title: Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS).
abstract: OBJECTIVE
  To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).
  
  
  BACKGROUND
  Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal pancreatectomies were in a minimally invasive fashion and 85% of surgeons welcomed MIDP training. The feasibility and impact of a nationwide training program is unknown.
  
  
  METHODS
  From 2014 to 2015, 32 pancreatic surgeons from 17 centers participated in a nationwide training program in MIDP, including detailed technique description, video training, and proctoring on-site. Outcomes of MIDP before training (2005-2013) were compared with outcomes after training (2014-2015).
  
  
  RESULTS
  In total, 201 patients were included; 71 underwent MIDP in 9 years before training versus 130 in 22 months after training (7-fold increase, P < 0.001). The conversion rate (38% [n = 27] vs 8% [n = 11], P < 0.001) and blood loss were lower after training and more pancreatic adenocarcinomas were resected (7 [10%] vs 28 [22%], P = 0.03), with comparable R0-resection rates (4/7 [57%] vs 19/28 [68%], P = 0.67). Clavien-Dindo score ≥III complications (15 [21%] vs 19 [15%], P = 0.24) and pancreatic fistulas (20 [28%] vs 41 [32%], P = 0.62) were not significantly different. Length of hospital stay was shorter after training (9 [7-12] vs 7 [5-8] days, P < 0.001). Thirty-day mortality was 3% vs 0% (P = 0.12).
  
  
  CONCLUSIONS
  A nationwide MIDP training program was feasible and followed by a steep increase in the use of MIDP, also in patients with pancreatic cancer, and decreased conversion rates. Future studies should determine whether such a training program is applicable in other settings.
authors.affiliation: *Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands †Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands ‡Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands §Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands ||Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands ¶Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands #Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands **Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands ††Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands ‡‡Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands §§Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands ||||Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ¶¶Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands ##Department of Surgery, Jeroen Bosch Hospital, Den Bosch, The Netherlands ***Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands †††Department of Surgery, Isala Clincs, Zwolle, The Netherlands ‡‡‡Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands §§§Department of Surgery, Amphia Hospital, Breda, The Netherlands ||||||Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom.
authors.forename: Thijs
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mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D065187:Controlled Before-After Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010180:Pancreatectomy / Q000193:education* / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000193:education*; D016896:Treatment Outcome