title: Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists.
abstract: BACKGROUND
  In laparoscopic surgery, conversion to laparotomy is associated with worse clinical outcomes, especially if the conversion is due to a complication. Although apparently important, no commonly used definition of conversion exists. The aim of this study was to achieve multidisciplinary consensus on a uniform definition of conversion.
  
  
  METHODS
  On the basis of definitions currently used in the literature, a web-based Delphi consensus study was conducted among members of all four Dutch endoscopic societies. The rate of agreement (RoA) was calculated; a RoA of >70% suggested consensus.
  
  
  RESULTS
  The survey was completed by 268 respondents in the first Delphi round (response rate, 45.6%); 43% were general surgeons, 49% gynecologists, and 8% urologists. Average ± standard deviation laparoscopic experience was 12.5 ± 7.2 years. On the basis of the results of round 1, a consensus definition was compiled. Conversion to laparotomy is an intraoperative switch from a laparoscopic to an open abdominal approach that meets the criteria of one of the two subtypes: strategic conversion, a standard laparotomy that is made directly after the assessment of the feasibility of completing the procedure laparoscopically and because of anticipated operative difficulty or logistic considerations; and reactive conversion, the need for a laparotomy because of a complication or (extension of an incision) because of (anticipated) operative difficulty after a considerable amount of dissection (i.e., >15 min in time). A laparotomy after a diagnostic laparoscopy (i.e., to assess the curability of the disease) should not be considered a conversion. In the second Delphi round, a RoA of 90% was achieved with this definition.
  
  
  CONCLUSIONS
  After two Delphi rounds, consensus on a uniform multidisciplinary definition of conversion was achieved within a representative group of general surgeons, gynecologists, and urologists. An unambiguous interpretation will result in a more reliable clinical registration of conversion and scientific evaluation of the feasibility of a laparoscopic procedure.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands, m.d.blikkendaal@lumc.nl.
authors.forename: Mathijs D
authors.initials: MD
authors.lastname: Blikkendaal
authors.forename: Andries R H
authors.initials: AR
authors.lastname: Twijnstra
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.forename: Harrie P
authors.initials: HP
authors.lastname: Beerlage
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D032921:Consensus; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D003697:Delphi Technique; D013502:General Surgery / Q000706:statistics & numerical data*; D006176:Gynecology / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D014572:Urology / Q000706:statistics & numerical data*