Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy

Background Procedural conversion rates represent an important aspect of the feasibility of minimally invasive surgical (MIS) approaches. This study aimed to outline the rates and predictors of procedural completion/conversion for MIS hepatectomy and pancreatectomy. Methods All 2014 ACS-NSQIP laparoscopic and robotic hepatectomy and pancreatectomy procedures were identified and grouped into pure, open assist, or unplanned conversion to open. Risk adjusted multinomial logistic regression models were generated with completion (Pure) set as the primary outcome. Results 1667 (laparoscopic = 1360, robotic = 307) resections were captured. After risk adjustment, robotic DP was associated with similar open assist (relative risk ratio −1.9%, P = 0.602), but lower unplanned conversion (−8.2%, P = 0.004) and open assist + unplanned conversion (−10.1%, P = 0.015) compared to laparoscopic DP; while robotic PD was associated with lower open assist (−22.2%, P < 0.001), unplanned conversions (−15%, P = 0.006) and open assist + unplanned conversions (−37.2, P < 0.001) compared to laparoscopic PD. The robotic and laparoscopic approaches to hepatectomy were not associated with differences in pure MIS completion rates (P = NS) after risk adjustment. Conclusions The robotic approach to pancreatectomy was associated with higher rates of pure MIS completion compared to laparoscopy, whereas no difference in MIS completion rates was noted for robotic versus laparoscopic hepatectomy.