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

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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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References

  1. Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, Mignon A, Chapron C (2005) Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol 12:312–317

    Article  PubMed  Google Scholar 

  2. Hunter RW, McCartney AJ (1993) Can laparoscopic assisted hysterectomy safely replace abdominal hysterectomy? Br J Obstet Gynaecol 100:932–934

    Article  PubMed  CAS  Google Scholar 

  3. Twijnstra AR, Blikkendaal MD, van Zwet EW, Jansen FW (2013) Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol 20:64–72

    Article  PubMed  Google Scholar 

  4. Chew MH, Ng KH, Fook-Chong MC, Eu KW (2011) Redefining conversion in laparoscopic colectomy and its influence on outcomes: analysis of 418 cases from a single institution. World J Surg 35:178–185

    Article  PubMed  Google Scholar 

  5. Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner S (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15:827–832

    Article  PubMed  CAS  Google Scholar 

  6. Yang C, Wexner SD, Safar B, Jobanputra S, Jin H, Li VK, Nogueras JJ, Weiss EG, Sands DR (2009) Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc 23:2454–2458

    Article  PubMed  Google Scholar 

  7. Dindo D, Schafer M, Muller MK, Clavien PA, Hahnloser D (2010) Laparoscopy for small bowel obstruction: the reason for conversion matters. Surg Endosc 24:792–797

    Article  Google Scholar 

  8. David-Montefiore E, Rouzier R, Chapron C, Darai E (2007) Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 22:260–265

    Article  PubMed  CAS  Google Scholar 

  9. Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, Colombo FM (2002) Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc 9:333–338

    Article  PubMed  Google Scholar 

  10. Malzoni M, Perniola G, Perniola F, Imperato F (2004) Optimizing the total laparoscopic hysterectomy procedure for benign uterine pathology. J Am Assoc Gynecol Laparosc 11:211–218

    Article  PubMed  Google Scholar 

  11. Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E (2008) A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. Int J Gynaecol Obstet 103:227–231

    Article  PubMed  Google Scholar 

  12. Tan J, Sun Y, Zhong B, Dai H, Wang D (2009) A randomized, controlled study comparing minilaparotomy versus isobaric gasless laparoscopic assisted minilaparotomy myomectomy for removal of large uterine myomas: short-term outcomes. Eur J Obstet Gynecol Reprod Biol 145:104–108

    Article  PubMed  Google Scholar 

  13. Shawki S, Bashankaev B, Denoya P, Seo C, Weiss EG, Wexner SD (2009) What is the definition of “conversion” in laparoscopic colorectal surgery? Surg Endosc 23:2321–2326

    Article  PubMed  Google Scholar 

  14. Copi IM, Cohen C (2005) Introduction to logic, 12th edn. Pearson Education Inc, Upper Saddle River

    Google Scholar 

  15. Linstone HA, Turoff M (2002) The Delphi method: techniques and applications. http://is.njit.edu/pubs/delphibook/delphibook.pdf. Accessed 12 Mar 2013

  16. Fink A, Kosecoff J, Chassin M, Brook RH (1984) Consensus methods: characteristics and guidelines for use. Am J Public Health 74:979–983

    Article  PubMed  CAS  Google Scholar 

  17. Jones J, Hunter D (1995) Consensus methods for medical and health services research. BMJ 311:376–380

    Article  PubMed  CAS  Google Scholar 

  18. Janssen PF, Brolmann HA, Huirne JA (2011) Recommendations to prevent urinary tract injuries during laparoscopic hysterectomy: a systematic Delphi procedure among experts. J Minim Invasive Gynecol 18:314–321

    Article  PubMed  CAS  Google Scholar 

  19. Keeney S, Hasson F, McKenna H (2006) Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs 53:205–212

    Article  PubMed  Google Scholar 

  20. Garry R, Fountain J, Brown J, Manca A, Mason S, Sculpher M, Napp V, Bridgman S, Gray J, Lilford R (2004) EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess 8:1–154

    PubMed  CAS  Google Scholar 

  21. Kolkman W, Engels LE, Smeets MJ, Jansen FW (2007) Teach the teachers: an observational study on mentor traineeship in gynecological laparoscopic surgery. Gynecol Obstet Invest 64:1–7

    Article  PubMed  Google Scholar 

  22. Neudecker J, Klein F, Bittner R, Carus T, Stroux A, Schwenk W (2009) Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 96:1458–1467

    Article  PubMed  CAS  Google Scholar 

  23. Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, Fowler JM (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol 113:36–41

    Article  PubMed  Google Scholar 

  24. Atkinson SW (2004) Results of eVALuate study of hysterectomy techniques: conversion to open surgery should not be regarded as major complication. BMJ 328:642

    Article  PubMed  Google Scholar 

  25. Chapron C, Querleu D, Bruhat MA, Madelenat P, Fernandez H, Pierre F, Dubuisson JB (1998) Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases. Hum Reprod 13:867–872

    Article  PubMed  CAS  Google Scholar 

  26. Lengyel BI, Azagury D, Varban O, Panizales MT, Steinberg J, Brooks DC, Ashley SW, Tavakkolizadeh A (2012) Laparoscopic cholecystectomy after a quarter century: why do we still convert? Surg Endosc 26:508–513

    Article  PubMed  Google Scholar 

  27. Offodile AC, Balik E, Hoffman A, Moon V, Baxter R, Grieco M, Moradi D, Kim IY, Nasar A, Cekic V, Feingold DL, Arnell TD, Huang E, Whelan RL (2010) Is there a role for a strict incision length criterion for determining conversions during laparoscopic colorectal resection? Surg Innov 17:120–126

    PubMed  Google Scholar 

  28. Archer TM (2007) Characteristics associated with increasing the response rates of web-based surveys. http://pareonline.net/pdf/v12n12.pdf. Accessed 12 Mar 2013

  29. Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82:1406–1408

    Article  PubMed  CAS  Google Scholar 

  30. Twijnstra AR, Zeeman GG, Jansen FW (2010) A novel approach to registration of adverse outcomes in obstetrics and gynaecology: a feasibility study. Qual Saf Health Care 19:132–137

    Article  PubMed  CAS  Google Scholar 

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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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Authors and Affiliations

  1. Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands

    Mathijs D. Blikkendaal, Andries R. H. Twijnstra & Frank Willem Jansen

  2. Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands

    Anne M. Stiggelbout

  3. Department of Urology, Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch, The Netherlands

    Harrie P. Beerlage

  4. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands

    Willem A. Bemelman

Authors
  1. Mathijs D. Blikkendaal
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  2. Andries R. H. Twijnstra
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  3. Anne M. Stiggelbout
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  4. Harrie P. Beerlage
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  5. Willem A. Bemelman
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  6. Frank Willem Jansen
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Corresponding author

Correspondence to Frank Willem Jansen.

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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

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