Conversion in Minimally Invasive Liver Surgery: The Impact of Conversion Urgency and Surgical Approach.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Minimally invasive liver surgery (MILS) offers benefits, but conversion to open surgery may negate them and introduce risks.
• The impact of conversion on outcomes may vary based on urgency (emergency vs. elective) and surgical approach (robotic vs. laparoscopic).

Purpose of the Study:

• To evaluate the outcomes of emergency and elective conversions in robotic liver resection (RLR) and laparoscopic liver resection (LLR).
• To compare conversion outcomes between RLR and LLR.
• To identify risk factors for conversion in RLR and LLR.

Main Methods:

• Retrospective analysis of 10,548 MILS procedures from 34 international centers.
• Propensity score matching compared converted MILS with elective open liver surgery.
• Multivariable logistic regression identified conversion risk factors for RLR and LLR separately.

Main Results:

• 6.8% of MILS procedures were converted (n=719).
• Both emergency and elective conversions had longer operative times and increased Pringle maneuver use compared to open surgery.
• Emergency conversions were linked to higher blood loss, transfusion rates, severe morbidity, and mortality. No significant perioperative differences were found between RLR and LLR conversions, but RLR conversion mortality was 7.7%.

Conclusions:

• Emergency conversions in MILS are associated with adverse outcomes, underscoring the need for timely, controlled conversions.
• Elective conversions appear safe, suggesting careful planning is key.
• Further research is needed to investigate the safety of robotic liver resection conversions.