The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS)

Abstract

Objective: To develop and update evidence- and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update. Methods: Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, the AGREE II-GRS tool for methodological guideline quality assessment, and external validation by a Validation Committee. Results: Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the two-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic and 31 on general MIPS covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee. Conclusions: The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers and medical societies.

Prince and princesses: The current status of robotic surgery in surgical oncology

“…RPDs per year to reduce morbidity compared to open PD. 95,96 Furthermore, future studies investigating the long-term oncologic outcomes of robotic pancreas surgery are necessary and should be conducted at high-volume centers.…”

Safe implementation of a minimally invasive hepatopancreatobiliary program, a narrative review and institutional experience

“…Several guidelines and consensus statements exist to help facilitate safe practices, but patient selection criteria are surgeon and institution dependent. 8,10,19,20,43 As a part of the MIS HPB program, it is important for the surgical, anesthesia, and nursing team to determine appropriate criteria for patient selection. From a surgeon's standpoint, this should consider patient and tumor factors associated with increasing difficulty such as vascular involvement, recent pancreatitis, and anatomic variations.…”

The current status of minimally invasive pancreatectomy and implications of the Brescia guidelines

“…Despite these trends, there is currently no nationally sanctioned training program for robotic pancreas surgery. Given the complexity of these procedures and the high postoperative morbidity rates, minimizing the risk for patients calls for stringent, evidence-based guidelines and an appropriate curriculum for trainees ( 22 ). The challenge with robotic PD lies in the suggested learning curve of at least 20–40 cases to achieve proficiency.…”

“…Many of the recommendations were similar for both laparoscopic and robotic surgery, however, there were some significant differences for the topics of learning curves, cost-effectiveness, and artificial intelligence. The eight identified domains’ significant findings are abbreviated as follows ( 22 ):…”