Spontaneous ureteral rupture: is immediate surgical intervention always necessary? Presentation of four cases and review of the literature.



Laparoscopic surgery has received wide acceptance within the urologic community. Conversion from standard laparoscopy to the open technique may sometimes be necessary. Conversion to an open procedure may have negative implications for both the surgeon and the patient. Conversion to hand-assisted laparoscopy under these circumstances, however, may obviate open surgery. We intended to review our results and emphasize the efficacy and safety of conversion to hand assistance during standard laparoscopy when necessary.


We retrospectively reviewed the results of laparoscopic nephrectomies performed by one surgeon. Demographic and perioperative data were noted. Conversions from standard laparoscopy were analyzed in detail.


A total of 161 laparoscopic nephrectomies were performed. Conversion was deemed appropriate in 6 of 150 standard laparoscopies. Surgery was successfully completed in five with hand assistance. The reason to convert was failure to progress in three patients and control of hemostasis in two patients. Open surgery was performed in a patient who could not tolerate pneumoperitoneum.


Conversion to hand-assisted laparoscopy is safe and effective when the surgeon decides to convert from standard laparoscopy. Conversion to hand assistance may prevent conversion to an open procedure in these situations.