TY - JOUR
T1 - Minimally invasive hepatopancreatobiliary surgery in North America
T2 - an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy
AU - Zureikat, Amer H.
AU - Borrebach, Jeffrey
AU - Pitt, Henry A.
AU - Mcgill, Douglas
AU - Hogg, Melissa E.
AU - Thompson, Vanessa
AU - Bentrem, David J.
AU - Hall, Bruce L.
AU - Zeh, Herbert J.
N1 - Publisher Copyright:
© 2017 International Hepato-Pancreato-Biliary Association Inc.
PY - 2017/7
Y1 - 2017/7
N2 - Background 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. Methods 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. Results 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. Conclusions 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.
AB - Background 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. Methods 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. Results 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. Conclusions 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.
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U2 - 10.1016/j.hpb.2017.03.004
DO - 10.1016/j.hpb.2017.03.004
M3 - Article
C2 - 28400087
AN - SCOPUS:85017113932
SN - 1365-182X
VL - 19
SP - 595
EP - 602
JO - HPB
JF - HPB
IS - 7
ER -