ArticleAnnals of surgical oncology2023
Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches.
Article in Annals of surgical oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- From laparoscopy to robotics in living donor hepatectomy: a systematic review and meta-analysis of comparative outcomes.Journal of robotic surgery · 2026Pooled it
- Robotic versus laparoscopic liver resection for difficult posterosuperior segments: a systematic review with a meta-analysis of propensity-score matched studies.Surgical endoscopy · 2025Pooled it
- Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Trial
- From IDEAL learning curve to team maturation: a decade of experience reducing conversion in laparoscopic liver resection.Surgical endoscopy · 2026Article
- Robotic Versus Laparoscopic Hepatectomy: a Systematic Review of Perioperative and Short-Term Oncologic Outcomes.Maedica · 2026Review
- ALPPS for perihilar cholangiocarcinoma in a patient with cirrhosis and cardiopulmonary comorbidities: a case report.International journal of surgery case reports · 2026Article
- Conversion in Minimally Invasive Liver Surgery: The Impact of Conversion Urgency and Surgical Approach.Annals of surgical oncology · 2026Article
- Robotic liver resection in minimally invasive expert centers is associated with a very low rate of bile leakage: results from a national multicenter cohort.Journal of robotic surgery · 2026Observational
- FRIES score: predicting conversion in robotic liver surgery.BJS open · 2026Article
- [Influencing factors and results of conversions in minimally invasive liver surgery : A single-center analysis of over 1200 consecutive cases].Chirurgie (Heidelberg, Germany) · 2026Article
- Better outcomes of robotic liver resection in segment VII/VIII compared to open and laparoscopic approach.Journal of robotic surgery · 2026Article
- Robotic Hepatectomy for Primary Liver Cancer.Annals of surgical oncology · 2026Review
- Risk factors of conversion to hand-assisted laparoscopic surgery or open surgery in laparoscopic liver resection: a multicenter prospective study (HiSCO-08).Scientific reports · 2025Article
- Laparoscopic Versus Open Caudate Lobe Resection: A Systematic Review with a Meta-Analysis of Comparative Studies.Journal of clinical medicine · 2025Review
- Complete transition from laparoscopic to robotic liver surgery achieves superior outcomes in difficult hepatectomies: a seven-year retrospective study.Surgical endoscopy · 2025Article
- Advances in minimally invasive liver surgery: comparing robotic and laparoscopic approaches.Hepatobiliary surgery and nutrition · 2025Article
- Article
- Minimally Invasive Surgery in Acute Bowel Obstruction: Should It Become the Standard of Care? A Prospective, Single Center, Observational Study.Journal of clinical medicine · 2024Article
- Robotic Versus Laparoscopic Liver Resection: A Nationwide Propensity Score Matched Analysis.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2024Article
- Experience-based transition to robotic surgery in an experienced program in minimally invasive hepatobiliary surgery.Surgical endoscopy · 2024Article
Corrections and comments
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Authors and funding
62 authors.
Funding
Abstract
introductionDespite the advances in minimally invasive (MI) liver surgery, most major hepatectomies (MHs) continue to be performed by open surgery. This study aimed to evaluate the risk factors and outcomes of open conversion during MI MH, including the impact of the type of approach (laparoscopic vs. robotic) on the occurrence and outcomes of conversions.
methodsData on 3880 MI conventional and technical (right anterior and posterior sectionectomies) MHs were retrospectively collected. Risk factors and perioperative outcomes of open conversion were analyzed. Multivariate analysis, propensity score matching, and inverse probability treatment weighting analysis were performed to control for confounding factors.
resultsOverall, 3211 laparoscopic MHs (LMHs) and 669 robotic MHs (RMHs) were included, of which 399 (10.28%) had an open conversion. Multivariate analyses demonstrated that male sex, laparoscopic approach, cirrhosis, previous abdominal surgery, concomitant other surgery, American Society of Anesthesiologists (ASA) score 3/4, larger tumor size, conventional MH, and Institut Mutualiste Montsouris classification III procedures were associated with an increased risk of conversion. After matching, patients requiring open conversion had poorer outcomes compared with non-converted cases, as evidenced by the increased operation time, blood transfusion rate, blood loss, hospital stay, postoperative morbidity/major morbidity and 30/90-day mortality. Although RMH showed a decreased risk of conversion compared with LMH, converted RMH showed increased blood loss, blood transfusion rate, postoperative major morbidity and 30/90-day mortality compared with converted LMH.
conclusionsMultiple risk factors are associated with conversion. Converted cases, especially those due to intraoperative bleeding, have unfavorable outcomes. Robotic assistance seemed to increase the feasibility of the MI approach, but converted robotic procedures showed inferior outcomes compared with converted laparoscopic procedures.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.