underwent laparoscopic cholecystectomy so the percentage of conversion for male patients is 4.44 % while for female patients is 6.45%.Conclusions: The conversion rate in this study is 6% and the most common cause for conversion is dense adhesions in the Calot’s triangle, no biliary duct injury that need conversion is found in this study and the rate for conversion is higher in female patients.

PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2018PD16-09 PARTIAL NEPHRECTOMY CONVERTING TO RADICAL NEPHRECTOMY: IMPACT OF PATIENT AND SURGICAL FACTORS Akbar Ashrafi, Peter Mekhail, Ricardo Brandina, Grant Redrow, Mihir Desai, Inderbir Gill, and Monish Aron Akbar AshrafiAkbar Ashrafi More articles by this author , Peter MekhailPeter Mekhail More articles by this author , Ricardo BrandinaRicardo Brandina More articles by this author , Grant RedrowGrant Redrow More articles by this author , Mihir DesaiMihir Desai More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Monish AronMonish Aron More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.821AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative conversion of partial nephrectomy to radical nephrectomy may be related to tumor complexity, patient or surgical factors. The aim of this study was to describe the causes for conversion and assess for patient and surgical predictors of conversion in patients undergoing partial nephrectomy at a high-volume academic center. METHODS We identified all patients who were scheduled to have robotic, laparoscopic or open partial nephrectomy at our institution between January 2011 and December 2014. The intraoperative reason for conversion to radical nephrectomy was collated from retrospective review of operative notes. Several variables were analyzed including, age, gender, Charlson co-morbidity score, ASA score, tumor size, procedure type, renal function and complication data. Multivariable logistic regression was used to identify independent predictors for conversion. RESULTS A total of 878 patients were scheduled for partial nephrectomy (PN). The rate of conversion to radical nephrectomy (RN) was 3.6% (n=32). The most common reasons for conversion were invasion of hilar structures in 12 patients (38%), insufficient residual kidney in 11 (35%), excessive intraoperative bleeding in 4 (13%), suspected positive margin in 2 patients (13%) and anesthesiology-related in 1 patient. Patients that were converted had similar preoperative eGFR (73 vs 79 mL/minute/1.73 m2, p=0.2), rates of diabetes (34% vs 23%, p=0.1), mean Charlson co-morbidity score (1.1 vs 1.5, p=0.2) and mean ASA score (2.3 vs 2.5, p=0.3). Patients that had conversion to RN were more likely to be older (mean age 67 vs 61, p=0.02), have hypertension (81% vs 62%, p=0.03) and have larger tumors (mean size 5.2 vs 3.2cm, p<0.01). In the robot-assisted PN group, 10 of 628 cases were converted (1.6%) compared to 4 of 45 cases in open PN (8.2%) and 18 of 173 in the laparoscopic PN group (9.4%, p<0.01). On multivariable logistic regression, tumor size (OR 1.2), hypertension (OR 2.8) and robotic surgery (OR 0.14) were independent predictors of conversion. There were no differences in the complication (3% vs 12%, p=0.2) or malignancy rate (81% vs 78%, p=0.7) though postoperative eGFR was significantly lower in patients that had conversion compared to the PN group (40 vs 65 mL/minute/1.73 m2, p<0.01). CONCLUSIONS Intraoperative conversion of partial nephrectomy to radical nephrectomy was most commonly due to invasion of hilar structures or insufficient residual kidney in this series. Conversion was associated with hypertension and larger tumor size, and increased the risk of chronic kidney disease postoperatively. Robot-assisted partial nephrectomy reduced the risk of conversion compared to the open or laparoscopic approach. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e319-e320 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Akbar Ashrafi More articles by this author Peter Mekhail More articles by this author Ricardo Brandina More articles by this author Grant Redrow More articles by this author Mihir Desai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...