Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy

Amer H. Zureikat, Jeffrey Borrebach, Henry A. Pitt, Douglas Mcgill, Melissa E. Hogg, Vanessa Thompson, David J. Bentrem, Bruce L. Hall, Herbert J. Zeh

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)595-602
Number of pages8
JournalHPB
Volume19
Issue number7
DOIs
StatePublished - Jul 2017
Externally publishedYes

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Pancreatectomy
Minimally Invasive Surgical Procedures
Robotics
Hepatectomy
North America
Risk Adjustment
Logistic Models
Laparoscopy
Odds Ratio

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Minimally invasive hepatopancreatobiliary surgery in North America : an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. / Zureikat, Amer H.; Borrebach, Jeffrey; Pitt, Henry A.; Mcgill, Douglas; Hogg, Melissa E.; Thompson, Vanessa; Bentrem, David J.; Hall, Bruce L.; Zeh, Herbert J.

In: HPB, Vol. 19, No. 7, 07.2017, p. 595-602.

Research output: Contribution to journalArticle

Zureikat, Amer H. ; Borrebach, Jeffrey ; Pitt, Henry A. ; Mcgill, Douglas ; Hogg, Melissa E. ; Thompson, Vanessa ; Bentrem, David J. ; Hall, Bruce L. ; Zeh, Herbert J. / Minimally invasive hepatopancreatobiliary surgery in North America : an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. In: HPB. 2017 ; Vol. 19, No. 7. pp. 595-602.
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abstract = "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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AU - Borrebach, Jeffrey

AU - Pitt, Henry A.

AU - Mcgill, Douglas

AU - Hogg, Melissa E.

AU - Thompson, Vanessa

AU - Bentrem, David J.

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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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