Low conversion rate during minimally invasive major hepatectomy:Ten-year experience at a high-volume center

Document Type



Medical College Pakistan; Gastroenterology


Background:Minimally invasive approaches for major hepatectomy have been marred by significantrates of conversion and associated morbidity. This study aimed to determine risk factors for conversion aswell as postoperative morbidity in patients undergoing minimally invasive right-sided hepatectomy(MIRH).

Methods:Data for patients undergoing MIRH between 2008 and 2017 at Emory University werereviewed. Risk factors for conversion were determined using multivariate regression analysis. Outcomesof conversion patients were compared with those who underwent successful MIRH or elective opensurgery.

Results:Unplanned conversion occurred in 7 (6.25%) of 112 patients undergoing MIRH. Primary reasonfor conversion was difficult dissection secondary to inflammation and severe adhesions. No preoperativeclinical factor was identified that predicted conversions. Converted cases had higher EBL and pRBCtransfusion compared to non-converted cases however morbidity was similar to those undergoing pri-mary open surgery.

Conclusion:Difficult dissection and adhesions remained the only clinically applicable parameter leadingto unplanned conversions. While these did offset benefits of a successful minimally invasive approach, itdid not increase risk of postoperative complications compared with planned open surgery.

Publication (Name of Journal)

The American Journal of Surgery