33 Cases Cinical Analysis For Conversion Form Laparoscopic Surgery To Open Approach

Objective:To study the clinical factors in conversion from laparoscopic surgery to open approach.Methods.33 cases from laparoscopic surgery to open aprroch from2003 to 2009 were analyzed retrospectively. One,33 were converted to laparotomy before the surgical indications were:8 cases of uterine fibroids,6 cases of uterine adenomyosis, and 10 cases of ovarian cyst,3 cases of ectopic pregnancy,1 case of pelvic tumor. Second,33 cases were converted to open surgical procedures:seven cases of uterine myoma core addition to surgery; two cases of cornual wedge resection. One case of heterotopic tubal dissection; five cases of hysterectomy; 10 ovarian malignant tumor; a uterine myomectomy plus ends intestinal anastomosis; a myomectomy uterine gland plus ureteral repair; one cases of cyst excision laparoscopy appendectomy.5 cases of uterine myomectomy.Results:Laparoscopy converted to open surgery in our hospital was significantly lower than the foreign reports, such as the Beijing Union Medical College Hospital with the domestic rate of conversion to open was close. This 10403 cases of laparoscopic surgery,33 were converted to laparotomy, transfer rate of 0.32%. The data showed that, due to benign disease to severe abdominal adhesions, malignant disease, hemorrhage, complications of the laparotomy 4 because the main reason for the proportion was 30.3%,30.3%,12.1%,9.1%. Laparoscopic surgery from 2003 to 2007, Classâ… -â…¡based on surgery, laparotomy was primarily due to the severe abdominal adhesions,30.3%(10/33). Reasons for abdominal surgery, patients who lack operational technology, lack of experience, laparoscopic instruments imperfect. Laparoscopic surgery from 2007 to 2009 Class III-IV based on surgery, mainly due to conversion of laparoscopic ovarian disease,30.3%(10/33). Because preoperative diagnosis is not clear, the expansion of indications for surgery, surgery more difficult.Conclusion:First,2003-2009 Dalian Maternity Hospital were 10,403 cases of laparoscopic surgery,33 patients converted to laparotomy, laparotomy rate of 0.32%, slightly lower than reported in the literature.Second,severe abdominal adhesions, malignant disease, blood loss, complications, laparoscopic converted to open surgery in our hospital is the main reason.Third,laparoscopic surgery carried out in different periods for different levels of operation, which turn laparotomy for different reasons.2003-2004 in our hospital to carry out laparoscopic surgery converted to laparotomy I class the main focus on blood loss; 2005-2007 Classâ…¡-â…¢carried out surgery, the main focus switch to open surgery in pelvic adhesions, intraoperative bleeding and Deputy injury; IV types of surgery carried out in 2008-2009, the reasons for conversion to open misdiagnosed as benign ovarian tumor, conversion to open radical surgery.Four,conversion to open is not a measure of the success of laparoscopic surgery the only standard, timely laparotomy help prevent and reduce complications.Five,strict operative and master the principle of gradual and orderly progress from easy to difficult to master anatomy of laparoscopic abdominal cavity of knowledge to strengthen the preoperative evaluation of patients, have helped reduce the rate of laparoscopic converted to open surgery.