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. 2023 Sep;75(6):1457-1469.
doi: 10.1007/s13304-023-01597-2. Epub 2023 Jul 24.

Ten years of Italian mini-invasiveness: the I Go MILS registry as a tool of dissemination, characterization and networking

Francesca Ratti  1   2 , Alessandro Ferrero  3 , Alfredo Guglielmi  4 , Umberto Cillo  5 , Felice Giuliante  6 , Vincenzo Mazzaferro  7 , Luciano De Carlis  8   9 , Giuseppe Maria Ettorre  10 , Salvatore Gruttadauria  11 , Fabrizio Di Benedetto  12 , Giorgio Ercolani  13   14 , Raffaele Dalla Valle  15 , Andrea Belli  16 , Elio Jovine  17   18 , Matteo Ravaioli  19 , Luca Aldrighetti  20   21 ; Italian Group of Minimally Invasive Liver Surgery (I Go MILS)
Collaborators, Affiliations

Ten years of Italian mini-invasiveness: the I Go MILS registry as a tool of dissemination, characterization and networking

Francesca Ratti et al. Updates Surg. 2023 Sep.

Abstract

Purposes of this study are to evaluate the main changes that have occurred in the Italian MILS activity in the last decade in terms of indications, approaches and outcomes as reported in the national registry and to provide specific details on the main areas of development of MILS. Data from patients undergoing minimally invasive liver resections at centers included in the I Go MILS Registry from its start-up (November 2014) to March 2023 were analyzed for the purposes of this study. The registry is intention-to-treat and prospective. Global recruitment trends stratified by indication to surgery and type of approach were analysed. 7413 MILS procedures were performed across all centers (median number of procedures per center: 63). Years (2020-2023) displayed a significantly higher proportion of treated patients diagnosed with hepatocellular carcinoma (HCC) (38.2% vs. 28.9% and 33.9%, p < 0.001) and cholangiocarcinoma (6.7% vs. 6.5% and 4.2%, p < 0.001) compared to the preceding triennial periods. Additionally, technical complexity demonstrated an increased prominence in Years (2019-2023) with a significantly higher percentage of grade III cases compared to the earlier periods (39.3% vs. 21.7% and 25.6%, p < 0.001). Annual case trends focusing on laparoscopic and robotic techniques demonstrated a steadily increase in the use of these techniques for complex case mix of indications. Overall, attitude and attention to MILS approach has evolved, so that currently indications to hepatic mini-invasiveness have expanded and surgical technique has been refined: Areas mainly involved in increasing growth trends are hepatocellular carcinoma, possible applications of MILS in transplant setting, intrahepatic cholangiocarcinoma and robotic approach.

Keywords: Evolution; Laparoscopy; Liver surgery; Registry; Robotics.

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