title: The difficulty of laparoscopic liver resection.
abstract: Grading of difficulty is needed for laparoscopic liver resection (LLR). Indications for LLR are expanding worldwide from minor to major resections, particularly in institutions having surgeons with advanced skills. If the degrees of surgical difficulty were defined, it would serve as a useful guide when introducing LLR and stepping up to the more advanced LLR. As no previous study has addressed the degrees of difficulty of various LLR procedures, we devised a practical scoring system for this purpose. We extracted the following five factors from preoperative information to score difficulty levels: (1) tumor location, (2) extent of liver resection, (3) tumor size, (4) proximity to major vessels, and (5) liver function. This difficulty index is comprised of the cumulative score for the five individual factors. There has not yet been a standard definition of difficulty. Our proposed scoring system might be a practical means of assessing the difficulty of LLR procedures. However, this system must be prospectively validated.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan, d-ban.msrg@tmd.ac.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ban
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kudo
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ito
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mitsunori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsumura
authors.forename: Arihiro
authors.initials: A
authors.lastname: Aihara
authors.forename: Takanori
authors.initials: T
authors.lastname: Ochiai
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Osamu
authors.initials: O
authors.lastname: Itano
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D020380:Needs Assessment; D060787:Neoplasm Grading / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000503:physiopathology* / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome