Abstract
BACKGROUND: Minimally invasive liver surgery is associated with lower complication rates compared to open liver surgery. Due to the growing acceptance and increasing experience with minimally invasive liver resections, open conversions have become rare but are associated with inferior postoperative outcomes. OBJECTIVES: We aimed to investigate the risk factors for conversion and outcomes in patients undergoing minimally invasive liver resections. MATERIAL AND METHODS: We performed a post hoc analysis of 1209 consecutive minimally invasive liver resections at our center between 2015 and 2024. The factors and perioperative outcomes of conversion to open procedures were analyzed. RESULTS: The conversion rate was 4.1% and left hemihepatectomy was associated with an increased conversion rate. The Harmonic Ace® and Waterjet® parenchyma dissectors were associated with lower conversion rates. The most common reasons for conversion were technical and adhesions. Major complications (Clavien Dindo ≥ III) within the first 90 days occurred in 18.3% of cases and conversions were associated with an increased complication rate. CONCLUSION: In conclusion, this study highlights the influencing factors which correlate to open conversion in minimally invasive liver resections. Open conversion was an independent predictor of an increased complication rate.