A survey of current practices and barriers to expanding laparoscopic HPB surgery in Canada

Jrearz, Ricky; Govindarajan, Anand; Jayaraman, Shiva

doi:10.1016/j.hpb.2016.09.010

Cited by 8 publications

(6 citation statements)

References 13 publications

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“…The first is a moderate response rate (51.2%), hampering access to a more complete view of the national scenario. This rate is below other world liver surgery surveys, which reached 75% of responders 6 , 20 . It is the nature of any survey that only part of the population is approached and only part of the surveyed surgeons may reply 6 .…”

Section: Discussioncontrasting

confidence: 60%

Liver Resection in Brazil: A National Survey

Fonseca

Jeismann

Krüger

et al. 2018

ABCD, arq. bras. cir. dig.

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Background:Liver surgery has developed significantly in the past decades. In Brazil, the interest on it has grown significantly, but there is no study regarding its clinical practice. Despite intrinsic limitations, surveys are well suited to descriptive studies and allow understanding the current scenario. Aim:To provide an overview on the current spread of liver surgery in Brazil, focusing on groups´ profile, operative techniques and availability of resources. Method:From May to November 2016, was conducted a national survey about liver surgery profile in Brazil composed by 28 questions concerning surgical team characteristics, technical preferences, surgical volume, results and available institutional resources. The survey was sent by e-mail to 84 liver surgery team leaders from different centers including all regions of the country. Results:Forty-three study participants (51.2%), from all Brazilian regions, responded the survey. Most centers have residency/fellowship programs (86%), perform and do laparoscopic procedures (91%); however, laparoscopy is still responsible for a little amount of surgeries (1-9% of laparoscopic procedures over all liver resections in 39.5% of groups). Only seven centers (16.3%) perform more than 50 liver resections/year. Postoperative mortality rate is between 1-3% in 55% of the centers. Conclusion:This is the first depiction of liver surgery in Brazil. It showed a surgical practice aligned with worldwide excellence centers, concentrated on hospitals dedicated to academic practice.

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Section: Discussioncontrasting

confidence: 60%

Liver Resection in Brazil: A National Survey

Fonseca

Jeismann

Krüger

et al. 2018

ABCD, arq. bras. cir. dig.

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“…The consensus statements did not specifically address surgical approach, such as minimally invasive versus open, acknowledging the current variability in practice. 23,[51][52][53] While being consistent with the available evidence, technical recommendations as voted on by the expert panel leave room for flexibility and tailoring of the surgical approach to individual cases and surgeons' expertise. Future updates of the consensus may include additional statements regarding minimally invasive approaches as the field evolves and the uptake of minimally invasive techniques increased for LR.…”

Section: Discussionmentioning

confidence: 99%

“…For surgeons, recruitment was facilitated during the 2017 Canadian Update in Surgical Procedures (CUSP) for HPB Surgery. The practice of those surgeons was reflective of the Canadian HPB surgery field, whereby most surgeons (86%) use minimally invasive approaches for minor LR, and a minority (23%) for major LR such as lobectomies 23 .…”

Section: Methodsmentioning

confidence: 99%

Patient blood management for liver resection: consensus statements using Delphi methodology

Hallet

Jayaraman

Martel

et al. 2019

HPB

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Background: Blood loss and transfusion remain a significant concern in liver resection (LR). Patient blood management (PBM) programs reduce use of transfusions and improve outcomes and costs, but are not standardized for LR. This study sought to create an expert consensus statement on PBM for LR using modified Delphi methodology. Methods: An expert panel representing hepato-biliary surgery, anesthesiology, and transfusion medicine was invited to participate. 28 statements addressing the 3 pillars of PBM were created. Panelists were asked to rate statements on a 7-point Likert scale. Three-rounds of iterative rating and feedback were completed anonymously, followed by an in-person meeting. Consensus was reached with at least 70% agreement. Results: The 35 experts panel recommended routine pre-operative transfusion risk assessment, and investigation and management of anemia with iron supplementation. Intra-operatively, restrictive fluid administration without routine central line insertion was recommended, along with intermittent hepatic pedicle occlusion and surgical techniques considerations. Specific criteria for restrictive intra-operative and post-operative transfusion strategy were recommended. Conclusions: PBM for LR included medical and technical interventions throughout the perioperative continuum, addressing specificities of LR. Diffusion and adoption of these recommendations can standardize PBM for LR to improve patient outcomes and resource utilization.

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“…Minimal invasive distal pancreatectomy is increasingly advocated as the preferred procedure for resection of lesions located in the distal pancreas. [1][2][3] Despite the lack of high-level evidence, implementation has gradually taken place and laparoscopy has been endorsed as a safe procedure with favourable short-term outcomes. 4,5 However, data stem largely from institutional series and the risk of an early publication bias towards series with highly selected patients, selected surgeon experiences, reporting of studies with favourable outcomes and unbalanced comparison without adjustment of confounders against open distal pancreatectomies may have occurred.…”

Section: Introductionmentioning

confidence: 99%

A nationwide cohort study of resection rates and short-term outcomes in open and laparoscopic distal pancreatectomy

Søreide

Olsen

Nymo

et al. 2019

HPB

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Background: Distal pancreatectomy (DP) is increasingly done by laparoscopy but data from routine practise are scarce. We describe practise in a national cohort. Methods: Data from the Norwegian Patient Register of all patients undergoing DP from 2012 to 2016. National resection rates were analysed. Short-term outcomes include length of stay, reoperation, readmissions and 90-day mortality. Risk is reported as odds ratio (OR) with 95% confidence interval (c.i.).Results: Of 554 procedures, 327 (59%) were laparoscopic. Median age was 66 years (iqr 55-72) and 52% were women. Resection rates increased during the period for all DP (from 1.76 to 2.39 per 100.000/ yr), and significantly for laparoscopic DP (adjusted R-square 0.858; P = 0.015). Elderly patients had more resection (r 2 = 0.11; P = 0.019). Splenectomy (n = 427; 77%) was less likely with laparoscopy (laparoscopy 72% vs open 84%, respectively; OR 0.64, 95% c.i. 0.42-0.97; P = 0.035). Multivisceral resections occurred more often in open DP (5.3% vs 1.2% for laparoscopy, OR 4.51, 1.44-14.2; P = 0.008). Reoperation occurred in 34 (6%), readmission in 109 (20%), and mortality in 8 (1.4%).Hospital stay was shorter for laparoscopic DP. Conclusion:Use of DP increases in the population, particularly in the elderly, with use of laparoscopic access and an association with a reduced hospital stay.

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A survey of current practices and barriers to expanding laparoscopic HPB surgery in Canada

Cited by 8 publications

References 13 publications

Liver Resection in Brazil: A National Survey

Liver Resection in Brazil: A National Survey

Patient blood management for liver resection: consensus statements using Delphi methodology

A nationwide cohort study of resection rates and short-term outcomes in open and laparoscopic distal pancreatectomy

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