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

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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.

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Acknowledgements

We would like to thank Monia Ilunga, MS, for her ongoing support and assistance in coordinating the working group meeting.

SAGES HPB Committee: Domenech Asbun6, Subhashini Ayloo8, Åsmund Avdem Fretland9, Georgios Georgakis10, Ana Gleisner11, Melissa Hogg12, Onur Kutlu13, David Kwon14, Edwin Onkendi15, Ankit D. Patel16, Nicolò Pecorelli17, Patricio M. Polanco18, Sharona Ross19, Mihir M. Shah16, Eve Simoneau20, Olivier Soubrane21, Iswanto Sucandy19

Funding

J.W. was supported by the University of California, San Francisco, Noyce Initiative Computational Innovator Postdoctoral Fellowship Award. M.M.S. was supported by the National Cancer Institute of the National Institutes of Health from the Emory K12 Clinical Oncology Training Program (K12 CA237806) and the Georgia CTSA ULI Program (UL1 TR002378). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Author notes

  1. Jane Wang, Pamela Lu, and Misha Armstrong are co-first authors.

  2. Adnan Alseidi, Alice Wei, and Hop S. Tran Cao are co-senior authors.

Authors and Affiliations

  1. Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Jane Wang & Adnan Alseidi

  2. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA

    Pamela Lu & Hop S. Tran Cao

  3. Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York City, NY, USA

    Misha Armstrong

  4. Department of Surgery, The MetroHealth System, Cleveland, OH, USA

    Kevin El-Hayek

  5. Department of Surgery, University of Toronto, Toronto, Canada

    Sean Cleary

  6. Department of Surgery, Baptist Health Miami Cancer Institute, Miami, FL, USA

    Horacio Asbun & Domenech Asbun

  7. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA

    Alice Wei

  8. Department of Surgery, Alpert School of Medicine, Brown University, Providence, RI, USA

    Subhashini Ayloo

  9. The Intervention Centre and Department of HPB Surgery, Oslo University Hospital, Oslo, Norway

    Åsmund Avdem Fretland

  10. Department of Surgery, Stony Brook University, Stony Brook, NY, USA

    Georgios Georgakis

  11. Department of Surgery, University of Colorado Cancer Center, Aurora, CO, USA

    Ana Gleisner

  12. Department of Surgery, Northshore University Health System, Evanston, IL, USA

    Melissa Hogg

  13. Department of Surgery, University of Miami Health System, Miami, FL, USA

    Onur Kutlu

  14. Department of Surgery, Cleveland Clinic, Cleveland, OH, USA

    David Kwon

  15. Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Edwin Onkendi

  16. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Ankit D. Patel & Mihir M. Shah

  17. Division of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy

    Nicolò Pecorelli

  18. Department of Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Patricio M. Polanco

  19. Department of Surgery, Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA

    Sharona Ross & Iswanto Sucandy

  20. Division of HPB Surgery and Liver Transplantation, University of Montreal, Montreal, Canada

    Eve Simoneau

  21. Department of Surgery, Institut Mutualiste Montsouris, Paris, France

    Olivier Soubrane

Authors
  1. Jane Wang
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  7. Adnan Alseidi
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Consortia

SAGES HPB Committee

  • Domenech Asbun
  • , Subhashini Ayloo
  • , Åsmund Avdem Fretland
  • , Georgios Georgakis
  • , Ana Gleisner
  • , Melissa Hogg
  • , Onur Kutlu
  • , David Kwon
  • , Edwin Onkendi
  • , Ankit D. Patel
  • , Nicolò Pecorelli
  • , Patricio M. Polanco
  • , Sharona Ross
  • , Mihir M. Shah
  • , Eve Simoneau
  • , Olivier Soubrane
  •  & Iswanto Sucandy

Corresponding author

Correspondence to Hop S. Tran Cao.

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Disclosures

Adnan Alseidi has received a speaker honorarium from Ethicon/Johnson & Johnson. Domenech Asbun is a consultant for Stryker and has received honoraria from Boston Scientific. Horacio Asbun is a consultant for Stryker, Ethicon, and Boston Scientific. Åsmund Avdem Fretland has received a speaker honorarium from Olympus and Bayer. Sean Cleary is a consultant for Ethicon and is on the advisory panel for Surgical Safety Technology. Georgios Georgakis is a consultant for Intuitive Surgical, Inc. Melissa Hogg has received a research grant from Intuitive Surgical, Inc. Ankit D. Patel has received a speaker honorarium from Intuitive Surgical, Inc. Sharona Ross is a consultant for Intuitive Surgical, Inc. and has received research grants from Intuitive Surgical, Inc. and Medtronic. Hop Tran Cao has received a research grant from Intuitive Surgical, Inc. Alice Wei is a consultant for Histosonics and Biosapien. Patricio M. Polanco serves as a proctor for Intuitive Surgical, Inc. and a consultant for iota Bioscience inc. and Palisade Bio inc. Edwin Onkendi is a proctor for Intuitive Surgical, Inc. Mihir M. Shah is a proctor for Intuitive Surgical, Inc. Jane Wang, Pamela Lu, Misha Armstrong, Kevin El-Hayek, Subhashini Ayloo, Ana Gleisner, Onur Kutlu, David Kwon, Nicolò Pecorelli, Eve Simoneau, Olivier Soubrane, and Iswanto Sucandy have no conflicts of interest or financial ties to disclose.

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Members of SAGES HPB Committee are presented in Acknowledgement section.

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Wang, J., Lu, P., Armstrong, M. et al. Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10957-x

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