title: Risk factors for robotic gynecologic procedures requiring conversion to other surgical procedures.
abstract: OBJECTIVE
  To determine the incidence of, and risk factors for, conversion from robotic gynecologic procedures to other procedure types.
  
  
  METHODS
  A retrospective cohort study included data from women who underwent any robotic gynecologic procedures between January 1, 2011 and December 31, 2012 at a tertiary care referral center in the USA. Demographic data, perioperative data, and surgeon experience (monthly case volume) data were retrieved; potential risk factors were compared between robotic procedures that were converted to other procedures and those completed as robotic procedures.
  
  
  RESULTS
  There were 942 robotic procedures during the study period. Conversion from robotic to any other type of procedure was recorded for 47 (5.0%, 95% confidence interval 3.8-6.6) procedures and robotic-to-open-surgery conversion occurred in 16 (1.7%, 95% confidence interval 1.0-2.7) procedures. Conversion from robotic surgery to another approach was associated with higher body mass index (P<0.001), previous laparotomy (P=0.042), and surgeons having a lower monthly robotic surgical case volume (P=0.011). Asthma (P=0.008), intra-operative bowel injury (P<0.001), intra-operative vascular injury (P=0.003), and single-port robotic surgery (P=0.034) were associated with increased odds of requiring conversion from robotic procedures.
  
  
  CONCLUSIONS
  The overall incidence of conversion from robotic surgery to laparotomy was low. Higher body mass index, previous laparotomy, history of asthma, using a single-port approach, and surgeon case volume were associated with the risk of conversion.
authors: Obstetrics, Gynecology, and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ungerc@ccf.org.
authors: Cecile A
authors: CA
authors: Unger
authors: Obstetrics, Gynecology, and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors: Mark P
authors: MP
authors: Lachiewicz
authors: Obstetrics, Gynecology, and Women's Health Institute, Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors: Beri
authors: B
authors: Ridgeway
mesh_terms: D000328:Adult; D000368:Aged; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007813:Laparotomy / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D062606:Tertiary Care Centers; D014481:United States
keywords: Robotic hysterectomy; Robotic surgery; Robotic-assisted laparoscopy