Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists

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• 作者：Mathijs D. Blikkendaal (1)
  Andries R. H. Twijnstra (1)
  Anne M. Stiggelbout (2)
  Harrie P. Beerlage (3)
  Willem A. Bemelman (4)
  Frank Willem Jansen (1)
  
• 关键词：Definition ; Conversion ; Minimal invasive surgery ; Laparoscopy ; Patient safety
• 刊名：Surgical Endoscopy
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：27
• 期：12
• 页码：4631-4639
• 全文大小：
• 作者单位：Mathijs D. Blikkendaal (1)
  Andries R. H. Twijnstra (1)
  Anne M. Stiggelbout (2)
  Harrie P. Beerlage (3)
  Willem A. Bemelman (4)
  Frank Willem Jansen (1)
  
  1. Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
  2. Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
  3. Department of Urology, Jeroen Bosch Ziekenhuis, ? Hertogenbosch, The Netherlands
  4. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  
• ISSN：1432-2218

文摘

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.