Advertisement

Intraoperative Decision-Making: Converting to taTME, When and for Whom?

  • Isacco Montroni
  • Antonino Spinelli
Chapter

Abstract

Converting from one approach to another always comes as a tough pill to swallow. It is so for the surgeon, whose plans have to change while accepting that the initially preferred strategy has failed. It also poses challenges for the operating room (OR) staff who must rapidly modify the work setting in order to create the best possible environment to complete the case. There are challenges for the hospital administration as well, since there is evidence that conversion increases the intraoperative and postoperative costs of the surgical process. Most importantly, for the patient, as in the vast majority of cases, converting from a minimally invasive approach to open surgery leads to worst short- and long-term outcomes.

Keywords

taTME TAMIS Conversion Laparoscopy Minimally invasive surgery Outcomes Implications 

References

  1. 1.
    Cleary RK, Mullard AJ, Ferraro J, Regenbogen SE. The cost of conversion in robotic and laparoscopic colorectal surgery. Surg Endosc. 2018;32(3):1515–24.  https://doi.org/10.1007/s00464-017-5839-8. Epub 2017 Sep 15.CrossRefPubMedGoogle Scholar
  2. 2.
    de Neree Tot Babberich MPM, van Groningen JT, Dekker E, Wiggers T, Wouters MWJM, Bemelman WA, Tanis PJ, Dutch Surgical Colorectal Audit. Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level? Surg Endosc. 2018;32(7):3234–46.CrossRefGoogle Scholar
  3. 3.
  4. 4.
    Bhama AR, Charlton ME, Schmitt MB, Cromwell JW, Byrn JC. Factors associated with conversion from laparoscopic to open colectomy using the National Surgical Quality Improvement Program (NSQIP) database. Colorect Dis. 2015;17:257–64.CrossRefGoogle Scholar
  5. 5.
    Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MHGM, de Lange-de Klerk ESM, et al. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;372:1324–32.CrossRefGoogle Scholar
  6. 6.
    Jayne D, Pigazzi A, Marshall H, Croft J, Corrigan N, Copeland J, Quirke P, West N, Rautio T, Thomassen N, Tilney H, Gudgeon M, Bianchi PP, Edlin R, Hulme C, Brown J. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA. 2017;318(16):1569–80.CrossRefGoogle Scholar
  7. 7.
    Yang C, Wexner SD, Safar B, Jobanputra S, Jin H, Li VK, Nogueras JJ, Weiss EG, Sands DR. Conversion in laparoscopic surgery: does intraoperative complication influence outcome? Surg Endosc. 2009;23(11):2454–8.  https://doi.org/10.1007/s00464-009-0414-6. Epub 2009 Mar 25.CrossRefPubMedGoogle Scholar
  8. 8.
    Wexner SD. Definitions of conversion—reactive vs preemptive. Presented at the 8th Annual International Colorectal Disease Symposium, hosted by the Cleveland Clinic Florida, Fort Lauderdale, FL in February. 1997.Google Scholar
  9. 9.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative. Transanal Total Mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017 Jul;266(1):111–7.CrossRefGoogle Scholar
  10. 10.
    Cooper MA, Ibrahim A, Lyu H, Makary MA. Underreporting of robotic surgery complications. J Healthc Qual. 2015;37(2):133–8.  https://doi.org/10.1111/jhq.12036.CrossRefPubMedGoogle Scholar
  11. 11.
    Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP, TaTME Registry Collaborative. Transanal Total Mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017;266(1):111–7.CrossRefGoogle Scholar
  12. 12.
    Buess G, Theiss R, Günther M, Hutterer F, Pichlmaier H. Endoscopic surgery in the rectum. Endoscopy. 1985;17(1):31–5.CrossRefGoogle Scholar
  13. 13.
    Christoforidis D, Cho HM, Dixon MR, Mellgren AF, Madoff RD, Finne CO. Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg. 2009;249(5):776–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Isacco Montroni
    • 1
  • Antonino Spinelli
    • 2
    • 3
  1. 1.Colorectal SurgeryAUSL- Romagna, Ospedale per gli Infermi- FaenzaFaenzaItaly
  2. 2.Division of Colon and Rectal SurgeryHumanitas Clinical and Research CenterMilanItaly
  3. 3.Department of Biomedical SciencesHumanitas UniversityMilanItaly

Personalised recommendations