Abstract
Laparoscopic and robotic minimally invasive liver surgery (MILS) is gaining popularity. Recent data and views on the implementation of laparoscopic and robotic MILS throughout Europe are lacking. An anonymous survey consisting of 46 questions was sent to all members of the European-African Hepato-Pancreato-Biliary Association. The survey was completed by 120 surgeons from 103 centers in 24 countries. Median annual center volume of liver resection was 100 [IQR 50-140]. The median annual volume of MILS per center was 30 [IQR 16-40]. For minor resections, laparoscopic MILS was used by 80 (67%) surgeons and robotic MILS by 35 (29%) surgeons. For major resections, laparoscopic MILS was used by 74 (62%) surgeons and robotic MILS by 33 (28%) surgeons. The majority of the surgeons stated that minimum annual volume of MILS per center should be around 21-30 procedures/year. Of the surgeons performing robotic surgery, 28 (70%) felt they missed specific equipment, such as a robotic-CUSA. Seventy (66%) surgeons provided a formal MILS training to residents and fellows. In 5 years' time, 106 (88%) surgeons felt that MILS would have superior value as compared to open liver surgery. In the participating European liver centers, MILS comprised about one third of all liver resections and is expected to increase further. Laparoscopic MILS is still twice as common as robotic MILS. Development of specific instruments for robotic liver parenchymal transection might further increase its adoption.
Highlights
Invasive liver surgery (MILS) was first described by Gagner et al.1 in 1993 with a laparoscopic approach and by Giulianotti et al.2 in 2003 with a robotic approach
A systematic review of comparative cohort studies reported reduced morbidity and shorter hospital stay with robotic minimally invasive liver surgery (MILS) as compared to open liver surgery
Non-normally distributed continuous data were presented as medians and interquartile ranges (IQRs) or 95%
Summary
Invasive liver surgery (MILS) was first described by Gagner et al. in 1993 with a laparoscopic approach and by Giulianotti et al. in 2003 with a robotic approach. MILS over open liver surgery, including reduced intraoperative blood loss, shorter hospital stay and less morbidity with equivalent oncological results.. An increasing number of studies assessed the use of robotic MILS.. A systematic review of comparative cohort studies reported reduced morbidity and shorter hospital stay with robotic MILS as compared to open liver surgery.. The present opinions of European liver surgeons on the current and future practice of laparoscopic and robotic MILS are unknown. Laparoscopic and robotic minimally invasive liver surgery (MILS) is gaining popularity. Recent data and views on the implementation of laparoscopic and robotic MILS throughout Europe are lacking
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