Is conversion a complication of laparoscopic surgery.
BACKGROUND
In this paper, we review our laparoscopic and thoracoscopic experience and look specifically at the cases that resulted in conversion.


METHODS
Data were retrieved on all minimally invasive surgical procedures performed in our institution.


RESULTS
There were 1,759 cases performed between 1997 and 2007. Of these, 1,648 cases were laparoscopic and 111 thoracoscopic. There were 508 appendicectomies (34 interval), 216 fundoplications (21 redo), 183 diagnostic laparoscopies, 137 pyloromyotomies, 35 cholecystectomies, 27 splenectomies, 98 Fowler-Stephens procedures,79 nephrectomies (including heminephrectomies), 48 Palomo procedures, 75 assisted percutaneous endoscopicgastronomies, 31 pull-through procedures for Hirschsprung's disease, and 210 others. There were 45 conversions (2.6%) over the time period; 40% of all cases converted were in children who had previously had surgery, and 13% of the conversions were enforced due to bleeding or visceral injury at the time of surgery.Looking at the conversion for specific operations, this was 1.4% for appendicectomies, 2% for pyloromyotomies,and 1% for fundoplications. The rate was highest for thoracoscopic cases and nephrectomies at 10%; 82% of all conversions occurred during the first 1,000 cases (56% of our experience).


CONCLUSIONS
Our conversion rate is 2.6%. There has been a significant fall in our conversion rate over the 11 years, despite the increased number, breadth, and complexity of our caseload. We attribute this to the learning curve associated with minimally invasive surgery. Conversion is more common in patients who have had previous surgery, thoracoscopic procedures, and nephrectomies.
Adikibi
Boma T
BT
Department of Pediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK.
MacKinlay
Gordon A
GA
Munro
Fraser D
FD
Clark
Claire
C
D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000706:statistics & numerical data*; D013906:Thoracoscopy / Q000706:statistics & numerical data