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.
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Acknowledgments
The authors would like to thank all the respondents for their time to complete the survey. Additionally, we would like to thank Dr. C. de Kroon and Dr. C. van Meir (gynecologists) and Dr. E. Consten and Dr. P. Tanis (general surgeons) for their presence in the pilot group, and S. Hofwijk (medical student) for her help in categorizing the free-text definitions of all respondents as an independent second observer.
Disclosures
Mathijs Blikkendaal, Andries Twijnstra, Anne Stiggelbout, Harrie Beerlage, Willem Bemelman, and Frank Willem Jansen have no conflicts of interest or financial ties to disclose.
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Blikkendaal, M.D., Twijnstra, A.R.H., Stiggelbout, A.M. et al. Achieving consensus on the definition of conversion to laparotomy: a Delphi study among general surgeons, gynecologists, and urologists. Surg Endosc 27, 4631–4639 (2013). https://doi.org/10.1007/s00464-013-3086-1
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DOI: https://doi.org/10.1007/s00464-013-3086-1