Is called conversion from laparoscopy to open. It occurs when the surgeon, who had planned a minimally invasive operation, realizes during the work that he cannot proceed with that technique and decides to switch to traditional methods: cutting instead of small holes in which to introduce endoscopic instruments. On Sunday afternoon, the change of plans was necessary for Pope Francis.
Professor Francesco Corcione, you are considered one of the best operators in Italy in the field of intervention on diverticula. What unexpected events can lead to choices other than those foreseen on the basis of the diagnostic images?
Much, first of all, depends on the experience of surgeons. Inexperienced operators stop immediately in the face of difficulties. And certainly not the case of my colleagues at the Gemelli Polyclinic, coordinated by Sergio Alfieri, who will have switched to using the scalpel only after verifying the ineffectiveness of the various laparoscopic options, lists the first element that leads to the conversion of the ordinary general surgery at the Federico II University of Naples, emeritus president of the Italian Society of Surgery.
I obviously don’t know the specific case. In general, the reasons that lead to open surgery are uncontrollable bleeding, presence of visceral adhesions, anatomical reasons otherwise not removable, anesthetic problems or complications, for example the discovery of openings, which cannot be resolved laparoscopically.
Are the adhesions only due to previous surgery or are they also of another nature? We do not know if Pope Francis had already been operated on in Argentina before becoming Pope.
Most adhesions result from previous open surgery episodes, but can also be caused by other causes. It is up to the surgeon’s ability to circumvent these obstacles by removing them before proceeding with the left hemitectomy, ie resection of the sigmoid and descending colon.
How frequent is the conversion?
In the literature the figure of 20% is reported. Two out of ten operations instead of laparoscopy lead to open-label surgery. The percentage varies according to the experience of the team.
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Do the times in the operating room get longer?
Yes, but a trained team manages to keep a “delay” on the times of half an hour.
Is the diagnosis of diverticular stenosis always benign?
No, the literature describes the 3% probability that a diagnosis of malignancy will emerge from the stenosis. The real certainty is given by the histological examination on the operative piece. Until then the presumed kindness.