HPB Blog, March 2017

The March issue of HPB is a special feature issue focusing on minimally invasive pancreatic surgery and based on a state-of-the-art conference supported by IHPBA and AHPBA and held as part of the IHPBA World Conference in Sao Paolo, Brazil in April 2016.  The meeting was co-chaired by David Kooby and Chuck Vollmer and the organising committee included a broad geographic representation of pancreatic surgeons. This issue of HPB contains 9 papers from this meeting including the first by Vollmer et al which describes the organisation of the consensus meeting and its scope. Bassi and Andianello set out the criteria required for the safe practice of minimally invasive pancreatic resection (MIPR) and make the case for the need for outcome monitoring for safe and effective integration of MIPR into existing open resection programmes. Montagnini et al have tackled the subject of nomenclature for MIPR and robotic procedures through using a Delphi approach in an effort to standardize the language used in the literature around pancreatic surgery both in terms of the surgical approach but also the resection itself. van Hilst and colleagues present a World wide survey of pancreatic surgeons  which includes responses from more than 400 surgeons. They report the widescale acceptance of MI distal pancreatectomy (MIDP) but the slower acceptance the opinion that there is a need for further evaluation of MI pancreaticoduodenectomy (MIPD). Interestingly they identified a gap in training for MIPR.

Røsok et al have produced a paper, which analyses the outcomes of MIDP versus open distal pancreatectomy. They acknowledge that the quality of studies was poor and that there were no randomised controlled trials. Comparative analysis based on in hospital and cancer outcomes shows equivalency between MIDP and open distal pancreatectomy with less blood loss and shorter hospital stays in laparoscopically operated patients. This theme is continued in the paper by Kendrick and colleagues who looked at the evidence for MIPD versus open pancreaticoduodenectomy. They too found no randomised studies but a large number of cohort studies. In this case there was a tendency for longer operating times in MIPD patients who also had less blood loss and shorter hospital stays compared with patients undergoing open pancreaticoduodenectomy. Conlon et al present a cost analysis of MIPR versus open resection and show that operative costs are higher for MIPR but overall hospital costs are lower for MIPR related to the shorter hospital stay. They make the case for a detailed analysis of patient outcomes in future studies. Barkun et al report on the discussions that were held regarding the best methodological approach to evaluate the wide-scale introduction of MIPR. No specific resolution was reached regarding methodology however a resolution was made to create a prospective international registry for MIPR cases to inform future study design. Hogg and colleagues tackled the issue of approaches to training in MIPR. They argue that in most centres case volume is in adequate to allow training solely in the operating room and they propose a number of measures including improvement of general laparoscopic skills, virtual trainers and courses to assist acquisition of necessary skills for MIPR coupled with a need for close performance monitoring of outcomes. The March issue continues on the pancreatic theme with a further 4 articles on aspects of pancreatic surgery which have been submitted independently of the Sao Paolo MIPR meeting.

Stephen Wigmore 
Professor of Transplantation Surgery 
Edinburgh University

Table of contents

MIPR Conference Videos 

Published on Monday 20th March 2017