Bastawrous AL, et al. - Patients undergoing primary elective sigmoidectomy for the diverticular disease were identified using the US Premier Healthcare Database, for risk factors for conversion of laparoscopic and robotic-assisted sigmoidectomy to open surgery. Researchers identified 13,240 sigmoidectomy patients; 8076 of these underwent laparoscopic sigmoidectomy, 1301 underwent robotic-assisted sigmoidectomy, 3863 underwent open surgery. Observations revealed higher risk of conversion among patients who were Black compared with Caucasian, were Medicaid-insured vs Commercially insured, had a Charlson Comorbidity Index ≥ 2 vs 0, were obese, had concomitant colon resection, had peritoneal abscess or fistula, or had lysis of adhesions. Robotic-assisted sigmoidectomy (vs laparoscopic), hand-assisted surgery, higher surgeon volume, and surgeons who were colorectal specialties were noted to be correlated with a significantly lower risk of conversion. Additional morbidity and healthcare costs were evident with the conversion from minimally invasive to open sigmoidectomy for diverticular disease. They suggest considering the modifiable risk factors for conversion to reduce adverse associated outcomes.