ArticleBMC surgery2019
The external validation of a difficulty scoring system for predicting the risk of intraoperative complications during laparoscopic liver resection.
Article in BMC surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- External validation of Tampa Difficulty Scoring System for robotic liver resection using Americas Minimally Invasive Liver Surgery Registry (AMILES).Surgical endoscopy · 2025Article
- Which technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?Langenbeck's archives of surgery · 2025Article
- Laparoscopic and Open Distal Pancreatectomy-An Initial Single-Institution Experience with a Propensity Score Matching Analysis.Life (Basel, Switzerland) · 2025Article
- The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience.Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques · 2024Article
- Ranking as a Procedure for Selecting a Replacement Variable in the Score Predicting the Survival of Patients Treated with Curative Intent for Colorectal Liver Metastases.Medicina (Kaunas, Lithuania) · 2023Article
- A machine learning analysis of difficulty scoring systems for laparoscopic liver surgery.Surgical endoscopy · 2022Article
- External validation of different difficulty scoring systems of laparoscopic liver resection for hepatocellular carcinoma.Surgical endoscopy · 2022Article
- The learning curve of laparoscopic liver resection utilising a difficulty score.Radiology and oncology · 2021Article
- Evaluation of the Iwate Model for Predicting the Difficulty of Laparoscopic Liver Resection: Does Tumor Size Matter?Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2021Article
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7 authors.
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Abstract
backgroundThis study aimed to externally validate and upgrade the recent difficulty scoring system (DSS) proposed by Halls et al. to predict intraoperative complications (IOC) during laparoscopic liver resection (LLR).
methodsThe DSS was validated in a cohort of 128 consecutive patients undergoing pure LLRs between 2008 and 2019 at a single tertiary referral center. The validated DSS includes four difficulty levels based on five risk factors (neoadjuvant chemotherapy, previous open liver resection, lesion type, lesion size and classification of resection). As established by the validated DSS, IOC was defined as excessive blood loss (> 775 mL), conversion to an open approach and unintentional damage to surrounding structures. Additionally, intra- and postoperative outcomes were compared according to the difficulty levels with usual statistic methods. The same five risk factors were used for validation done by linear and advanced nonlinear (artificial neural network) models. The study was supported by mathematical computations to obtain a mean risk curve predicting the probability of IOC for every difficulty score.
resultsThe difficulty level of LLR was rated as low, moderate, high and extremely high in 36 (28.1%), 63 (49.2%), 27 (21.1%) and 2 (1.6%) patients, respectively. IOC was present in 23 (17.9%) patients. Blood loss of >775 mL occurred in 8 (6.2%) patients. Conversion to open approach was required in 18 (14.0%) patients. No patients suffered from unintentional damage to surrounding structures. Rates of IOC (0, 9.5, 55.5 and 100%) increased gradually with statistically significant value among difficulty levels (P < 0.001). The relations between the difficulty level, need for transfusion, operative time, hepatic pedicle clamping, and major postoperative morbidity were statistically significant (P < 0.05). Linear and nonlinear validation models showed a strong correlation (correlation coefficients 0.914 and 0.948, respectively) with the validated DSS. The Weibull cumulative distribution function was used for predicting the mean risk probability curve of IOC.
conclusionThis external validation proved this DSS based on patient's, tumor and surgical factors enables us to estimate the risk of intra- and postoperative complications. A surgeon should be aware of an increased risk of complications before starting with more complex procedures.
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