There has been a revolution in surgery in recent years which requires retraining tens of thousands of surgeons. This amazing change is due to the rapid development of Endovideosurgical (Minimally Invasive) Technology and the expansion of its field of application. Many surgeons quickly applied the laparoscopic technique to a variety of surgeries. This highlighted the main advantages of the laparoscopic approach over open surgeries, including reduction in postoperative pain, shorter hospital stays and more courteous disability durations.
The introduction of minimally invasive technologies naturally brings new challenges. The main problem is that of the safe and correct integration of laparoscopic surgery into abdominal surgery.
Unfortunately, laparoscopic procedures are not without the complications characteristic of “open surgery”. There are also specific complications. Complications and complex anatomical situations during laparoscopic surgery can be the cause of the transition / switch to an open surgical method.
material and methods
We present the experience of complications and dangers reached General practitioners have been performing laparoscopic procedures in our clinical hospital since 2013. From September 2013 to April 2015, 1,812 laparoscopic operations were performed by endoscopy.
Since the reasons for the conversion are different for each pathology, an analysis of the reasons for certain types of operations is presented below.
Switch to laparotomy for laparoscopic cholecystectomy
Laparoscopic cholecystectomy has virtually replaced conventional open cholecystectomy as the gold standard for symptomatic cholelithiasis and inflammation of the gallbladder. Laparoscopic accreditation brings many advantages at the expense of higher complication rates, especially in training centers. It was quickly adopted by most surgeons and received enthusiastically by the public.
In our hospital, the number of unsuccessful laparoscopic cholecystectomy attempts decreased reliably due to the experience of each surgeon and all operating room staff. The vast majority of failures were due to narrowed gallbladder surgery and acute calcareous cholecystitis.
Reasons for change during laparoscopic cholecystectomy:
I. Inability to perform and laparoscopic surgery due to morphological changes in organs and tissues.
1) an infiltrate in the gallbladder.
With laparoscopic division of the infiltrate, there is a high probability of damage to the applied organs. Sometimes this damage goes unnoticed during surgery. This is the reason for the conversion of 24 observations, which accounted for 53.4% of the total conversions in acute calcium cholecystitis and 10 (26.3%) in chronic calcium cholecystitis. A dense infiltrate in chronic calcareous cholecystitis is also used in a certain percentage. Clinically symptomatic of chronic inflammation of the gallbladder, dense infiltration is usually diagnosed interrogatively in routine patients. In 9 (20%) patients with acute calcareous cholecystitis, the reason for the change was the combination of a dense infiltrate and a cholecystitis abscess.