ArticleSurgical endoscopy2025
Exploring the potential utility of modified difficulty scores based on the IWATE criteria for assessing the surgical difficulty of laparoscopic repeat liver resection.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
- Medial-to-lateral approach for laparoscopic right hepatectomy of the remnant liver: a safe technique for patients with a history of posterior segment resection (with video)Journal of minimally invasive surgery · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLaparoscopic repeat liver resection (LRLR) is more challenging than initial laparoscopic liver resection in some cases because of intra-abdominal adhesions and liver deformation caused by previous operations. However, there are insufficient reports on difficulty scoring systems for LRLR. In this study, we aimed to explore whether the IWATE criteria and its modified scoring system could effectively predict surgical outcomes in patients undergoing LRLR.
methodsPatients who underwent LRLR at the Kobe University Hospital between 2014 and 2024 were enrolled. We assessed the correlation between difficulty scores based on the IWATE criteria and LRLR surgical outcomes. The correlation between the modified difficulty scores and LRLR surgical outcomes were also evaluated. The modified difficulty scores were calculated by adding 2 points for ipsilateral recurrence and 1 point for a previous history of open liver resection to the original difficulty scores of the IWATE criteria.
resultsEighty-four patients who underwent LRLR were enrolled. The median value of the IWATE criteria and modified difficulty score was 4 and 6, respectively. The median operation time and blood loss were 287 min and 10 mL, respectively. Nineteen (23%) patients experienced postoperative complications, wherein four (5%) had Clavien-Dindo grade ≥ IIIa complications. The IWATE criteria difficulty score correlated with operation time (r = 0.52, 95% confidential interval CI 0.35-0.66, P < 0.001) and blood loss (r = 0.26, 95% CI 0.05-0.45, P = 0.018), while the modified difficulty score correlated with operation time (r = 0.53, 95% CI 0.36-0.67, P < 0.001), blood loss (r = 0.31, 95% CI 0.11-0.49, P = 0.004), and overall postoperative complications (odds ratio 1.34 [interquartile range 1.23, 1.47], P = 0.019).
conclusionsThe IWATE criteria and modified difficulty score may be useful for assessing LRLR surgical difficulty. Additionally, the modified difficulty score may more precisely predict the risk of postoperative complications.
Indexed as
Identifiers
40968212What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.