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

Area of Science:

• Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Minimally invasive hepato-pancreato-biliary (MIS HPB) surgery offers good outcomes but lacks standardized implementation requirements.
• Establishing clear guidelines is essential for the safe dissemination of MIS HPB surgical programs.

Purpose of the Study:

• To develop a consensus statement for the safe implementation and dissemination of MIS HPB surgical programs.
• To define standardized requirements for centers and surgeons performing MIS HPB surgery.

Main Methods:

• A literature search identified 16 key safety questions for MIS HPB surgery.
• A modified nominal group technique was employed with 23 expert surgeons to reach consensus.

Main Results:

• Consensus was reached on the need for formal guidelines for institutions and surgeons in MIS HPB surgery.
• Most participants (91%) agreed on minimum annual institutional volume cutoffs for complex procedures.
• A majority agreed on the importance of surgeon responsibility, formal training, institutional support, and outcomes data collection.

Conclusions:

• Safe implementation of MIS HPB surgery necessitates structured training, adequate case volumes, and robust institutional support.
• Continuous monitoring of outcomes and surgeon expertise is vital for maintaining program safety and efficacy.