title: A survey in the hepatopancreatobiliary community on ways to enhance patient recovery.
abstract: OBJECTIVE
  Both laparoscopic techniques and multimodal enhanced recovery programmes have been shown to improve recovery and reduce length of hospital stay. Interestingly, evidence-based care programmes are not widely implemented, whereas new, minimally invasive surgical procedures are often adopted with very little evidence to support their effectiveness. The present survey aimed to shed light on experiences of the adoption of both methods of optimizing recovery.
  
  
  METHODS
  An international, web-based, 18-question, electronic survey was composed in 2010. The survey was sent out to 673 hepatopancreatobiliary (HPB) centres worldwide in June 2010 to investigate international experiences with laparoscopic liver surgery, fast-track recovery programmes and surgery-related equipoise in open and laparoscopic techniques and to assess opinions on strategies for adopting laparoscopic liver surgery in HPB surgical practice.
  
  
  RESULTS
  A total of 507 centres responded (response rate: 75.3%), 161 of which finished the survey completely. All units reported performing open liver resections, 24.2% performed open living donor resections, 39.1% carried out orthotopic liver transplantations, 87.6% had experience with laparoscopic resections and 2.5% performed laparoscopic living donor resections. A median of 50 (range: 2-560) open and 9.5 (range: 1-80) laparoscopic liver resections per surgical unit were performed in 2009. Patients stayed in hospital for a median of 7 days (range: 2-15 days) after uncomplicated open liver resection and a median of 4 days (range: 1-10 days) after uncomplicated laparoscopic liver resection. Only 28.0% of centres reported having experience with fast-track programmes in liver surgery. The majority considered the instigation of a randomized controlled trial or a prospective register comparing the outcomes of open and laparoscopic techniques to be necessary.
  
  
  CONCLUSIONS
  Worldwide dissemination of laparoscopic liver resection is substantial, although laparoscopic volumes are low in the majority of HPB centres. The adoption of enhanced recovery programmes in liver surgery is limited and should be given greater attention.
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands. e.wong@maastrichtuniversity.nl
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Wong-Lun-Hing
authors.forename: Toine M
authors.initials: TM
authors.lastname: Lodewick
authors.forename: Jan H M B
authors.initials: JH
authors.lastname: Stoot
authors.forename: Marc H A
authors.initials: MH
authors.lastname: Bemelmans
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Cornelis H C
authors.initials: CH
authors.lastname: Dejong
authors.forename: Ronald M
authors.initials: RM
authors.lastname: van Dam
mesh_terms: D016009:Chi-Square Distribution; D019091:Critical Pathways; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006498:Hepatectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D020407:Internet; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D019520:Living Donors; D019990:Perioperative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016730:Program Development; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome