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Updated: May 5, 2026
Application of Hemostatic Devices in Laparoscopic Hepatectomy
Published on: April 19, 2022
Proposal of a Modified Adhesion Score as a Predictor of Technical Difficulty and Surgical Risks of Repeat
Junichi Shindoh1,2, Yuta Kobayashi3, Satoshi Okubo1
1Hepatobiliary-Pancreatic Surgery Division, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
Background:
TORAD score is a grading system that evaluates the technical difficulty of repeat hepatectomy (ReHx), and its clinical relevance has been reported in several studies. However, recent advances in minimally invasive surgery have rendered the ability of this scoring system to discriminate between different levels of adhesion severity inadequate.
Method:
We developed a modified grading system to accurately evaluate the adhesion severity related to the difficulty of ReHx through a video review of 214 patients.
Results:
The modified grading system consists of three parts: (1) A score, the severity of adhesions around the hepatic hilum; (2) B score, the severity of adhesions around the liver; and (3) C score, the severity of adhesions at the site of the previous cut surface. Each of the scores is based on a four-level severity scale, and the sum of the three scores is termed the TORAD score, v2.0. High inter-observer agreement was confirmed in the assessment of these adhesion categories (kappa value: 0.972-1.000), and the TORAD scores, v2.0 were found to show good correlations with the short-term surgical outcomes.
Conclusion:
The modified grading system offers promise as an optimal scale for evaluating the technical difficulty and surgical risk of ReHx associated with adhesions.
