Reducing conversion in minimally invasive distal pancreatectomy: patient selection, training, and robotics

Minimally invasive surgery (MIS) has become the preferred approach to distal pancreatectomy at many high-volume institutions, but only accounts for 15% of distal pancreatectomies performed in the United States (1,2). This approach is used for a variety of histologies, including malignancy (3-5). As with all minimally invasive procedures, there is a risk of conversion to an open procedure, which rises with the complexity of the procedure. The conversion rate for MIS distal pancreatectomy varies in the literature from 3–31% for laparoscopic procedures (6).