Robotic Surgery Has Lower Risk of Open Conversion than Laparoscopy for Abdominal Procedures

Gangemi A, Ebadinejad A, Lisi AP, et al. The CONVERSION Study: Open Conversion Risk in Robotic vs Laparoscopic Surgery—A 20-Year Meta-analysis Ann Surg. November 2025. 

This 20-year meta-analysis aggregated 360 studies, including 211,078 robotic and 1,358,201 laparoscopic abdominal procedures performed across 30 countries. Robotic surgery demonstrated consistently lower open conversion rates, producing a pooled odds ratio that favored robotics despite substantial heterogeneity. Patient factors, including age, sex, and body mass index (BMI), did not significantly modify the association on meta-regression. Most included data were retrospective, and definitions of conversion varied across studies.

Robotic cohorts were typically older and had higher BMI, yet still exhibited lower conversion risk, suggesting a true modality level technical advantage rather than simple case mix effects. Procedural representation was broad, including 15 abdominal operations and learning curve data were inconsistently captured. The overall dataset approached 1.57 million patients, supporting strong statistical power but limiting procedure-specific granularity.

For abdominal MIS practice, these findings indicate that robotic platforms may meaningfully reduce open conversion, an endpoint associated with higher morbidity, longer hospitalization, and increased cost. Still, the very wide procedural mix, inconsistent operative reporting, and potential publication bias constrain the precision of the pooled estimate. Prospective, operation-specific studies with standardized conversion definitions and surgeon volume adjustment are needed to identify which procedures derive the greatest benefit.