Higher BMI significantly raises the risk of converting from minimally invasive to open surgery for colorectal procedures.

• Laparoscopic surgery rates were 36.4% in Nova Scotia versus 49.3% in the national cohort, with conversion rates of 23.1% and 19.3%, respectively.
• BMI was a strong predictor of conversion: odds ratio of 2.54 for Nova Scotia and 1.61 for the national cohort.

Surgeon experience matters—higher laparoscopic volume correlates with lower conversion rates, especially for right hemicolectomies. This underscores the need for careful patient selection and potential collaboration with experienced laparoscopic surgeons.