98 - Freie Mitteilung
17. Mai 2019, 14:15 - 15:45, Kursaal Arena, 5. OG
Adoption of minimally-invasive surgery access in abdominal surgery in Western Europe during the past 20 years
M. Schneider, A. Rickenbacher, M. Müller, D. Cabalzar-Wondberg, S. Käser, M. Turina, Presenter: M. Schneider (Zürich)
New technological developments have profoundly changed the treatment of various abdominal diseases. We aimed to investigate how minimally-invasive surgery (MIS) access was adopted in general surgery, gynecology and urology across a time period of 20 years.
The present study is a retrospective analysis of all inpatient hospital admissions in Switzerland between 1998 and 2017. Data were provided by the Swiss Federal Statistical Office covering 27’121’637 admissions. Cases were identified based on ICD-10 and CHOP codes of the respective year. Statistical & graphical analyses were performed with R.
Rates for laparoscopic appendectomies (AE) (n=186’929) increased from 22% in 1998 to 96.6% in 2017. Mean length of hospital stay (LOS) decreased from 4 to 2 days, while it remained unchanged for open AE. In contrast, MIS approaches were already performed in 75.3% of cholecystectomies (CCE, n=57’788) in 1998 and further increased to 93.6% in 2017. LOS after MIS CCE was consistently 4 days shorter than for open CCE. In contrast, MIS approaches were adopted more slowly for oncologic resections: left hemicolectomies/sigmoidectomies for colorectal cancer (n=14’226) were performed MIS in 30% of cases in 2009 and exceeded 50% in 2017. LOS decreased from 14 days to 11 for open and to 7 for left-sided MIS colectomies. Implementation of MIS techniques were slower for resections of the right colon (n=10’552), reaching over 30% in 2015 for the first time with a mean LOS of 11 for open and 8 for MI operations in 2017. MIS approaches also increased in other disciplines: While in 1998, all radical prostatectomies for prostate cancer (n=41’618) were performed using the open technique, MIS procedures increased to 71.2% in 2017, with 66.4% performed robotically. Mean LOS decreased from 12 days to 8 days for open approaches and 6 days for MI surgery. Rates of selected complications decreased for all studied operations, with near consistently lower complication rates in MIS operations.
While MIS approaches were implemented earlier in less challenging operations such as AE and CCE, MIS approaches are now also implemented for more complex oncological abdominal operations (colectomy, prostatectomy). The differences in LOS and complication rates between open and MIS approaches are significantly in favor of MIS access, further endorsing the use of this approach.