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Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis
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The CONVERSION Study: Open Conversion Risk in Robotic vs Laparoscopic Surgery-A 20-Year Meta-analysis.

Antonio Gangemi1,2, Amir Ebadinejad3, Anthony P Lisi1

  • 1Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum Università of Bologna. Via Massarenti, 9 - 40138 Bologna, Italy.

Annals of Surgery
|November 14, 2025
PubMed
Summary
This summary is machine-generated.

Robotic-assisted surgery (RAS) shows a lower rate of conversion to open surgery (OC) compared to laparoscopy (LAP) across many abdominal procedures. This finding supports RAS in surgical decision-making, considering procedure-specific data.

Keywords:
da Vincilaparoscopicmeta-analysisopen conversionoutcomesrobot surgery

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Outcomes Research
  • Comparative Effectiveness

Background:

  • Conversion to open surgery (OC) negatively impacts patient outcomes and healthcare costs.
  • A comprehensive understanding of OC risk differences between robotic-assisted surgery (RAS) and laparoscopy (LAP) across various surgical specialties is needed.

Purpose of the Study:

  • To systematically compare the incidence of OC between RAS and LAP for 15 distinct abdominal procedures.
  • To provide a cross-disciplinary estimate of OC risk associated with RAS versus LAP.

Main Methods:

  • A PRISMA-guided systematic review and meta-analysis of studies published between 2000 and 2023.
  • Pooled random-effects odds ratios (OR) were calculated to compare OC rates (RAS vs. LAP).
  • Meta-regression analyses explored the influence of patient factors (age, BMI, sex) on OC rates.

Main Results:

  • The review included 360 studies encompassing 211,078 RAS and 1,358,201 LAP cases from 30 countries.
  • Robotic-assisted surgery (RAS) demonstrated significantly lower pooled odds of conversion to open surgery (OC) compared to laparoscopy (LAP).
  • Patient demographics including age, BMI, and sex did not significantly affect OC rates in meta-regression analyses.

Conclusions:

  • Robotic-assisted surgery (RAS) is associated with a reduced risk of conversion to open surgery (OC) across a wide range of abdominal procedures.
  • These findings support the use of RAS in surgical decision-making, while highlighting the importance of considering procedural heterogeneity and potential learning-curve effects.