The influence of the I Go MILS (italian group of minimally invasive liver surgery) registry on the implementation of MILS programs in a single center

Abstract

Background: In 2014 the I Go MILS registry was established with the aim to collect MILS experience and to promote it in Italy. The primary endpoint of the present study was to evaluate the recent trends in MILS diffusion and to analyze its correlation with the registry establishment in a single, tertiary referral center. Methods: 2230 liver laparoscopic resections were performed between 2004 and 2016: 506 of them were performed laparoscopically. The MILS/Total Series (TS) ratio was evaluated to analyse the correlation between laparoscopic activity and registry establishment. Results: The overall MILS/TS ratio was 22.7% in the study period, ranging from 5.8% in 2005 to 56% in 2016. The cut-off point for spread of MILS activity (>30%) was determined after 2014 (Registry). The median number of laparoscopic procedures before and after 2014 was 35 and 81 respectively (p<0.05). Registry establishment resulted among factors significantly associated with MILS approach. After 2014, the median number of major hepatectomies and complex liver resections per year significantly increased (respectively 6 and 11 before 2014 and 25 and 38 after 2014, p<0.05). After 2014, outcomes in terms of blood loss, morbidity, mortality and length of stay did not significantly differ from the previous period. Conversion rate was 11.8% before and 15.7% after 2014. Conclusion: The birth of I Go MILS registry promoted the diffusion and implementation of MILS programs, witnessing the role of MILS as mandatory in a liver surgery program.