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Assessment of surgical difficulty in multiple laparoscopic liver resection using the aggregate value of scores based
Daisuke Takimoto1, Hidetoshi Gon1, Shohei Komatsu2
1Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
Background:
No studies exist regarding the methods for evaluating the surgical difficulty of multiple laparoscopic liver resection (MLLR). Hence, this study aimed to evaluate the usefulness of total scores calculated using the IWATE criteria for each resection site to assess the surgical difficulty of MLLR.
Methods:
Medical records of patients who underwent MLLR at Kobe University Hospital between 2010 and 2023 were retrospectively reviewed. First, the total difficulty score was calculated for each patient by summing the IWATE criteria scores for all resection sites. Subsequently, we analyzed the correlation between this total difficulty score and surgical outcomes of MLLR. Finally, receiver operating characteristic analysis was employed to determine the optimal cutoff value of the total difficulty score. This cutoff value was used to categorize patients into the high- and low-total difficulty score groups, allowing for a comparison of their surgical outcomes.
Results:
This study included 63 patients. The total difficulty score correlated with operation time [r = 0.54, 95% confidential interval (CI): 0.34-0.70, P < 0.001] and blood loss (r = 0.27, 95% CI: 0.03-0.90, P = 0.029), and was associated with postoperative complications (odds ratio: 1.33, 95% CI: 1.14-1.60, P < 0.001). Patients with total difficulty scores ≤ 11 and ≥ 12 were included in the low- and high-score groups, respectively. The high-score group exhibited longer operation times (481 min vs. 372 min, P = 0.001), greater blood loss (110 ml vs. 50 ml, P = 0.005), and higher overall complication rates (71% vs. 29%, P = 0.001) than the low-score group.
Conclusions:
The total difficulty score based on the IWATE criteria may be a useful tool for assessing surgical difficulty in MLLR.
Insights
The IWATE criteria total difficulty score effectively assesses surgical difficulty in multiple laparoscopic liver resections (MLLR). Higher scores correlate with longer operation times, increased blood loss, and more postoperative complications.
Area of Science:
- Hepatobiliary Surgery
- Minimally Invasive Surgery
- Surgical Assessment
Background:
- No established methods exist for evaluating the surgical difficulty of multiple laparoscopic liver resections (MLLR).
- This study addresses the need for a standardized approach to assess MLLR complexity.
Purpose of the Study:
- To evaluate the utility of total scores derived from the IWATE criteria for assessing MLLR surgical difficulty.
- To correlate these scores with surgical outcomes and identify optimal cutoff values.
Main Methods:
- Retrospective review of 63 MLLR patient records (2010-2023).
- Calculation of total IWATE difficulty scores for each patient.
- Correlation analysis with operation time, blood loss, and postoperative complications.
- Receiver operating characteristic analysis to determine optimal score cutoff.
Main Results:
- Total difficulty score significantly correlated with operation time (r=0.54) and blood loss (r=0.27).
- Higher scores were associated with increased postoperative complications (OR=1.33).
- Patients with scores ≥12 (high difficulty) had longer operations, greater blood loss, and higher complication rates than those with scores ≤11 (low difficulty).
Conclusions:
- The total difficulty score using IWATE criteria shows promise as a valuable tool for evaluating surgical difficulty in MLLR.
- This scoring system can aid in pre-operative risk assessment and surgical planning for MLLR.
