Conversion rates from total robotic hysterectomy to laparotomy in gynecologic oncology surgery

The widespread adoption of the da Vinci robotic systems across medical centres has enabled gynecology oncologists to perform more complex gynecologic procedures by minimally invasive approaches, leading to improved patient outcomes. In this context, conversion - both planned and unplanned - from robotics to laparotomy represent a key metric. We conducted a narrative review to determine the conversion rate from robotic to laparotomy and synthesized the key reasons why conversions take place in gynecologic oncology procedures. A total of 27 retrospective/prospective studies were included in the review, with a total of 474/11,766 (4.0%) documented robotic cases with conversions. The most prominent reason for robotic conversion to laparotomy in gynecologic oncology was for the purpose of specimen removal due to uterine size (N.=105). Second, came the extent of disease (N.=74), and third were adhesions (N.=65). A clear association between conversion and Body Mass Index was gleaned from the data. Our narrative review shows a 4.0% conversion rate from robotic to laparotomy in complex gynecologic oncology procedures. Reasons relate to planned conversion as in the case of specimen removal, whereas a number of cases were related to upholding oncologic principles and avoid tumor spillage or adhesions.