CONVERSION RATE OF LAPAROSCOPIC NEPHRECTOMY TO OPEN NEPHRECTOMY

Abstract

Background: Laparoscopic nephrectomy has gained widespread acceptance in urological surgery over the past two decades, offering notable advantages such as improved visualization, reduced hospital stays, and superior cosmetic outcomes compared to open surgery. Despite these benefits, the approach presents a steep learning curve and a risk of intraoperative complications that may necessitate conversion to open surgery. Limited data exist on unplanned conversions during laparoscopic nephrectomy in developing countries, particularly in South Asian settings.

Objective: To determine the frequency of conversion from laparoscopic nephrectomy to open nephrectomy and identify the intraoperative factors contributing to conversion in a tertiary care center.

Methods: This descriptive study was conducted in the Department of Urology, Institute of Kidney Diseases, Peshawar, from October 2023 to September 2024. A total of 76 patients scheduled for laparoscopic nephrectomy for benign or malignant indications were included using a non-probability convenience sampling technique. Preoperative evaluation included clinical assessment, laboratory tests, and imaging. Conversion to open surgery was performed when complications such as uncontrolled bleeding, visceral injury, or poor progression arose. Data were analyzed using SPSS version 25. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± standard deviation. Statistical significance was set at p ≤ 0.05.

Results: Of the 76 patients, 55.3% were female and 44.7% were male, with a mean age of 48.2 ± 12.6 years. The overall conversion rate was 6.6% (n=5), with a significantly higher rate in radical nephrectomies (17.4%) compared to simple nephrectomies (1.9%) (p=0.02). Reasons for conversion included uncontrolled bleeding in 5.3% (n=4) and poor progression in 1.3% (n=1). Converted cases had a longer operative time (155 ± 7.9 min) and hospital stay (4.0 ± 1.0 days) compared to uneventful laparoscopic cases (98.9 ± 18.7 min, 1.5 ± 0.7 days).

Conclusion: The frequency of conversion to open nephrectomy was within acceptable limits and primarily associated with complex oncological cases. Understanding conversion causes can enhance surgical preparedness and patient safety in laparoscopic nephrectomy.