title: Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: zureikatah@upmc.edu.
authors.forename: Amer H
authors.initials: AH
authors.lastname: Zureikat
authors.affiliation: Wolff Center of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borrebach
authors.affiliation: Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.affiliation: Wolff Center of University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Mcgill
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Hogg
authors.affiliation: American College of Surgeons - National Surgical Quality Improvement Program, Chicago, IL, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Thompson
authors.affiliation: Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.affiliation: American College of Surgeons - National Surgical Quality Improvement Program, Chicago, IL, USA; Department of Surgery and Olin Business School, Washington University in St Louis, St Louis, MO, USA; BJC Healthcare, St Louis, MO, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Hall
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Herbert J
authors.initials: HJ
authors.lastname: Zeh
mesh_terms: D061887:Conversion to Open Surgery / Q000009:adverse effects; D016208:Databases, Factual; D019538:Health Care Surveys; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D016015:Logistic Models; D015999:Multivariate Analysis; D009656:North America; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D016896:Treatment Outcome