Application of minimally invasive pancreatic surgery: an Italian survey
- 56 Downloads
The value of minimally invasive pancreatic surgery (MIPS) is still debated. To assess the diffusion of MIPS in Italy and identify the barriers preventing wider implementation, a questionnaire was developed under the auspices of three Scientific Societies (AISP, It-IHPBA, SICE) and was sent to the largest possible number of Italian surgeons also using the mailing list of the two main Italian Surgical Societies (SIC and ACOI). The questionnaire consisted of 25 questions assessing: centre characteristics, facilities and technologies, type of MIPS performed, surgical techniques employed and opinions on the present and future value of MIPS. Only one reply per unit was considered. Fifty-five units answered the questionnaire. While 54 units (98.2%) declared to perform MIPS, the majority of responders were not dedicated to pancreatic surgery. Twenty-five units (45.5%) performed < 20 pancreatic resections/year and 39 (70.9%) < 10 MIPS per year. Forty-nine units (89.1%) performed at least one minimally invasive (MI) distal pancreatectomy (DP), and 10 (18.2%) at least one MI pancreatoduodenectomy (PD). Robotic assistance was used in 18 units (31.7%) (14 DP, 7 PD). The major constraints limiting the diffusion of MIPS were the intrinsic difficulty of the technique and the lack of specific training. The overall value of MIPS was highly rated. Our survey illustrates the current diffusion of MIPS in Italy and underlines the great interest for this approach. Further diffusion of MIPS requires the implementation of standardized protocols of training. Creation of a prospective National Registry should also be considered.
KeywordsMinimally invasive surgery Laparoscopy Robotic surgery Pancreatic surgery Survey Italy
We thank the “Associazione Italiana Studio Pancreas” (AISP), the “Italy National Chapter of International Hepato-Pancreato-Biliary Association” (It-IHPBA), and the “Società Italiana di Chirurgia Endoscopica” (SICE) for the creation, patronage and active support of this survey. We also thank the “Società Italiana di Chirurgia” (SIC) and the “Associazione Chirurghi Ospedalieri Italiani” (ACOI) for their endorsement and logistical support for this survey.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Research involving human participants and/or animals
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study formal consent is not required.
- 4.Rogers EM (1995) Diffusion of innovations, 4th edn. Free Press, New YorkGoogle Scholar
- 12.Vollmer CM, Asbun HJ, Barkun J, Besselink MG, Boggi U, Conlon KC, Han HS, Hansen PD, Kendrick ML, Montagnini AL, Palanivelu C, Røsok BI, Shrikhande SV, Wakabayashi G, Zeh HJ, Kooby DA (2017) Proceedings of the first international state-of-the-art conference on minimally-invasive pancreatic resection (MIPR). HPB (Oxford) 19:171–177CrossRefGoogle Scholar
- 13.Kooby DA, Vollmer CM (2017) State of the art on minimally invasive pancreatic resections: IHPBA 2016 conference. In: Boggi U (ed) Minimally invasive surgery of the pancreas. Springer, Italy, pp 1–13Google Scholar
- 15.Casistica Posti Letto per Struttura Ospedaliera (2015) http://www.dati.salute.gov.it/imgs/C_17_dataset_18_download_itemDownload_0_upFile.csv. Accessed 16 Jan 2018
- 16.De Rooij T, Lu MZ, Steen MW, Gerhards MF, Dijkgraaf MG, Busch OR, Lips DJ, Festen S, Besselink MG, Dutch Pancreatic Cancer Group (2016) Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg 264:257–267CrossRefPubMedGoogle Scholar
- 21.Hogg ME, Besselink MG, Clavien PA, Fingerhut A, Jeyarajah DR, Kooby DA, Moser AJ, Pitt HA, Varban OA, Vollmer CM, Zeh HJ 3rd, Hansen P (2017) Minimally Invasive Pancreatic Resection Organizing Committee. Training in minimally invasive pancreatic resections: a paradigm shift away from “See one, Do one, Teach one”. HPB (Oxford) 19:234–245CrossRefGoogle Scholar
- 22.De Rooij T, van Hilst J, Topal B, Bosscha K, Brinkman DJ, Gerhards MF, de Hingh IH, Karsten TM, Lips DJ, Luyer MD, Marsman HA, van Rijssen LB, Steen MW, Busch OR, Festen S, Besselink MG; Dutch Pancreatic Cancer Group (2017) Outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LAELAPS-2). Ann Surg. https://doi.org/10.1097/SLA.0000000000002563 Google Scholar
- 27.Ravaioli M, Pinna AD, Francioni G, Montorsi M, Veneroni L, Grazi GL, Palini GM, Gavazzi F, Stacchini G, Ridolfi C, Serenari M, Zerbi A (2014) A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery. Ann Surg 260(5):871–875. https://doi.org/10.1097/sla.0000000000000975 (discussion 875–7) CrossRefPubMedGoogle Scholar
- 28.Aldrighetti L, Ratti F, Cillo U, Ferrero A, Ettorre GM, Guglielmi A, Giuliante F, Calise F (2017) Italian Group of Minimally Invasive Liver Surgery (I GO MILS). Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry. Updates Surg 69(3):271–283CrossRefPubMedGoogle Scholar