Crossing borders in minimally invasive pancreatic and liver surgery

This thesis aims to assess and improve outcomes in minimally invasive pancreas and liver surgery with a focus on international multicenter collaboration. Included in this thesis are evidence-based guidelines within minimally invasive pancreatic surgery which were lacking and therefore a consensus meeting was organized in Miami in March 2019 where all evidence to date was summarized and guidelines were established with the aim to optimize patient safety and operative outcomes. The need for national and international registries in minimally invasive pancreatic surgery was highlighted and therefore E-MIPS decided to set up such a registry. Data of this first year was included in this thesis and were used to provide an overview of minimally invasive pancreatic surgery practice across Europe and additionally to show differences between the laparoscopic and robotic approach for distal pancreatectomy and pancreatoduodenectomy. For this thesis, several studies were performed comparing different approaches in pancreas and liver surgery. The robotic and laparoscopic approach in distal pancreatectomy were compared, as were laparoscopic and open right posterior sectionectomy. Additionally, a systematic review on both elderly and obese patients undergoing either minimally invasive distal pancreatectomy or pancreatoduodenectomy is included.
In minimally invasive liver surgery, most studies only include high volume expert centers and therefore might not be easily translated to general practice. Some nationwide or international registries collect data prospectively on minimally invasive liver resections. A study was included in this thesis comparing the design and included variables of these large nationwide registries.