The CONVERSION Study: Open Conversion Risk in Robotic vs Laparoscopic Surgery-A 20-Year Meta-analysis

Objective: To compare the rate of conversion to open surgery (OC) between robotic-assisted surgery (RAS) and laparoscopy (LAP) across 15 abdominal procedures. Background: OC worsens outcomes and costs; a cross-disciplinary estimate of OC risk in RAS versus LAP across general surgery and subspecialties has been lacking. Methods: PRISMA-guided systematic review (PubMed, Web of Science, Scopus; 2000-2023). Primary endpoint: pooled random-effects odds ratio (OR) for OC (RAS vs LAP) with 95% CIs; heterogeneity quantified by I² and τ². Meta-regression tested age, BMI, and sex. Results: 360 studies (14 RCTs, 36 prospective, 310 retrospective; 211,078 RAS and 1,358,201 LAP) from 30 countries met inclusion. RAS had lower pooled odds of OC than LAP across procedures and study types. Meta-regression showed no significant effect of age, BMI, or sex on OC. Heterogeneity was moderate-to-high overall and varied by procedure (full metrics and forest plots in SDC, http://links.lww.com/SLA/F670). Conclusions: Across diverse abdominal procedures, RAS is associated with lower OC risk. Findings support multi-specialty decision-making, while acknowledging heterogeneity, learning-curve effects, and procedure-specific evidence gaps.