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Robotic-assisted Lateral Pancreaticojejunostomy for Chronic Pancreatitis
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Open Conversion at Robotic Adrenalectomy: Rates and Predictors.

Andrea Marmiroli1,2,3, Mattia Longoni1,4,5, Quynh Chi Le1,6

  • 1Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.

Journal of Surgical Oncology
|July 12, 2026
PubMed
Summary

The rate of open conversion during robotic adrenalectomy decreased significantly over time. Patients with multiple comorbidities undergoing robotic adrenalectomy at low-volume hospitals face the highest risk of conversion to open surgery.

Keywords:
NISconversionradical adrenalectomyrobotic

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Area of Science:

  • Urology
  • Surgical Oncology
  • Robotic Surgery

Background:

  • The rates and predictors of open conversion during robotic adrenalectomy (rRA) remain largely unknown.
  • Understanding these factors is crucial for improving patient outcomes and surgical planning.

Purpose of the Study:

  • To analyze temporal trends in open conversion rates during rRA.
  • To identify independent predictors of open conversion in patients undergoing rRA.

Main Methods:

  • Utilized the National Inpatient Sample (NIS) database from 2009-2019, identifying patients who underwent rRA.
  • Assessed temporal trends using Estimated Annual Percentage Changes (EAPC).
  • Employed multivariable logistic regression to determine predictors of open conversion.

Main Results:

  • A total of 2,292 patients were included, with 286 (12.0%) experiencing open conversion.
  • Open conversion rates declined significantly from 39.2% to 10.2% over the study period (EAPC -15.9%, p=0.0003).
  • Higher comorbidity burden (Charlson Comorbidity Index [CCI] ≥4) and procedures at low-volume hospitals independently predicted open conversion (OR: 2.0 for both, p<0.001).

Conclusions:

  • Open conversion rates in rRA have substantially decreased over the past decade.
  • Patients with a CCI ≥4 undergoing rRA at low-volume hospitals represent a high-risk group, with a 25.9% conversion rate.
  • Transferring high-risk patients to medium-high volume hospitals could potentially halve the conversion rate to 13.4%.