Risk factors and management of conversions to an open approach in laparoscopic urologic procedures: Analysis of 670 consecutive cases

112 Risk factors and management of conversions to an open approach in laparoscopic urologic procedures: Analysis of 670 consecutive cases Nedelea A.S., Borcaias R., Botea M., Dragomiristeanu I., Chira I., Lubasinski P., Jinga V. Spitalul Theodor Burghele, Dept. of Urology, Bucharest, Romania INTRODUCTION & OBJECTIVES: This study aims to determine risk factors and common intraoperative events that led to conversion from laparoscopic to open approach in urological procedures. MATERIAL & METHODS: A descriptive and retrospective study was performed. We included 670 patients, all admitted to our department during 4 consecutive years, from 01.01.2011 to 31.12.2014 who underwent laparoscopic procedures. We have searched and selected all cases in which the laparoscopic procedures were converted to an open approach. We studied comorbidities, preoperative health status, age, previous surgical interventions, ASA risk, urologic surgery type and other factors that might lead to conversion to an open approach. RESULTS: The overall rate of conversion to open approach was around 6%. The most frequent causes for conversion were the inability to progress in 50 % of the converted cases followed by vascular/visceral injury in 40%. 52% of all conversions took place at patients that had a preoperative score of II on the ASA scale (American Society of Anaesthesiologists' classification of Physical Health) followed in frequency by patients with III (32%), I(12%) and IV(4%). There were no significant differences in conversion percentage between surgeons, most of them happening at the beginning of the learning curve. 48% of converted cases have had abdominal surgery in the past. Among laparoscopic urological procedures, transperitoneal nephrectomies carry the highest risk of conversion to open surgery, with more than 60% of all conversions. CONCLUSIONS: Complications of laparoscopic urological surgery that lead to conversion are rare; nevertheless, they require permanent caution for early detection. Conversion to an open approach is highly dependent on the operator’s learning curve status and the type of procedure performed rather than any preoperative factors. Eur Urol Suppl 2015; 14(6): e1274