Laparoscopic cholecystectomy after a quarter century: why do we still convert?
Laparoscopic cholecystectomy after a quarter century: why do we still convert?
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DOI：
10.1007/s00464-011-1909-5
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发表时间：
2012-02
影响因子：
3.1
通讯作者：
Tavakkolizadeh, Ali
中科院分区：
文献类型：
--
作者：
Lengyel, Balazs I.;Azagury, Dan;Varban, Oliver;Panizales, Maria T.;Steinberg, Jill;Brooks, David C.;Ashley, Stanley W.;Tavakkolizadeh, Ali
腹腔镜胆囊切除术(LC)是切除胆囊者的黄金标准手术。然而，有时需要改用开放手术。外科医生决定将腹腔镜病例转换为开腹病例的原因很复杂，也很难理解。然而，随着开腹胆囊切除术经验的减少，这一手术不再是曾经的“安全”选择。在这种模式转变迫在眉睫的情况下，这项研究的目的是确定转换的主要原因，并最终制定有助于降低转换率的指导方针。使用国家外科质量改进计划(NSQIP)数据库和财务记录，作者回顾了2002至2009年间在他们机构进行的1193例胆囊切除术，确定了70例中转手术。两名独立的外科医生审阅了手术笔记，并确定了中转的原因。评估了当时的港口数量和改装前的解剖程度，并将其用于创建新的改装类别。比较两组患者的住院时间(LOS)、30天并发症、手术时间和费用以及住院费用。在91%的改信案例中，改信是选择性的。在这些转换中，49%的端口数量不到四个。根据新的转换类别，大多数转换是在最小或没有尝试解剖之后执行的。在损失、并发症、手术室费用或住院费用方面，不同类别之间没有差异。在6例急诊中转中，出血和担心胆总管损伤是主要原因。胆总管损伤1例。在49%的病例中，在没有真正尝试进行腹腔镜解剖的情况下进行了中转手术。考虑到这种对中转情况的新见解，作者建议外科医生在腹腔镜术中做出真正的努力，如放置四个端口并尝试在将病例转换为开腹手术之前提升胆囊壁。
Laparoscopic cholecystectomy (LC) is the gold standard procedure for gallbladder removal. However, conversion to open surgery is sometimes needed. The factors underlying a surgeon's decision to convert a laparoscopic case to an open case are complex and poorly understood. With decreasing experience in open cholecystectomy, this procedure is however no longer the “safe” alternative it once was. With such an impending paradigm shift, this study aimed to identify the main reasons for conversion and ultimately to develop guidelines to help reduce the conversion rates. Using the National Surgical Quality Improvement Program (NSQIP) database and financial records, the authors retrospectively reviewed 1,193 cholecystectomies performed at their institution from 2002 to 2009 and identified 70 conversions. Two independent surgeons reviewed the operative notes and determined the reasons for conversion. The number of ports at the time and the extent of dissection before conversion were assessed and used to create new conversion categories. Hospital length of stay (LOS), 30-day complications, operative times and charges, and hospital charges were compared between the new groups. In 91% of conversion cases, the conversion was elective. In 49% of these conversions, the number of ports was fewer than four. According to the new conversion categories, most conversions were performed after minimal or no attempt at dissection. There were no differences in LOS, complications, operating room charges, or hospital charges between categories. Of the six emergent conversions (9%), bleeding and concern about common bile duct (CBD) injury were the main reasons. One CBD injury occurred. In 49% of the cases, conversion was performed without a genuine attempt at laparoscopic dissection. Considering this new insight into the circumstances of conversion, the authors recommend that surgeons make a genuine effort at a laparoscopic approach, as reflected by placing four ports and trying to elevate the gallbladder before converting a case to an open approach.
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DOI：
10.1007/s00464-009-0374-x
发表时间：
2009-11-01
影响因子：
3.1
作者：
Low, Shiong-Wen;Iyer, Shridhar Ganpathi;Madhavan, Krishnakumar
通讯作者：
Madhavan, Krishnakumar
影响因子：
2.9
作者：
BEGOS, DG;MODLIN, IM
通讯作者：
MODLIN, IM
影响因子：
3
作者：
Lo, CM;Fan, ST;Wong, J
通讯作者：
Wong, J
影响因子：
--
作者：
Low, A;Decker, D;Hirner, A
通讯作者：
Hirner, A
DOI：
10.1007/s004640080004
发表时间：
2001-08-01
影响因子：
3.1
作者：
Lichten, JB;Reid, JJ;Friedman, RL
通讯作者：
Friedman, RL