Reasons for open conversion in robotic liver surgery: A systematic review with pooled analysis of more than 1000 patients

Abstract

BACKGROUND: Conversion to open during minimally invasive liver resection has a high rate. To identify the reasons to convert could help in defining a strategy to decrease the event "conversion." METHODS: A systematic review has been performed. Our large series of robotic hepatic resections were analyzed and included in the review. RESULTS: Fifty papers were selected and carefully evaluated in full text. Twenty-nine were ultimately used for analysis, including all published robotic liver resections. Our series included 11 conversions out of 139 patients (7.9%). Adhesions were not a declared reason to convert. The robotic approach still had a high percentage of open conversions because of difficulties in assessing the tumor margin. CONCLUSIONS: Causes for conversion were carefully analyzed and compared with what previously described for the pure laparoscopic approach. This could be crucial in defining how to improve the performance and minimize the conversion rate.