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Saiura. Mini-invasive Surg 2023;7:2 https://dx.doi.org/10.20517/2574-1225.2022.119 Page 5 of 6

In minimally invasive pancreatectomy, Ohtsuka et al. reported large-scale prospective data of laparoscopic
[9]
pancreatectomy of 1429 patients . The authors showed that short-term results were comparable in a
propensity matching analysis of 69 centers. Nakata et al. showed that laparoscopic
pancreaticoduodenectomy was safely introduced, but the number of patients has been small and only a few
centers have used it, and it is currently being shifted to RPD . Institutions with experience in laparoscopic
[10]
distal pancreatectomy are characterized by shorter operation times, less blood loss and a lower incidence of
pancreatic fistulas. Those with experience in laparoscopic pancreaticoduodenectomy had a higher rate of
pure laparoscopic procedures and shorter operation times.

Difficulty scores for laparoscopic surgery have also been developed in Japan. In 2014, Ban et al. developed
difficulty scores for liver resection, and in 2018, Otsuka et al. reported difficulty scores for distal
pancreatectomy [11,12] . The development of difficulty scores has contributed greatly to improving the safety of
laparoscopic surgery.

CONCLUSION
While minimally invasive surgery offers significant benefits to patients, it also carries unique risks. We hope
that the Japanese system will serve as a useful reference for the safe deployment of highly advanced
minimally invasive HPB surgery.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declares that he is bound by confidentiality agreements that prevent him from disclosing his
conflicts of interest in this work.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.

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