title: Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases.
abstract: BACKGROUND
  As a consequence of continuous technical developments in liver surgery, laparoscopic liver resection (LLR) is increasingly performed worldwide.
  
  
  METHODS
  Between January 2004 and December 2011, 265 LLR were performed in 242 patients for various diseases. The experience of LLR is reported focusing on risk factors of conversion and their management.
  
  
  RESULTS
  The overall conversion rate was 17/265 (6.4%), equally distributed over the period of the study. Statistically significant factors for conversion were found to be LLR of the postero-superior (P-S) segments (SI, SIVa; SVII; SVIII) (12.7% converted versus 2.5% non-converted groups, P = 0.01) and a major compared with a minor hepatectomy (15.2% vs. 4.6%, P = 0.02 respectively). A R0 resection was achieved in 93.2% of cases. According to Dindo's classification, complications were recorded as grade I (n = 20); grade II (6); grade III (11) and grade IV(1) events (total morbidity rate of 14%). Univariate analysis identified a major hepatectomy and resection involving P-S segments as prognostic factors for conversion whereas multivariate analysis identified the latter as an independent risk factor [P = 0.003, odds ratio (OR) = 5.9, 95% confidence interval (CI) = 1.8-18.8].
  
  
  CONCLUSIONS
  LLR can be safely performed with low overall morbidity. According to this experience and irrespective of the learning curve, resections of P-S segments were identified as an independent risk factor for conversion in LLR.
authors.affiliation: Department of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent, Belgium.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Troisi
authors.forename: Roberto
authors.initials: R
authors.lastname: Montalti
authors.forename: Jurgen G M
authors.initials: JG
authors.lastname: Van Limmen
authors.forename: Daniele
authors.initials: D
authors.lastname: Cavaniglia
authors.forename: Koen
authors.initials: K
authors.lastname: Reyntjens
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.forename: Bernard
authors.initials: B
authors.lastname: De Hemptinne
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome