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The mechanism of the herniation is thought to be a defective rotation of the superior mesenteric vein during embryonic development. Paraduodenal hernias are not high on the list of differentials for bowel obstruction. Some form of surgery is mandatory for all cases. The inferior mesenteric vein has to be sacrificed in some cases to facilitate reduction of the hernia contents. A mesh repair is reserved for large defects and recurrent hernias. Laparoscopic repair has been infrequently reported in the literature. Based on our experience, the laparoscopic approach seems to be effective in the repair of paraduodenal hernias. It carries all of the benefits of minimal access surgery, while providing a sound repair.

Laparoscopic repair is well-tolerated and can be accomplished with minimum morbidity in ventral hernias.

So far, our endoscope-based transumbilical cholecystectomy technique has not yielded satisfactory results in humans. Further instrument and accessory improvements may increase both success rate and acceptance. Scarless surgery without the inherent risks of a transluminal approach may then become feasible.

Surgical volume is not sufficient to ensure quality and patient safety in MIPR. Safe adoption of these complex procedures should consider innovative mastery-based training outside of the operating room, novel video based coaching techniques and prospective reporting of patient data and outcomes using standardized definitions.

Available evidence for comparison of MIDP to ODP is weak, although the number of studies is high. Observed outcomes of MIDP are promising. In the absence of randomized control trials, an international registry should be established.

Background: The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow and the worldwide utilization and attitudes towards MIPR remain unknown. Methods: We developed an anonymous online survey (61 questions) in order to gain knowledge on opinions and use of both, laparoscopic and robot-assisted pancreatic resections. The survey was sent to all surgeon members of the 6 largest hepato-pancreato-biliary associations. Results: In total, 435 surgeons from 50 countries completed the survey. Responders performed a median of 22(IQR:0-450) pancreatic resections as primary surgeon