Alarmed by a spate of deaths following laparoscopic operations last year at Gunma University Hospital, a surgeons association has surveyed other medical institutions and found a worryingly high death rate nationwide.
The Japanese Society of Hepato-Biliary-Pancreatic Surgery surveyed 212 medical institutions in January and found that one in 10 patients who underwent “highly technical” laparoscopic liver surgery died within 90 days. Those who had a less specialized form of laparascopic surgery had a better survival rate.
Gunma University Hospital said in November that eight people died within four months of laparascopic surgery conducted by the same surgeon between 2010 and 2014.
The 212 medical centers are designated by the society as training centers. It asked them about procedures carried out and the resulting survival rate, and received responses from 207 institutions, including Gunma University Hospital.
The society, headed by Masaru Miyazaki, a professor at Chiba University’s General Surgery Hepato-Biliary-Pancreatic Unit, collected data on laparoscopic liver and pancreatic surgery performed between 2011 and 2014 and analyzed mortality rates.
It found a 1.45 percent mortality rate in laparoscopic liver removal procedures that required high expertise, a technique that is not covered by public health insurance. This compares with 0.27 percent for lower-level laparoscopic operations covered by the insurance.
As for laparoscopic liver surgery involving removal of the bile duct, considered the most complex operation of this kind, four out of 41 patients died after the operations, a mortality rate of 9.76 percent. This is two to three times higher than abdominal surgeries performed without the use of abdominoscope, in which the death rate is between 3 and 5 percent.
“In all abdominal surgeries, regardless whether the operation is performed with or without an abdominoscope, safety and validity are the top priority,” Miyazaki said.
“If the mortality rate is higher in cases of laparoscopic surgery, medical institutions should reconsider whether it is worth continuing the practice.”
As the data included the recent deaths at Gunma University Hospital, the society concluded that the facility’s performance was at fault.
It has decided to remove the hospital’s accreditation as a training center for laparoscopic surgery.
The association also urged more than half of the institutions that reported performing liver resection surgeries in the absence of approval by an ethics committee to revise their procedures and apply such screening.