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



(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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