Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands
van der Poel, Marcel J.; Fichtinger, Robert S.; Bemelmans, Marc; Bosscha, Koop; Braat, Andries E.; de Boer, Marieke T.; Dejong, Cornelis H. C.; Doornebosch, Pascal G.; Draaisma, Werner A.; Gerhards, Michael F.; Gobardhan, Paul D.; Gorgec, Burak; Hagendoorn, Jeroen; Kazemier, Geert; Klaase, Joost; Leclercq, Wouter K. G.; Liem, Mike S.; Lips, Daan J.; Marsman, Hendrik A.; Mieog, J. Sven D.; Molenaar, Quintus I.; Nieuwenhuijs, Vincent B.; Nota, Carolijn L.; Patijn, Gijs A.; Rijken, Arjen M.; Slooter, Gerrit D.; Stommel, Martijn W. J.; Swijnenburg, Rutger-Jan; Tanis, Pieter J.; te Riele, Wouter W.; Terkivatan, Turkan; van den Tol, Petrousjka M.; van den Boezem, Peter B.; van der Hoeven, Joost A.; Vermaas, Maarten; Abu Hilal, Moh'd; van Dam, Ronald M.; Besselink, Marc G.; Zonderhuis, Babs; Rinkes, Inne B.; Hoff, Christiaan; Oosterling, Steven
(2019) HPB, volume 21, issue 12, pp. 1734 - 1743
(Article)
Abstract
BACKGROUND: While most of the evidence on minimally invasive liver surgery (MILS) is derived from expert centers, nationwide outcomes remain underreported. This study aimed to evaluate the implementation and outcome of MILS on a nationwide scale. METHODS: Electronic patient files were reviewed in all Dutch liver surgery centers and all
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patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume. RESULTS: Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P < 0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P < 0.001). Outcomes of minor MILS were comparable with international studies (conversion 0-13%, mortality <1%). In centers which performed ≥20 MILS annually, major MILS was associated with less conversions (14 (11%) versus 41 (30%), P < 0.001), shorter operating time (184 (117-239) versus 200 (139-308) minutes, P = 0.010), and less overall complications (37 (30%) versus 58 (42%), P = 0.040). CONCLUSION: The nationwide use of MILS is increasing, although large variation remains between centers. Outcomes of major MILS are better in centers with higher volumes.
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Keywords: Aged, Attitude of Health Personnel, Conversion to Open Surgery/statistics & numerical data, Female, Hepatectomy/statistics & numerical data, Humans, Laparoscopy/statistics & numerical data, Learning Curve, Liver/surgery, Male, Middle Aged, Netherlands/epidemiology, Operative Time, Postoperative Complications/epidemiology, Retrospective Studies, Robotic Surgical Procedures/statistics & numerical data, Surgeons, Surveys and Questionnaires, Journal Article, Multicenter Study
ISSN: 1365-182X
Publisher: John Wiley & Sons Inc.
Note: Funding Information: We would like to acknowledge the following collaborators:, Babs Zonderhuis (Amsterdam UMC, location VUmc), Inne B. Rinkes (University Medical Center Utrecht), Christiaan Hoff (Medical Center Leeuwarden), and Steven Oosterling (Kennemer Hospital). Publisher Copyright: © 2019 International Hepato-Pancreato-Biliary Association Inc. Copyright: Copyright 2019 Elsevier B.V., All rights reserved.
(Peer reviewed)