Status of minimally invasive HPB surgery in the UK from consultant and trainee perspectives

Abstract

Introduction: This survey took a snapshot of current attitudes towards minimally invasive HPB surgery from a consultant and trainee perspective. Methods: Two google surveys were emailed to all identified HPB centres in the UK to consultants and trainees (ST5+). The questionnaire contained 33 and 31 questions respectively regarding minimally invasive HPB practice and training. Results: Thirty-five HPB consultants completed the survey. The most common indications for conversion to open surgery were failure to progress in 91.4% (n=32), excessive intraoperative blood loss in 85.7% (n=30) and access issues in 85.7% (n=30). The majority (78.8%, n=26) of HPB surgeons surveyed undertook MIDP while 21.2% (n=7) did not as they deferred them to other surgeon(s) who regularly performed them. Only one consultant undertook minimally invasive pancreaticoduodenectomy (MIPD), robotically; 48.4% (n=15) declared not performing MIPDs as they were not convinced MIS is superior to an open approach. Eighty-five-point seven percent (n=30) performed minimally invasive minor liver resection and segmentectomy (MImLRS), 70.6% (n=24) reported better outcomes with an MIS approach, 23.5% (n=8) reported no difference in outcomes between the MIS and open approaches. Seventy percent (n= 5) performed minimally invasive major liver resection (MIMLR) laparoscopically and 30% (n=3) robotically; 56.3% (n=17) reported equivalent or better outcomes with an open approach while 23.3% (n=7) reported better outcomes with MIMLR. Half of polled HPB trainees did not have access to laparoscopic HPB procedures (excluding laparoscopic cholecystectomy); 22.2% (n=4) of trainees had a mentor in laparoscopic HPB procedures. Forty-four-point four percent of trainees (n=8) reported going to laparoscopic courses on cadaveric/live models while 44.4% (n=8) used internet-based media to improve their laparoscopic skills; 72.2% (n=13) desired an extension to training (or fellowship) to consolidate their laparoscopic training. Conclusion: MImLRS and MIDP would appear to be accepted approaches by most HPB consultants which correlates with a perception that outcomes are better/comparable to open approaches. This is less clear for MIPD and MIMLR. HPB trainees suffer from a lack of laparoscopic HPB exposure leading to seek further laparoscopic HPB experience with fellowships post certificate of completion of training.