Laparoscopic surgery for fibroid uterus: when to convert to laparotomy

The risk of conversion to conventional laparotomy during any laparoscopic surgery is inherent in the procedure itself. The conversion should not be regarded as an adverse event or failure but an attempt to complete surgery safely and efficiently. In general, converted cases are associated with more intraoperative blood loss and a longer hospital stay, thus increasing the morbidity. The risk factors that can lead to conversion are increased specimen weight, adhesions, poor vision, hemorrhage, organ damage, obesity, and encountering associated pathologies, especially endometriosis. Knowledge of these risk factors during the preoperative evaluation can help in correct decision-making and counseling for realistic expectations of the surgical outcomes. There are two types of conversions: strategic and reactive conversion. A balance between strategic and reactive conversion should be maintained by a good surgical team while leaning on strategic conversions. Having an understanding of surgical anatomy and confidence in one’s own surgical skills can help the surgical team make this timely decision.