title: Conversions in laparoscopic renal surgery: causes and outcomes.
abstract: OBJECTIVE
  We examined conversions in laparoscopic renal surgery, evaluating the causes and outcomes.
  
  
  METHODS
  A single institution review of all laparoscopic renal surgeries, excluding renal donors, over a nine-year period was performed. Cases were evaluated for intraoperative results, conversions, and complications.
  
  
  RESULTS
  399 laparoscopic renal surgeries were identified (394 available for review) with 41 conversions (31 open, 8 hand-assisted, 2 retroperitoneal). Intraoperative and postoperative complications occurred in 3.0% and 12.2%, respectively. The most common reason for conversion was a lack of progress (20), followed by difficult anatomy (8), tumor thrombus (5), and bleeding (4). Open conversion rates for hand-assisted laparoscopic (HAL), transperitoneal laparoscopic, retroperitoneal laparoscopic (RPL), and robot-assisted were 17.1%, 6.9%, 13.2%, and 1.8%, respectively, although HAL and RPL were more often used for bilateral procedures, previous abdominal surgery, and large specimens (P<0.05). Surgical indication significantly impacted perioperative outcome, where autosomal dominant polycystic kidney disease and partial nephrectomy were associated with the highest rate of open conversion (13%), while nephroureterectomy had the highest rate of complications (40%). Cases in which there were large specimens weighing over 1500 g were converted in 40% of cases vs 8.2% for smaller specimens, P<0.001. Previous abdominal surgery did not impact conversion rate (11.9% without vs 9.3% with previous surgery, P=0.401). Cases that were converted had a significantly higher blood loss, operative time, transfusion rate, hospital stay, and complication rate (P<0.05).
  
  
  CONCLUSIONS
  Rate of conversion to an open procedure is significantly impacted by surgical indication, specimen size, and surgical technique. Any conversion is associated with an increased perioperative morbidity.
authors.affiliation: Department of Urology, Indiana University, Indianapolis, Indiana 46202, USA.
authors.forename: Bert S
authors.initials: BS
authors.lastname: Ivey
authors.forename: Steven M
authors.initials: SM
authors.lastname: Lucas
authors.forename: Carl A
authors.initials: CA
authors.lastname: Meyer
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Emley
authors.forename: Aaron
authors.initials: A
authors.lastname: Bey
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gardner
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
mesh_terms: D000005:Abdomen / Q000601:surgery; D006801:Humans; D007668:Kidney / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D016896:Treatment Outcome