title: Conversion to hand assistance may prevent conversion to an open procedure in standard laparoscopic nephrectomy.
abstract: OBJECTIVE
  Laparoscopic surgery has received wide acceptance within the urologic community. Conversion from standard laparoscopy to the open technique may sometimes be necessary. Conversion to an open procedure may have negative implications for both the surgeon and the patient. Conversion to hand-assisted laparoscopy under these circumstances, however, may obviate open surgery. We intended to review our results and emphasize the efficacy and safety of conversion to hand assistance during standard laparoscopy when necessary.
  
  
  METHODS
  We retrospectively reviewed the results of laparoscopic nephrectomies performed by one surgeon. Demographic and perioperative data were noted. Conversions from standard laparoscopy were analyzed in detail.
  
  
  RESULTS
  A total of 161 laparoscopic nephrectomies were performed. Conversion was deemed appropriate in 6 of 150 standard laparoscopies. Surgery was successfully completed in five with hand assistance. The reason to convert was failure to progress in three patients and control of hemostasis in two patients. Open surgery was performed in a patient who could not tolerate pneumoperitoneum.
  
  
  CONCLUSIONS
  Conversion to hand-assisted laparoscopy is safe and effective when the surgeon decides to convert from standard laparoscopy. Conversion to hand assistance may prevent conversion to an open procedure in these situations.
authors.affiliation: Department of Urology, Bilim University, Istanbul, Turkey.
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
authors.forename: Can
authors.initials: C
authors.lastname: Obek
authors.forename: Mustafa Bilal
authors.initials: MB
authors.lastname: Tuna
authors.forename: Haluk
authors.initials: H
authors.lastname: Akpinar
authors.forename: Oktay
authors.initials: O
authors.lastname: Demirkesen
authors.forename: Fatih
authors.initials: F
authors.lastname: Atug
authors.forename: Ilter
authors.initials: I
authors.lastname: Tüfek
mesh_terms: D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology