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Page 4 of 6 Saiura. Mini-invasive Surg 2023;7:2 https://dx.doi.org/10.20517/2574-1225.2022.119

Table 1. Public insurance reimbursement of minimally invasive HBP surgery in Japan
Year Events
1990 First laparoscopic cholecystectomy in Japan
1991 First laparoscopic liver resection in Japan
1993 First laparoscopic pancreatectomy in Japan
2000 Laparoscopic liver resection selected as AMCS procedure
2004 Laparoscopic pancreatectomy selected as AMCS procedure
2010 Public insurance reimbursement of laparoscopic minor hepatectomy
2012 Public insurance reimbursement of laparoscopic distal pancreaticoduodenectomy
2016 Public insurance reimbursement of laparoscopic advanced hepatectomy and laparoscopic pancreaticoduodenectomy
2020 Public insurance reimbursement of robotic-assisted pancreatectomy
AMCS: Advanced medical care system.

Table 2. Institutional and operator criteria for minimally invasive pancreatectomy in Japan
Operation Institutional criteria Operator criteria
LDP 5 or more pancreatectomies per year
RDP 20 or more pancreatectomies per year Participation in a 5 or more robotic pancreatectomies as an operator. 20 or more
prospective case registry at an academic society pancreatectomies as an operator, including 5 or more cases of
laparoscopic pancreatectomies
LPD 50 or more pancreatectomies, including 20 or more 20 or more laparoscopic pancreatectomies as an operator
pancreaticoduodenectomy per year, 100 or more laparoscopic
surgeries per year

LDP: Laparoscopic distal pancreatectomy; LPD: laparoscopic pancreaticoduodenectomy; RDP: robotic distal pancreatectomy.

Table 3. Operative mortality rates of all prospective case registries of laparoscopic hepatectomy and pancreatectomy in Japan 8
Operation Cases Institutions 30-days mortality 90-days mortality
LDP 1197 98 0% 0.3%
LPD 232 25 0.4% 0.4%
LH 2653 278 0.08% 0.2%

LDP: Laparoscopic distal pancreatectomy; LH: laparoscopic hepatectomy; LPD: laparoscopic pancreaticoduodenectomy.

POST-ACCIDENT DISSEMINATION AND OUTCOMES
The results of prospective registry showed laparoscopic hepatopancreatic resection is safe and comparable
to open surgery [Table 3]. The 90-day mortality rates after laparoscopic distal pancreatectomy and
laparoscopic pancreaticoduodenectomy were 0.3% and 0.4%, respectively. The 90-day mortality rate after
laparoscopic hepatectomy was 0.08%. Japanese NCD data show that the number of minimally invasive HPB
surgery has increased dramatically over the past decade, as has been the case worldwide and in other areas
[6]
of gastrointestinal surgery . Ban et al. analyzed data focusing on laparoscopic liver resection, including
[7]
148,507 cases registered in the Japanese National Clinical Database between 2011 and 2017 . In their report,
the percentage of laparoscopic liver resections without additional vascular complications or biliary
reconstruction increased from 9.9% in 2011 to 24.8% in 2017. Operative mortality was 3.6% for both
advanced laparoscopic liver resection and open liver resection in 2011, and decreased to 1.0% and 2.0%,
respectively, in 2017. An international benchmark study of laparoscopic liver resection was recently
published, which, similar to reports from other countries, demonstrated the superiority of laparoscopic
surgery over open liver resection in terms of short-term outcomes such as blood loss and postoperative
hospital stay . Although minor hepatectomy was considered standard (IDEAL 3), major hepatectomy is
[8]
still under consideration (IDEAL 2b), and is recommended to use with caution.