Analysis of the causes of conversion to laparotomy in gynecological laparoscopy surgery

ObjectiveTo analyze the incidence of conversion to laparotomy in gynecological laparoscopy surgery, and its influencing factors.

MethodsThe clinical data of 2 683 patients of gynecological laparoscopy surgery in The First Affiliated Hospital of Bengbu Medical College from 2014 to 2018 were retrospectively analyzed.According to the laparoscopic surgery methods, the patients were divided into the type Ⅰ group(treatment with laparoscopy or appendage surgery), type Ⅱ group(treatment with ovariectomy or ovariectomy), type Ⅲ group(treatment with myomectomy, subtotal or total hysterectomy) and type Ⅳ group(treatment with extensive hysterectomy combined with pelvic lymphadenectomy).The operation methods and reasons of conversion to laparotomy in 22 patients were analyzed.

ResultsAmong the 2 683 laparoscopic patients, 22 cases were converted to laparotomy, and the conversion rate was 0.81%.The conversion rates of type Ⅰ, Ⅱ, Ⅲ and Ⅳ groups were 0.36%(6/1 680), 0.97%(3/310), 1.52%(10/660) and 9.09%(3/33), respectively.The conversion rates in type Ⅰ, Ⅱ and Ⅲ groups were lower than that in type Ⅳ group(P < 0.01).The causes of conversion to laparotomy included the severe adhesions36.36%(8/22), special lesions22.73%(5/22), bleeding18.18%(4/22), malignant tumors13.64%(3/22) and injuries9.09%(2/22).

ConclusionsThe occurrence of conversion to laparotomy in gynecological laparoscopy surgery is closely related to the difficulty of operation and scope of operation required.The strict preoperative evaluation, selection of surgical indications, use of appropriate surgical methods and improvement of operative skills are the effective methods to prevent gynecological laparoscopy conversion to laparotomy.