Common Reasons For Conversion Research Articles

Surgical Technique for Performing Endoscopic Carpal Tunnel Release without Converting to an Open Technique, and Analysis of the Reasons for Conversion

IntroductionEndoscopic carpal tunnel release (ECTR) has advantages over open carpal tunnel release (OCTR); however, complications with ECTR are more likely to occur if the surgeon continues the procedure despite encountering difficulties. Techniques to minimize the need for conversion to OCTR have been infrequently discussed in the literature. This study aims to present a technique for performing ECTR without conversion to the open approach and to analyze the reasons for such conversions. MethodsA total of 1,160 hands in 771 patients who underwent single-portal ECTR between January 2001 and December 2020 were analyzed. We evaluated the rate and reasons for conversion and compared clinical severity and electrodiagnostic grades between the ECTR and OCTR conversion groups to identify patient characteristics associated with conversion. ResultsA total of 18 hands in 17 patients required conversion to OCTR (1.56%). In the first 5 years, 9 out of 251 ECTRs (3.59%) were converted, but since then, the conversion rate significantly decreased with increasing surgical experience. The most common reasons for conversion were poor visualization of the transverse carpal ligament (TCL) due to the transbursal approach with a hypertrophic synovial membrane. As the preoperative clinical grade worsened, the conversion rate significantly increased. The OCTR conversion rate also tended to rise with more severe electrodiagnostic grades. Outcomes for all 18 wrists were successful at the 6-month follow-up. ConclusionA thorough subligamentous extrabursal approach is essential for achieving a clear endoscopic view of the TCL and performing ECTR without the need for conversion to open surgery.

Reasons for laparosopic cholecystectomy conversion in a small general hospital

Background: Laparoscopic cholecystectomy is one of the most common procedures in abdominal surgery. This procedure is the gold standard for the treatment of symptomatic cholelithiasis and acute cholecystitis. However, thedifficulty and possibility of safely performing laparoscopic cholecystectomy vary considerably due to the variety of local findings and the course of the procedure. If it is not possible to complete the procedure safely by laparoscopy, due to intraoperative complications or to avoid the occurrence of complications, it is necessary to convert laparoscopic cholecystectomy to open cholecystectomy.Methods: We performed retrospective research on cases of cholecystectomy performed on all patients at the Dr. Mustafa Beganović General Hospital in Gračanica from 2014 to 2020, which were started by laparoscopy and finished using laparoscopy or converted to open cholecystectomy. Results: There were 888 cases that started as laparoscopic cholecystectomy. In 43, or 5.39% of cases laparoscopic cholecystectomy was converted to open cholecystectomy. The most common reasons for conversion from LC to OC were adhesions, the inability to identify anatomical structures, and inflammation.Conclusion: The number of conversions in our sample is in accordance with the data from the relevant research and at the same time the incidence of bile duct injuries is very low.

Did conversion to thoracotomy during thoracoscopic lobectomy increase post-operative complications and prejudice survival? Results of best evidence topic analysis.

The potential complications related to unplanned conversion to thoracotomy remains a major concern in thoracoscopic lobectomy and may limit the wide adoption of this strategy. We reviewed the literature from 1990 until February 2022, analyzing all papers comparing successful thoracoscopic lobectomy versus converted thoracoscopic lobectomy and/or upfront thoracotomy lobectomy to establish whether unplanned conversion negatively affected outcomes. Thirteen studies provided the most applicable evidence to evaluate this issue. Conversion to thoracotomy was reported to occur in up to 23% of cases (range, 5%–16%). Vascular injury, calcified lymph nodes, and dense adhesions were the most common reasons for conversion. Converted thoracoscopic lobectomy compared to successful thoracoscopic lobectomy was associated with longer operative time and hospital stay in all studies, with higher postoperative complication rates in seven studies, and with higher perioperative mortality rates in four studies. No significant differences were found between converted thoracoscopic lobectomy and upfront thoracotomy lobectomy. Five studies evaluated long‐term survival, and in all papers conversion did not prejudice survival. Surgeons should not fear unplanned conversion during thoracoscopic lobectomy, but to avoid unexpected conversion that may negatively impact surgical outcome, a careful selection of patients is recommended–especially for frail patients.

Day Surgery Conversion: Rate and Possible Causes in King Fahad Specialist Hospital, Buraydah, Saudi Arabia.

IntroductionDay surgery is defined as the admission of a patient and discharge after the surgical procedure within the same day. It is becoming increasingly popular as it provides multiple advantages for the health care system and patients, including better resource utilization in the form of decreasing the cost, increasing the number of patients served, a reduction in the waiting list length, and preservation of hospital beds for complex advanced cases. Internationally, patients' admission rate after a planned day surgery was found at 1.5%. Etiologies for day surgery conversion vary among studies, 75% of which were labeled as potentially preventable. As patients are admitted, the benefits of day surgery decrease.AimThis study aimed to measure the unanticipated admission rate of day surgery while evaluating the reasons for admission in King Fahad Specialist Hospital, Buraydah, Qassim, Saudi Arabia.Materials and methodsThis is a retrospective review study in which all medical records of patients admitted and operated as day surgery from January 1, 2015 to February 28, 2021 in King Fahad Specialist Hospital in Buraydah, Qassim region in Saudi Arabia were evaluated. Variables collected included baseline characteristics such as age, gender, body mass index (BMI), chronic diseases, surgical history, operation name, complications, and causes of conversion.ResultsA total of 6,771 day surgery cases were found from January 1, 2015 to February 28, 2021. Of them, 231 cases were converted to inpatient admission, and the prevalence of conversion was 3.4%. The most common cause of conversion was pain (35.1%) followed by postoperative care (16%), need of antibiotics (12.1%), and bleeding (8.2%); most of these cases were associated with laparoscopic cholecystectomy. Furthermore, laparoscopic cholecystectomy (36.4%), hernia repair (12.1%), and pilonidal sinus excision were the most frequent surgical intervention.ConclusionThe day surgery conversion rate was minimal in this study (3.4%). Pain, postoperative care, and the need for antibiotics were the most common reasons for conversion. Continuous monitoring of day surgery conversion rate and causes will all help the institution to gain the maximum benefits of day surgeries.

Long-term oncologic outcome and risk factors after conversion in laparoscopic surgery for colon cancer.

The goal of this study was to evaluate the long-term oncologic outcomes after laparoscopic converted surgery for patients with colon cancer. Retrospective database of consecutive curative-intent laparoscopic-assisted surgery for primary stage I-III colon cancer was reviewed from 2000 to 2013. The patients were divided into non-conversion and conversion groups. The patient characters, operative features, perioperative parameters, pathologic features, and oncologic outcomes were compared. A total of 4010 patients were included in the study: 3929 in the non-conversion group and 81 (2%) in the conversion group. The median follow-up period was 63.9months. There were significant differences in age, preoperative clinical T-stage, and tumor size between the groups. In operative details between the two groups, there were also significant differences in access to surgery, tumor location, cancer obstruction, cancer perforation, and estimated blood loss (P < 0.001). The two most common reasons for conversion were adhesion (n = 37, 46%) and bleeding (n = 21, 26%). Multivariate analysis showed that conversion was an independent predictor of both overall survival (OS) (P < 0.001) and disease-free survival (P=0.003). The 5-year OS rate of the conversion group was 79.6%, and that of the non-conversion group was 96.2% (P < 0.001). The multivariate predictors of conversion were age, type of surgery, cancer obstruction, cancer perforation, and clinical T-stage. Conversion to open surgery may affect patient survival and recurrence after laparoscopic-assisted surgery for colon cancer. Our data suggest that conversion is associated with poor outcomes, but we should not hesitate to convert it to patients who have difficulty in laparoscopic surgery.

Rate and Risk Factors for Conversion and Complications of Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy has become the gold standard for the surgical treatment of gall bladder disease, but conversion to open cholecystectomy and both operative and post operative complications are still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion and complications could help surgeons during preoperative assessment and improve the informed consent of patients. In this study we retrospectively evaluated the rate and reasons for conversion and assessed complications of our laparoscopic cholecystectomy series. We included data of 720 consecutive patients who were attempted to laparoscopic cholecystectomy between January 2008 to March 2014 at Islami Bank Medical College Hospital, Rajshahi. The study included 468 (65%) female and 252 (35%) male with mean age of 38 years (range 16-78 years). Conversion to open procedure was carried out in 58 patients with conversion rate of 8.05%. Dense and extensive adhesions were the most common reasons for conversion (21, 36. 2%). The conversion rate due to operative complications was 13.8% of all converted cases. The major operative complications were extrahepatic bile ducts injuries 2(0.3%), duodenal injury 1(0.1%), excessive bleeding 10(1.4%). The incidence of postoperative complications was 2.8%. The most common post-operative complication was wound infection (11, 1. 52%) followed by biliary leakage in 4(0.55%) patients. Delayed complications seen in our series is port site hernia (1,0.13%). Laparoscopic cholecystectomy is the preferred method even in difficult cases. Conversion from laparoscopic to open cholecystectomy should be based on the sound clinical judgment of the surgeon and not be due to a lack of individual expertiseTAJ 2014; 27(2): 58-62

Critical adverse events during transfemoral TAVR in conscious sedation. Is an anesthesiologic support mandatory?

Transfemoral TAVR (tf-TAVR) under conscious sedation (CS) has become popular. The need of anesthesiologic support during tf-TAVR has been questioned. Critical events during the procedure might require immediate action. We analyzed the frequency of periprocedural critical adverse events (CAE) during tf-TAVR with CS in our institution. Tf-TAVR has been performed at our institution since 2007. We excluded patients from the first four years to minimize the influence of any learning curve. CAE were defined as occurrence of 1.) "CPR", 2.) "defibrillation", 3.) "emergency extracorporeal circulation (ECC)" and 4.) "conversion to general anesthesia (GA) not related to 1.)-3.)". Data was prospectively collected in our AVIATOR TAVR registry. 601 patients were analyzed retrospectively. Overall, CAE were recorded in 54 patients (9%). CPR was necessary in 12 patients (2%) and defibrillation in 10 patients (1.6%). ECC was rarely needed (n = 2, 0.3%). Conversion to GA was necessary in 34 patients (5.65%). Procedure-related conversion was necessary in 10 patients. With 24 patients, sedation-related conversion occurred more frequently. Unrest and pain were the most common reasons for conversion (n = 13, 2%) and respiratory distress in 11 patients (2%). Catecholaminergic support was needed in 269 (45%) patients. Vasopressors were more often applied (n = 249, 41%) than inotropes (n = 59, 10%). Even in a high-volume center, CAE may occur in nearly every tenth patient. Conversion to GA was the most common CAE. Catecholaminergic support (primary vasopressor support) was needed in nearly every second patient. These points underline the necessity of a cardiac anaesthesiologist to be in the room during the procedure. Despite experience, critical adverse events (CAE) still occur in TAVR patients. We analyzed the occurrence of CAE and the need for catecholaminergic support in sedated TAVR 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 ...

Predictors and outcome of conversion to cardiac surgery during transcatheter aortic valve implantation.

Due to increasing clinical experience with transcatheter aortic valve implantation (TAVI) procedures, sophisticated imaging and advanced device technology, TAVI complication rates are low; however, patients requiring conversion to surgery are confronted with an increased mortality risk. In this retrospective study, we evaluated the predictors for conversion and the outcomes of these patients. We analysed the records of all patients undergoing TAVI in our centre from 2011 to 2016 and focused on cases that required conversion to sternotomy. We investigated reasons and risk factors for conversion as well as 30-day and 1-year outcomes. During the study period, 32 (2.1%) of 1775 patients undergoing TAVI required immediate conversion to sternotomy. Annular rupture (5 of 32; 16%), device embolization (9 of 32; 28%) and pericardial tamponade (15 of 32; 47%) were the most common reasons for conversion. Usage of a self-expandable valve showed to be the only predictor for conversion (odds ratio 0.38, 95% confidence interval 0.16-0.90; P = 0.03). Survival at 30 days and 1 year was 56% and 41%, respectively. Patients who survived 30 days after conversion showed higher preoperative ejection fraction, shorter duration of surgery and shorter perfusion time. In this high-volume, single-centre experience, conversion to sternotomy during TAVI occurred in about 2%, with annular rupture, device embolization and pericardial tamponade being the most common causes. Complications requiring conversion showed to be unpredictable. However, in view of these life-threatening complications, the 30-day survival rate exceeding 50% emphasizes the importance of an experienced and well-attuned heart team providing immediate access to surgical bailout procedures.

MP49-06 WHEN PARTIAL NEPHRECTOMY IS UNSUCCESSFUL: UNDERSTANDING THE REASONS FOR CONVERSION FROM ROBOTIC PARTIAL TO RADICAL NEPHRECTOMY AT A TERTIARY REFERRAL CENTER

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II1 Apr 2017MP49-06 WHEN PARTIAL NEPHRECTOMY IS UNSUCCESSFUL: UNDERSTANDING THE REASONS FOR CONVERSION FROM ROBOTIC PARTIAL TO RADICAL NEPHRECTOMY AT A TERTIARY REFERRAL CENTER Önder Kara, Matthew J. Maurice, Pascal Mouracade, Ercan Malkoç, Julien Dagenais, Ryan J. Nelson, Jaya Sai Chavali, Robert J. Stein, Amr Fergany, and Jihad H. Kaouk Önder KaraÖnder Kara More articles by this author , Matthew J. MauriceMatthew J. Maurice More articles by this author , Pascal MouracadePascal Mouracade More articles by this author , Ercan MalkoçErcan Malkoç More articles by this author , Julien DagenaisJulien Dagenais More articles by this author , Ryan J. NelsonRyan J. Nelson More articles by this author , Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Robert J. SteinRobert J. Stein More articles by this author , Amr FerganyAmr Fergany More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1508AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Given the technical advantages offered by the robotic platform, there has been an upward trend in the utilization of robotic partial nephrectomy however little information exist on conversion from robotic partial nephrectomy (RPN) to radical nephrectomy (RN). Our aim was to identify the preoperative factors associated with conversion from RPN to RN, and to report the incidence of this event. METHODS Using our institutional review board-approved database, we abstracted data on 1023 RPN cases performed at our center between 2010 and 2015. Standard and converted cases were compared in terms of patients and tumor characteristics and perioperative, functional, and oncological outcomes. Logistic regression analysis was used to identify predictors of radical conversion. RESULTS The overall conversion rate was 3.1% (32/1023). The most common reasons for conversion were tumor involvement of hilar structures (n=8, 25%), Failure to achieve negative margin on frozen section (n=7, 21.8%), suspicion for advanced disease (n=5, 15.6%), and failure to progress (n=5, 15.6%). Patients requiring conversion were older (p<0.01) and had higher Charlson scores (p<0.01), including increased prevalence of CKD (p=0.02). Increasing tumor size (5 vs. 3.1 cm, p<0.01) and R.E.N.A.L score (9 vs. 8, p<0.01) also were associated with increased risk of conversion. Worse baseline renal function (OR 0.98 95% CI 0.96-0.99 p=0.04), high tumor size (OR 1.44, 95% CI 1.22-1.7, p<0.01), and increasing R.E.N.A.L score (p=0.02) were independent predictors of conversion. Compared to converted cases, standard RPN cases had similar short-term oncological outcomes but better renal functional preservation (p<0.01) at latest follow-up. CONCLUSIONS At a high-volume center, the rate of RPN conversion to RN is 3.1% including 2.2% of preoperatively anticipated nephrectomy cases. Increasing tumor size and complexity and poor preoperative renal function are the main predictors of conversion. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e648 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Önder Kara More articles by this author Matthew J. Maurice More articles by this author Pascal Mouracade More articles by this author Ercan Malkoç More articles by this author Julien Dagenais More articles by this author Ryan J. Nelson More articles by this author Jaya Sai Chavali More articles by this author Robert J. Stein More articles by this author Amr Fergany More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intraoperative conversion from partial to radical nephrectomy: Predictive factors and outcomes.

483 Background: Predictive risk factors for intraoperative conversion from partial to radical nephrectomy (RN) are poorly quantified. We evaluated preoperative predictors of conversion in a cohort of patients undergoing planned partial nephrectomy (PN). Methods: A prospectively maintained database was reviewed to identify patients who were scheduled to undergo (open, laparoscopic, or robot-assisted) PN that were converted to RN between 1990 and 2015. Reasons for conversion were collected from the operative report. Patient demographics and perioperative variables were evaluated including body mass index (BMI), tumor size, nephrometry score, hilar tumors, procedure type, intraoperative complications, and oncologic outcome. Results: A total of 2298 patients underwent successful PN. The rate of conversion to RN was 4% (n=99) patients. The median patient age was 60 years and median BMI was 30 kg/m2. The median American Society of Anesthesiologists (ASA) score was 3 and median Charlson Comorbidity Index (CCI) was 2. The median tumor size for the converted cases was 4.5 cm (1.0-10.1) and median nephrometry score was 9. Histology was clear cell-RCC in 79% of the tumors. A total of 30 patients had completely endophytic tumors. The most common reasons for conversion were hilar/renal sinus extension of the renal mass in 38 (38%) patients, positive surgical margin on frozen section or gross assessment in 27 (27%) patients, insufficient renal remnant in 27 (27%) patients, and excessive intraoperative bleeding in 7 (7%) patients. RN was performed open in 79, laparoscopically in 9, and robot-assisted in 11 cases. Intraoperative complications occurred in 1 (1%) patient underwent an attempted robot-assisted PN resulted in an injury to a major renal artery branch requiring conversion to RN. Patients were followed up for a median of 33 months. In the converted cohort, evidence of disease at last follow-up was found in 13 (13%) patients. Conclusions: The rate of conversion to RN was low in patients undergoing PN in this series. The most common reason for conversion was hilar/renal sinus extension of these complex renal masses while positive surgical margin and insufficient renal remnant were contributing equally at lower rates.

When Partial Nephrectomy is Unsuccessful: Understanding the Reasons for Conversion from Robotic Partial to Radical Nephrectomy at a Tertiary Referral Center

We sought to identify the preoperative factors associated with conversion from robotic partial nephrectomy to radical nephrectomy. We report the incidence of this event. Using our institutional review board approved database, we abstracted data on 1,023 robotic partial nephrectomies performed at our center between 2010 and 2015. Standard and converted cases were compared in terms of patients and tumor characteristics, and perioperative, functional and oncologic outcomes. Logistic regression analysis was done to identify predictors of radical conversion. The overall conversion rate was 3.1% (32 of 1,023 cases). The most common reasons for conversion were tumor involvement of hilar structures (8cases or 25%), failure to achieve negative margins on frozen section (7 or 21.8%), suspicion of advanced disease (5 or 15.6%) and failure to progress (5 or 15.6%). Patients requiring conversion were older and had a higher Charlson score (both p <0.01), including an increased prevalence of chronic kidney disease (p = 0.02). Increasing tumor size (5 vs 3.1 cm, p <0.01) and R.E.N.A.L. (radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, location relative to polar lines and hilar location) score (9 vs 8, p <0.01) were also associated with an increased risk of conversion. Worse baseline renal function (OR 0.98, 95% CI 0.96-0.99, p = 0.04), large tumor size (OR 1.44, 95% CI 1.22-1.7, p <0.01) and increasing R.E.N.A.L. score (p = 0.02) were independent predictors of conversion. Compared to converted cases, at latest followup standard robotic partial nephrectomy cases had similar short-term oncologic outcomes but better renal functional preservation (p <0.01). At a high volume center the rate of robotic partial nephrectomy conversion to radical nephrectomy was 3.1%, including 2.2% of preoperatively anticipated nephrectomy cases. Increasing tumor size and complexity, and poor preoperative renal function are the main predictors of conversion.

A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms.

Robotic-assisted liver resection (RALR) was introduced as procedures of overcoming the limitations of traditional laparoscopic liver resection (LLR). The aim of this review was to evaluate the surgical results of RALR from all published studies and the results of comparative studies of RALR versus LLR for hepatic neoplasm. Eligible studies involved RALR that published between January 2001 and December 2014 were reviewed systematically. Comparisons between RALS and LLR were pooled and analyzed by meta-analytical techniques using random- or fixed-effects models, as appropriate. In total, 29 studies, involving 537 patients undergoing RALR, were identified. The most common RALR procedure was a wedge resection and segmentectomy (28.67%), followed by right hepatectomy (17.88%), left lateral sectionectomy (13.22%), and bisegmentectomy (9.12%). The conversion and complication rates were 5.59 and 11.36%, respectively. The most common reasons for conversion were bleeding (46.67%) and unclear tumor margin (33.33%). Intracavitary fluid collections and bile leaks (40.98%) were the most frequently occurring morbidities. Nine studies, involving 774 patients, were included in meta-analysis. RALR had a longer operative time compared with LLR [mean difference (MD) 48.49; 95% confidence interval (CI) 22.49-74.49 min; p = 0.0003]. There were no significant differences between the two groups in blood loss [MD 31.53; 95% CI -14.74 to 77.79 mL; p = 0.18], hospital stay [MD 0.13; 95% CI -0.54 to 0.80 days; p = 0.18], postoperative overall morbidity [odds ratio (OR) 0.76; 95% CI 0.49-1.19; p = 0.23], and surgical margin status (OR 0.61; 95% CI 0.33-1.12; p = 0.11); cost was greater than robotic surgery (p = 0.001). RALR and LLR display similar safety, feasibility, and effectiveness for hepatectomies, but further studies are needed before any final conclusion can be drawn, especially in terms of oncologic and cost-effectiveness outcomes.

Twelve-month efficacy and safety of the conversion to everolimus in maintenance heart transplant recipients.

To determine the clinical reasons for conversion to everolimus (EVL) and long-term outcomes in heart transplant (HT) recipients. A retrospective 12-mo study has been carried out in 14 Spanish centres to assess the efficacy and safety of conversion to EVL in maintenance HT recipients. Two hundred and twenty-two patients were included (mean age: 53 ± 10.5 years; mean time from HT: 8.1 ± 4.5 years). The most common reasons for conversion were nephrotoxicity (30%), chronic allograft vasculopathy (20%) and neoplasms (17%). The doses and mean levels of EVL at baseline (conversion to EVL) and after one year were 1.3 ± 0.3 and 1.2 ± 0.6 mg/d and 6.4 ± 3.4 and 5.6 ± 2.5 ng/mL, respectively. The percentage of patients receiving calcineurin inhibitors (CNIs) at baseline and on the final visit was 95% and 65%, respectively. The doses and mean levels of CNIs decreased between baseline and month 12 from 142.2 ± 51.6 to 98.0 ± 39.4 mg/d (P < 0.001) and from 126.1 ± 50.9 to 89.2 ± 47.7 ng/mL (P < 0.001), respectively, for cyclosporine, and from 2.9 ± 1.8 to 2.6 ± 1.9 mg/d and from 8.3 ± 4.0 to 6.5 ± 2.7 ng/mL (P = 0.011) for tacrolimus. In the subgroup of patients converted because of nephrotoxicity, creatinine clearance increased from 34.9 ± 10.1 to 40.4 ± 14.4 mL/min (P < 0.001). There were 37 episodes of acute rejection in 24 patients (11%). The most frequent adverse events were oedemas (12%), infections (9%) and gastrointestinal problems (6%). EVL was suspended in 44 patients (20%). Since the database was closed at the end of the study, no further follow-up data is available. Conversion to EVL in maintenance HT recipients allowed minimisation or suspension of the CNIs, with improved kidney function in the patients with nephrotoxicity, after 12 mo.

Open versus minimally invasive management of gastric GIST: An international multi-institutional analysis of short- and long-term outcomes.

85 Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the GI tract. Overall surgical experience with minimally invasive surgery (MIS) has increased, however, published reports on MIS resection of GIST are currently limited to small, single institution experiences. Methods: 397 patients who underwent surgical resection of a gastric GIST between 1998 and 2012 were identified from an international, multi-center database. The impact of the MIS approach on recurrence and survival was analyzed by the use of propensity-score matching by comparing clinicopathologic factors between patients who underwent open vs MIS resection. Results: Median patient age was 65 years and 50% were female. Median tumor size was 4.3cm (IQR 3.0-7.6cm). A minority of patients received neoadjuvant therapy (6%). Overall, 186 (47%) patients had a MIS approach: laparoscopic (89%), laparoscopic hand assist (4%), combined laparo-endoscopic (3%) and robotic (4%). There were 19 (10%) conversions to open; the most common reasons for conversion were tumor more extensive than anticipated (26%) and unclear anatomy (16%). Patients who underwent MIS resections had smaller tumors (MIS: 3.5cm vs open: 5.8cm; p&lt;0.01). MIS resections were associated with minimal blood loss (MIS: 50 cc vs open: 225 cc) and shorter operative time (MIS: 160 min vs open: 201 min) (both p&lt;0.01). There was no difference in rates of tumor rupture (MIS: 1.1% vs open: 0.9%; p=0.81). An R0 resection was achieved in the majority of patients (MIS: 98% vs open: 92%; p=0.07). MIS patients had a lower incidence of grade 3 or 4 complications (MIS: 3% vs open: 10%; p=0.01) and a shorter length of stay (MIS: 3d vs open: 8d; p&lt;0.01). After propensity score matching for age, sex, tumor size, mitotic rate and tumor rupture, there was no difference in risk of recurrence or overall survival for the MIS treated group vs. the open group (HR 0.65 &amp; HR 0.76, respectively; both p&gt;0.05). Conclusions: An MIS approach for gastric GIST is associated with a low incidence of complications and a comparable R0 resection rate. The long-term oncological outcome following MIS is excellent and therefore the MIS approach should be considered preferable.

Complications of diverticular disease: surgical laparoscopic treatment

Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of our study was to evaluate the outcome of laparoscopic colon resection in patients with diverticulitis and with complications like colon-vescical fistula, peridiverticular abscess, perforation or stricture. All patients underwent laparoscopic colectomy within 8 years period. Main data recorded were age, sex, return of bowel function, operation time, duration of hospital stay, ASA score, body mass index (BMI), early and late complications. During the study period, 33 colon resections were performed for diverticulitis and complications of diverticulitis. We performed 5 associated procedures. We had 2 postoperative complications; 1 of these required a redo operation with laparotomy for anastomotic leak and 3 patients required conversion from laparoscopic to open colectomy. The most common reasons for conversion were related to the inflammatory process with a severe adhesion syndrome. Mean operative time was 229 minutes, and average postoperative hospital stay was 9,8 days. Laparoscopic surgery for complications of diverticular disease is safe, effective and feasible. Laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis in our institution.

Open Versus Laparoscopic Resection of Primary Tumor for Incurable Stage IV Colorectal Cancer

To investigate the hypothesis that laparoscopic primary tumor resection is safe and effective when compared with the open approach for colorectal cancer patients with incurable metastases. There are only a few reports with small numbers of patients on laparoscopic tumor resection for stage IV colorectal cancer. Data from consecutive patients who underwent palliative primary tumor resection for stage IV colorectal cancer between January 2006 and December 2007 were collected retrospectively from 41 institutions. Short- and long-term outcomes were compared between patients who underwent laparoscopic or open resection. A total of 904 patients (laparoscopic group: 226, open group: 678) with a median age of 64 years (range: 22-95) were included in the analysis. Conversion was required in 28 patients (12.4%) and the most common reasons for conversion (23/28: 82%) were bulky or invasive tumors. There was no 30-day postoperative mortality in either group. The complication rate (NCI-CTCAE grade 2-4) after laparoscopic surgery (17%) was significantly lower than that after open surgery (24%) (P = 0.02), and the difference was greater (4% vs 12%; P < 0.001) when we limited the analysis to severe (≥grade 3) complications. The median length of postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group (14 vs 17 days; P = 0.002). In univariate analysis, overall survival for the laparoscopic group was significantly better than that for open surgery (median survival time: 25.9 vs 22.3 months, P = 0.04), although no difference was apparent in multivariate analysis. Compared with open surgery, laparoscopic primary tumor resection has advantages in the short term and no disadvantages in the long term. It is a reasonable treatment option for certain stage IV colorectal cancer patients with incurable disease.

Bowel Preparation Prior to Laparoscopic Colorectal Resection: What Is the Current Practice?

Much has been published on the role of mechanical bowel preparation (MBP) in open colorectal resection; however, the current study shows little evidence on the use of MBP prior to laparoscopic colorectal resections. In contrast to open procedures, MBP could influence the diameter of the bowel and thus the exposure of the surgical field in laparoscopy. This study aimed to assess the current practice of Dutch laparoscopic surgeons regarding MBP prior to colorectal resections. In January 2010, members of the Dutch Association for Endoscopic Surgery were invited to fill out an online questionnaire investigating whether MBP is prescribed prior to laparoscopic colorectal surgery, and which considerations are taken into account when choosing or omitting MBP. The 82 (49%) returned questionnaires showed that 20% of respondents prescribe MBP prior to colonic resections, while 63% prescribe MBP prior to rectal resections. The most common reasons for giving MBP were the construction of a protective ileostoma (22%), improvement of the surgical field exposure (16%), and "other reasons" specified by free text (21%). The three most common reasons for conversion were inadequate surgical field exposure (88%), locally advanced tumor (68%), and adhesions (29%). Concerning the question which stages of the operation are influenced by MBP, 29% of respondents believed that the diameter of the small bowel was influenced by MBP, 29% indicated that the exposure of the surgical field was influenced by MBP, and 52% did not believe that any of the stages of the operation were influenced by MBP. The results of this questionnaire indicate that the implementation of MBP in laparoscopic colorectal surgery is based on individual preferences in the Netherlands. This emphasizes the need of new studies investigating the role of MBP on surgical field exposure in colorectal laparoscopic surgery.

Preoperative Liver Reduction Utilizing a Novel Nutritional Supplement

One of the most common reasons for conversion in bariatric surgery is hepatomegaly caused by inadequate exposure of the proximal stomach. This study utilizes a novel nutritional supplement with a calorie-restricted diet to reduce liver volume preoperatively. A consecutive series of morbidly obese patients consumed a nutritional supplement called Nuvista(®) for 4 weeks preoperatively. Preoperatively, each patient completed baseline demographics, blood work, urine ketone analysis, ultrasonography of the left lateral segment, and multiple questionnaires. At the time of surgery, these studies were repeated. Data were analyzed using a paired t-test and bivariate analysis where appropriate. A P<.05 was considered significant. Four men and 17 women were recruited with a mean preoperative weight and body mass index of 122.7±15.9 kg and 44.5±3.9, respectively. Mean preoperative liver volume of the left lateral segment was 562.5±291.3 cm(3). After 4 weeks of Nuvista, the mean weight and body mass index decreased significantly to 118.9±15.5 kg and 43.1±3.4, respectively (P<.001). The mean liver volume of the left lateral segment was significantly reduced to 299.9±162.1 cm(3) (P<.001). Mean liver reduction was 43.4%±17.2% (13.6%-81.9%, P<.05). Urinary ketone scores did not show any evidence of starvation. No preoperative factors correlated with liver volume reduction. Utilizing Nuvista, as part of a preoperative 4-week calorie-restricted regimen, significantly reduced lateral segment liver volume by 43.4%. This preoperative regimen incorporates healthy behavioral changes that are necessary to sustain long-term weight loss.

1520 INTRAOPERATIVE CONVERSION FROM PARTIAL TO RADICAL NEPHRECTOMY AT A SINGLE INSTITUTION FROM 2003 TO 2008

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111520 INTRAOPERATIVE CONVERSION FROM PARTIAL TO RADICAL NEPHRECTOMY AT A SINGLE INSTITUTION FROM 2003 TO 2008 David Galvin, Caroline Savage, Ari Adamy, Mathew Kaag, Frank O'Brien, Kallingal George, and Paul Russo David GalvinDavid Galvin New York, NY More articles by this author , Caroline SavageCaroline Savage New York, NY More articles by this author , Ari AdamyAri Adamy New York, NY More articles by this author , Mathew KaagMathew Kaag New York, NY More articles by this author , Frank O'BrienFrank O'Brien New York, NY More articles by this author , Kallingal GeorgeKallingal George New York, NY More articles by this author , and Paul RussoPaul Russo New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1513AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Little information on conversion from partial to radical nephrectomy exists. We assessed the intraoperative reasons and predictive factors for conversion in a contemporary series of patients undergoing PN. METHODS We identified all patients at our institution undergoing either open or laparoscopic PN who were converted to RN between 2003 and 2008. Renal function was assessed by glomerular filtration rate using the MDRD equation. Logistic regression analysis was used to determine whether tumor location, tumor size, body mass index, ASA score, age or gender was associated with risk of conversion. RESULTS The rate of conversion to RN was 6% (61 of 1,029 patients). In the OPN group 59 of 865 were converted (7% [95% CI: 5%, 9%]), and in the LPN group 2 of 164 (1.2% [95% CI: 0.01%, 4%]). The rate of conversion fell over time (figure 1). The most common reasons for conversion were invasion of hilar structures, size discrepancy and insufficient residual kidney. Converted patients were more likely to have larger tumors (OR per 1 cm increase 1.41; 95% CI: 1.24, 1.59), central location (OR for central vs peripheral location 7.74; 95% CI: 3.98, 15), lower preoperative GFR (OR per 10 mL/min/1.73m2 0.78; 95% CI: 0.67, 0.91) and present with symptoms (OR for any symptoms versus none 2.78; 95% CI: 1.54, 5.04) than those not converted. Median postoperative GFR was 46 ml/min/1.73m2 for the converted group and 61 ml/min/1.73m2 for those not converted (figure 2). CONCLUSIONS Conversion to RN was uncommon in patients undergoing PN in this series. Increasing tumor size, central location, lower preoperative GFR and symptoms at presentation were associated with increased risk of conversion, which increases the likelihood of postoperative CKD. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTsivian M, Joyce D, Packiam V, Lohse C, Boorjian S, Potretzke T, Chow G, Leibovich B, Sharma V and Thompson R (2022) Unplanned Conversion From Partial to Radical Nephrectomy: An Analysis of Incidence, Etiology, and Risk FactorsJournal of Urology, VOL. 208, NO. 5, (960-968), Online publication date: 1-Nov-2022. Volume 185Issue 4SApril 2011Page: e609-e610 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Galvin New York, NY More articles by this author Caroline Savage New York, NY More articles by this author Ari Adamy New York, NY More articles by this author Mathew Kaag New York, NY More articles by this author Frank O'Brien New York, NY More articles by this author Kallingal George New York, NY More articles by this author Paul Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...