Experience is critical in laparoscopy conversion rates

Fewer than 5% of laparoscopic urologic surgical procedures ever convert to open procedures. A new study confirms that as surgeons gain experience, the conversion rate falls even lower.

"We saw a significant diminution in the frequency of conversions as the case load and cumulative experience increased," Lee Richstone, MD, of North Shore Long Island Jewish Health System, New Hyde Park, NY, reported during a podium presentation yesterday. "The dropoff in the rate of conversion was seen across all procedures."

He and colleagues, including Louis R. Kavoussi, MD, conducted a retrospective study that tracked 2,128 laparoscopic procedures between 1993 and 2005. The study found that 3.3% of patients converted to open surgery over the 12-year study period. Both the absolute number of conversions and the rate of conversions fell over time. By the end of the study, the overall conversion rate was less than 1%.

What did not change were the indications for conversion. Vascular injuries accounted for 38.5% of conversions, followed by concern over margins (13.5%), bowel injury (13.5%), failure to progress (11.5%), adhesions (9.6%), diaphragmatic injury (1.9%), and other factors (11.5%). Patients over the age of 50 years had a five-fold risk for conversion. Body mass index, procedure type, prior abdominal surgery, estimated blood loss, and year of laparoscopic surgery had no significant effect on conversion.

"The simple fact that the frequency of conversion is less than 5% is of great utility in counseling patients," Dr. Richstone said. "When experienced hands embark on laparoscopic surgery, there is a high likelihood that you will complete it."