Related Experiment Video
Updated: Nov 27, 2025
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Inter-surgeon variability is associated with likelihood to undergo minimally invasive hepatectomy and postoperative
Diamantis I Tsilimigras1, J Madison Hyer1, Qinyu Chen1
1Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Introduction:
Minimally invasive liver surgery (MILS) has been increasingly adopted in clinical practice; yet, inter-surgeon variability in operative approach (MILS vs. open), as well as the impact of providers on the likelihood of undergoing MILS have not been well characterized.
Methods:
The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent hepatectomy between 2013 - 2017. The impact of patient- and procedure- related factors on the likelihood of MILS was investigated.
Results:
Overall 12,110 (91.6%) patients underwent open liver resection, while 1,112 (8.4%) patients had MILS. Based on total MILS volume, surgeons were categorized into average (1-3 cases), above average (4-7 cases) and high (>8 or more cases) MILS volume surgeons. While male patients (OR = 0.85, 95%CI 0.75-0.97) were less likely to undergo MILS, patients operated on more recently (year 2017; OR = 1.72, 95%CI 1.38-2.14) for a cancer indication (OR = 1.23, 95%CI 1.05-1.42) had a higher chance of MILS. After controlling for patient- and procedure-related characteristics, there was almost a two-fold variation in the odds that a patient underwent MILS versus open hepatectomy based on the individual surgeon provider (MOR = 1.75, 95%CI 1.48-1.99). Patients who had a MILS performed by a high-volume MILS surgeon had 36% lower odds of death within 90-days (OR = 0.64, 95%CI 0.51-0.79).
Conclusion:
The likelihood of undergoing MILS, as well as post-operative mortality, was heavily influenced by the individual surgeon provider rather than patient- or procedure-related factors.
Insights
Minimally invasive liver surgery (MILS) adoption varies significantly by surgeon, not patient factors. High-volume MILS surgeons reduce 90-day mortality, highlighting provider impact on outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Outcomes Research
- Health Services Research
Background:
- Minimally invasive liver surgery (MILS) adoption is increasing, but variability in approach and provider impact remains unclear.
- Understanding factors influencing MILS utilization is crucial for standardizing care and improving patient outcomes.
Purpose of the Study:
- To investigate inter-surgeon variability in operative approach for liver resection (MILS vs. open).
- To determine the impact of individual providers on the likelihood of patients undergoing MILS.
- To analyze the relationship between surgeon MILS volume and 90-day post-operative mortality.
Main Methods:
- Retrospective analysis of Medicare beneficiaries undergoing hepatectomy (2013-2017).
- Utilized Medicare 100% Standard Analytic Files to identify patient and procedure characteristics.
- Investigated surgeon provider and MILS volume as factors influencing MILS utilization and outcomes.
Main Results:
- MILS was performed in 8.4% of 13,222 hepatectomies; open resection in 91.6%.
- Male patients and those with non-cancer indications were less likely to undergo MILS.
- Surgeon provider demonstrated a two-fold variation in MILS likelihood, independent of patient/procedure factors.
- High-volume MILS surgeons were associated with 36% lower 90-day mortality (OR=0.64).
Conclusions:
- Individual surgeon provider significantly influences MILS utilization and post-operative mortality.
- Surgeon MILS volume is a critical factor in reducing short-term mortality after liver resection.
- Standardizing MILS adoption based on surgeon expertise may improve patient outcomes.
