Nationwide implementation of minimally invasive liver surgery: population-based analysis
Emil Östrand1,2, Jenny Rystedt1,2, Bobby Tingstedt1,2
1Department of Clinical Sciences Lund, Surgery, Lund University, Lund, Sweden.
BJS Open
|January 21, 2026
Summary
Nationwide implementation of minimally invasive liver surgery in Sweden shows increasing adoption and improved short-term outcomes. This approach, including robotic procedures, is safe and effective for colorectal liver metastases without compromising long-term survival.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Limited national-level data exist on minimally invasive liver surgery (MILS) implementation.
- Previous studies focused on high-volume centers and early adopters.
- This study assesses MILS in Sweden over 15 years, emphasizing colorectal liver metastases.
Purpose of the Study:
- To evaluate the nationwide implementation and outcomes of MILS in Sweden.
- To compare MILS with open liver surgery for colorectal liver metastases.
- To analyze trends in MILS adoption, including robotic procedures.
Main Methods:
- Analysis of data from the Swedish National Quality Registry for Liver, Gallbladder and Bile Duct Cancer (2009-2023).
- Inclusion of 9977 liver surgery procedures.
- Propensity score matching to compare open vs. MILS for colorectal liver metastases.
Main Results:
- MILS adoption increased significantly, comprising 14.9% of procedures.
- MILS demonstrated superior short-term outcomes: less blood loss, fewer major complications, and lower 30-day mortality.
- Robotic-assisted surgery saw a rapid increase, accounting for 38.4% of MILS in the late period.
- Propensity score matching confirmed reduced blood loss with MILS, with similar radical resection rates and overall survival for colorectal liver metastases.
Conclusions:
- Nationwide implementation of MILS in Sweden is safe and effective.
- MILS adoption, including robotic techniques, has risen substantially.
- MILS offers improved short-term outcomes without negatively impacting morbidity, mortality, or long-term survival for colorectal liver metastases.
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