Richstone et al identified a number of reasons for why a laparoscopic surgical procedure may be converted to an open one. The authors are from the North Shore-Long Island Jewish Health System, Ramathibodi Hospital in Bangkok, George Washington University and the Brady Urological Institute in Baltimore.
Reasons for conversion to an open procedure:
(1) injuries
(2) unexpected findings
(3) concerns or problems
Injuries:
(1) vascular injury
(2) bowel injury
(3) diaphgram injury
(4) damage to a ureter
(5) other injuries
Unexpected findings:
(1) vascular thrombosis
(2) fistula requiring more extensive surgery
(3) large tumor
Concerns or problems:
(1) adhesions
(2) cancer-related (margins, extent, etc)
(3) failure to progress
(4) bowel overdistention
The need for conversion should be expected if:
(1) the patient is elderly
(2) the patient has had previous surgery in the same area before
(3) the surgeon is inexperienced
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