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Difficulty of Laparoscopic Liver Resection: Proposal for a New Classification
Yoshikuni Kawaguchi1,2, David Fuks1, Norihiro Kokudo2
1Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
Annals of Surgery
|February 11, 2017
Summary
A new classification system objectively predicts laparoscopic liver resection difficulty. This system stratifies procedures into low, intermediate, and high grades, aiding surgical planning and risk assessment.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Surgical difficulty in laparoscopic liver resections (LLRs) is subjective.
- Objective assessment of LLR difficulty is lacking.
- Existing methods do not adequately capture the complexity of LLR.
Purpose of the Study:
- To develop an objective and practical classification system for predicting LLR difficulty.
- To stratify LLR procedures into distinct difficulty grades.
- To aid in surgical planning and risk stratification for LLR.
Main Methods:
- A prospectively maintained database from 1995-2015 was used.
- 452 LLRs without simultaneous procedures were analyzed.
- Procedures were grouped based on operative time, blood loss, and conversion rates.
Main Results:
- LLRs were categorized into three groups (I, II, III) based on objective scores.
- Group I included simpler resections (e.g., wedge), Group III complex ones (e.g., right hepatectomy).
- Morbidity and major complication rates significantly increased from Group I to III (P < 0.001).
Conclusions:
- The proposed classification system objectively stratifies LLR difficulty.
- It categorizes LLRs into low (Group I), intermediate (Group II), and high (Group III) grades.
- This system facilitates better surgical planning and patient risk assessment.
