Conversion to laparotomy in bening gynecologic laparoscopic surgery; Can surgical experience be protective

Cenk Guven, Cenk Mustafa Güven, Dilek Uysal
Medicine Science | International Medical Journal · 2023 · vol. 12(2) , pp. 368 · doi:10.5455/medscience.2023.01.011 · W4379052802
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This study of 305 benign gynecologic laparoscopic cases found that conversion to open surgery occurred in 2.29% of patients and was linked to technical problems rather than risk factors like endometriosis, surgical expertise, or patient characteristics.

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This retrospective study evaluated whether surgical expertise serves as a protective factor against conversion to open surgery during benign gynecologic laparoscopic procedures. The researchers analyzed data from 305 patients, comparing seven cases that required conversion to the 298 cases completed successfully via laparoscopy. Key findings indicated that while conversion significantly prolonged hospital stays and increased wound infection rates, factors such as age, body mass index, previous abdominal surgery, endometriosis, and surgeon experience did not statistically increase the risk of conversion. The authors concluded that conversions were primarily driven by technical difficulties rather than patient complexity or lack of surgical skill. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Laparoscopy is a surgical technique that is frequently used in the treatment of benign cases, but the conversion to open surgery (CTOS) complication is higher than laparotomy. In some cases, a conversion from laparoscopic surgery to open surgery is necessary to prevent or treat difficulties. In this study, the effect of surgical expertise on CTOS was evaluated on patients who had undergone laparoscopic surgery for benign indications. A total of 305 patients were included during the study period. These patients were divided into two groups: CTOS group (7 patients) and successful laparoscopy group (298 patients). Benign gynecological laparoscopy operation was converted to open surgery in 7 of 305 patients (2.29%) included in this study. Open surgery significantly prolonged hospital stays in patients compared to laparoscopic surgery. While wound infection was observed in 3 patients who underwent open surgery, no infection was observed in laparoscopic surgery group. Obtained results demonstrated that age, body mass index, sufficient surgical expertise, history of previous abdominal surgery and endometriosis, obstetrical status, abdomino-pelvic adhesions, and frozen pelvis did not create risk factor for CTOS in the treatment of benign cases with laparoscopic surgery. It was concluded that the conversion to open surgery is connected with technical problems instead of complication management or surgical complexity.
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Abstract

Laparoscopy is a surgical technique that is frequently used in the treatment of benign cases, but the conversion to open surgery (CTOS) complication is higher than laparotomy. In some cases, a conversion from laparoscopic surgery to open surgery is necessary to prevent or treat difficulties. In this study, the effect of surgical expertise on CTOS was evaluated on patients who had undergone laparoscopic surgery for benign indications. A total of 305 patients were included during the study period. These patients were divided into two groups: CTOS group (7 patients) and successful laparoscopy group (298 patients). Benign gynecological laparoscopy operation was converted to open surgery in 7 of 305 patients (2.29%) included in this study. Open surgery significantly prolonged hospital stays in patients compared to laparoscopic surgery. While wound infection was observed in 3 patients who underwent open surgery, no infection was observed in laparoscopic surgery group. Obtained results demonstrated that age, body mass index, sufficient surgical expertise, history of previous abdominal surgery and endometriosis, obstetrical status, abdomino-pelvic adhesions, and frozen pelvis did not create risk factor for CTOS in the treatment of benign cases with laparoscopic surgery. It was concluded that the conversion to open surgery is connected with technical problems instead of complication management or surgical complexity.

Keywords

Gynecology; laparoscopy; surgery; conversion to open surgery; laparotomy

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endometriosis

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