Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands

Marcel J. van der Poel, Robert S. Fichtinger, Marc Bemelmans, Koop Bosscha, Andries E. Braat, Marieke T. de Boer, Cornelis H. C. Dejong, Pascal G. Doornebosch, Werner A. Draaisma, Michael F. Gerhards, Paul D. Gobardhan, Burak Gorgec, Jeroen Hagendoorn, Geert Kazemier, Joost Klaase, Wouter K. G. Leclercq, Mike S. Liem, Daan J. Lips, Hendrik A. Marsman, J. Sven D. MieogQuintus I. Molenaar, Vincent B. Nieuwenhuijs, Carolijn L. Nota, Gijs A. Patijn, Arjen M. Rijken, Gerrit D. Slooter, Martijn W. J. Stommel, Rutger-Jan Swijnenburg, Pieter J. Tanis, Wouter W. te Riele, Turkan Terkivatan, Petrousjka M. van den Tol, Peter B. van den Boezem, Joost A. van der Hoeven, Maarten Vermaas, Moh'd Abu Hilal, Ronald M. van Dam, Marc G. Besselink*, Babs Zonderhuis, Inne B. Rinkes, Christiaan Hoff, Steven Oosterling, Dutch Liver Collaborative Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background: While most of the evidence on minimally invasive liver surgery (MILS) is derived from expert centers, nationwide outcomes remain underreported. This study aimed to evaluate the implementation and outcome of MILS on a nationwide scale.

Methods: Electronic patient files were reviewed in all Dutch liver surgery centers and all patients undergoing MILS between 2011 and 2016 were selected. Operative outcomes were stratified based on extent of the resection and annual MILS volume.

Results: Overall, 6951 liver resections were included, with a median annual volume of 50 resections per center. The overall use of MILS was 13% (n = 916), which varied from 3% to 36% (P <0.001) between centers. The nationwide use of MILS increased from 6% in 2011 to 23% in 2016 (P <0.001). Outcomes of minor MILS were comparable with international studies (conversion 0- 13%, mortality = 20 MILS annually, major MILS was associated with less conversions (14 (11%) versus 41 (30%), P <0.001), shorter operating time (184 (117- 239) versus 200 (139-308) minutes, P = 0.010), and less overall complications (37 (30%) versus 58 (42%), P = 0.040).

Conclusion: The nationwide use of MILS is increasing, although large variation remains between centers. Outcomes of major MILS are better in centers with higher volumes.

Original languageEnglish
Pages (from-to)1734-1743
Number of pages10
Issue number12
Publication statusPublished - Dec 2019
Event13th World Biennial Congress of the International Hepato Pancreato Biliary Association (IHPBA) - Geneva, Switzerland
Duration: 4 Sept 20187 Sept 2018



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