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17-06-2024

Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation

Authors: Jane Wang, Pamela Lu, Misha Armstrong, Kevin El-Hayek, Sean Cleary, Horacio Asbun, Adnan Alseidi, Alice Wei, Hop S. Tran Cao, SAGES HPB Committee

Published in: Surgical Endoscopy

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Abstract

Background

Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers or surgeons who wish to implement MIS HPB surgery. The aim of this study was to create a consensus statement regarding safe dissemination and implementation of MIS HPB surgical programs.

Methods

Sixteen key questions regarding safety in MIS HPB surgery were generated after a focused literature search and iterative review by three field experts. Participants for the working group were then selected using sequential purposive sampling and snowball techniques. Review of the 16 questions took place over a single 2-h meeting. The senior author facilitated the session, and a modified nominal group technique was used.

Results

Twenty three surgeons were in attendance. All participants agreed or strongly agreed that formal guidelines should exist for both institutions and individual surgeons interested in implementing MIS HPB surgery and that routine monitoring and reporting of institutional and surgeon technical outcomes should be performed. Regarding volume cutoffs, most participants (91%) agreed or strongly agreed that a minimum annual institutional volume cutoff for complex MIS HPB surgery, such as major hepatectomy or pancreaticoduodenectomy, should exist. A smaller proportion (74%) agreed or strongly agreed that a minimum annual surgeon volume requirement should exist. The majority of participants agreed or strongly agreed that surgeons were responsible for defining (100%) and enforcing (78%) guidelines to ensure the overall safety of MIS HPB programs. Finally, formal MIS HPB training, minimum case volume requirements, institutional support and infrastructure, and mandatory collection of outcomes data were all recognized as important aspects of safe implementation of MIS HPB surgery.

Conclusions

Safe implementation of MIS HPB surgery requires a thoughtful process that incorporates structured training, sufficient volume and expertise, a proper institutional ecosystem, and monitoring of outcomes.
Appendix
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Metadata
Title
Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation
Authors
Jane Wang
Pamela Lu
Misha Armstrong
Kevin El-Hayek
Sean Cleary
Horacio Asbun
Adnan Alseidi
Alice Wei
Hop S. Tran Cao
SAGES HPB Committee
Publication date
17-06-2024
Publisher
Springer US
Published in
Surgical Endoscopy
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-10957-x
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