Abstract
Background
A difficulty scoring system (DSS) based on the extent of liver resection, tumor location, liver function, tumor size, and tumor proximity to major vessels was previously developed to assess the difficulty of laparoscopic liver resection (LLR). Recently, we proposed a modified DSS for patients who undergo LLR for intrahepatic duct (IHD) stones. In this study, we validated the modified DSS for LLR for IHD stones.
Methods
We reviewed the clinical data of 121 patients who underwent LLR for IHD stones between July 2003 and November 2015 and validated the modified DSS in patients who underwent LLR according to their surgical outcomes. We divided the patients into subgroups according to their scores and compared the surgical outcomes, including hospital stay, operation time, blood loss, transfusion rate, and the postoperative complication rate and grade, among the subgroups of patients.
Results
The DSS score ranged from 3 to 12 in LLR for IHD stones. The operation time (P < 0.001) significantly increased according to the DSS score. The median hospital stay after surgery (P = 0.024) and transfusion rate (P = 0.001) were significantly different among subgroups of patients divided by their difficulty scores. When we divided the patients into two groups based on the side of liver of resected, the operation time (P < 0.001), mean difficulty score (P < 0.001), and blood loss (P = 0.041) were greater in patients who underwent right liver resection.
Conclusions
The surgical difficulty varies among patients undergoing the same LLR procedure for IHD stones. The modified DSS for IHD stones can effectively predict the surgery outcomes and complications of LLR.
Similar content being viewed by others
References
Kim TH, Kim SY, Tang A, Lee JM (2019) Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol 25:245–263
Vivek MA, Augustine AJ, Rao R (2014) A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg 10:62–67
Khoshrang H, Falahatkar S, Heidarzadeh A, Abad M, Rastjou Herfeh N, Naderi Nabi B (2014) Predicting difficulty score for spinal anesthesia in transurethral lithotripsy surgery. Anesth Pain Med 4:e16244
Adnet F, Borron SW, Racine SX, Clemessy JL, Fournier JL, Plaisance P, Lapandry C (1997) The intubation difficulty scale (IDS): proposal and evaluation of a new score characterizing the complexity of endotracheal intubation. Anesthesiology 87:1290–1297
Osborne SA, Severn P, Bunce CV, Fraser SG (2006) The use of a pre-operative scoring system for the prediction of phacoemulsification case difficulty and the selection of appropriate cases to be performed by trainees. BMC Ophthalmol 6:38
Lee MKt, Gao F, Strasberg SM (2015) Perceived complexity of various liver resections: results of a survey of experts with development of a complexity score and classification. J Am Coll Surg 220:64–69
Muangkaew P, Cho JY, Han HS, Yoon YS, Choi Y, Jang JY, Choi H, Jang JS, Kwon SU (2016) Defining surgical difficulty according to the perceived complexity of liver resection: validation of a complexity classification in patients with hepatocellular carcinoma. Ann Surg Oncol 23:2602–2609
Osborne SA, Adams WE, Bunce CV, Fraser SG (2006) Validation of two scoring systems for the prediction of posterior capsule rupture during phacoemulsification surgery. Br J Ophthalmol 90:333–336
Im C, Cho JY, Han HS, Yoon YS, Choi Y, Jang JY, Choi H, Jang JS, Kwon SU (2017) Validation of difficulty scoring system for laparoscopic liver resection in patients who underwent laparoscopic left lateral sectionectomy. Surg Endosc 31:430–436
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753
Han HS, Cho JY, Yoon YS (2009) Techniques for performing laparoscopic liver resection in various hepatic locations. J Hepatobiliary Pancreat Surg 16:427–432
Yoon YS, Han HS, Shin SH, Cho JY, Min SK, Lee HK (2009) Laparoscopic treatment for intrahepatic duct stones in the era of laparoscopy: laparoscopic intrahepatic duct exploration and laparoscopic hepatectomy. Ann Surg 249:286–291
Lee KB (2016) Histopathology of a benign bile duct lesion in the liver: morphologic mimicker or precursor of intrahepatic cholangiocarcinoma. Clin Mol Hepatol 22:400–405
Buell JF, Cherqui D, Geller DA, O'Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D'Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830
Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–650
Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O'Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schon MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–629
Cherqui D (2015) Laparoscopic liver resection: a new paradigm in the management of hepatocellular carcinoma? J Hepatol 63:540–542
Kawaguchi Y, Fuks D, Kokudo N, Gayet B (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17
Hasegawa Y, Wakabayashi G, Nitta H, Takahara T, Katagiri H, Umemura A, Makabe K, Sasaki A (2017) A novel model for prediction of pure laparoscopic liver resection surgical difficulty. Surg Endosc 31:5356–5363
Jeong CY, Kim KJ, Hong SC, Jeong SH, Ju YT, Lee YJ, Choi SK, Ha WS, Park ST, Jung EJ (2012) Laparoscopic left hemihepatectomy for left intrahepatic duct stones. J Korean Surg Soc 83:149–154
Liu X, Miao X, Liu X, Zhong D, Yao H, Wen Y, Dai W, Liu G (2014) Laparoscopic left hemihepatectomy for treatment of left intrahepatic duct stones. Am Surg 80:E350–351
Tan J, Tan Y, Chen F, Zhu Y, Leng J, Dong J (2015) Endoscopic or laparoscopic approach for hepatolithiasis in the era of endoscopy in China. Surg Endosc 29:154–162
Yang T, Lau WY, Lai EC, Yang LQ, Zhang J, Yang GS, Lu JH, Wu MC (2010) Hepatectomy for bilateral primary hepatolithiasis: a cohort study. Ann Surg 251:84–90
Suzuki Y, Mori T, Yokoyama M, Nakazato T, Abe N, Nakanuma Y, Tsubouchi H, Sugiyama M (2014) Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years. J Hepatobiliary Pancreat Sci 21:617–622
Cai X, Wang Y, Yu H, Liang X, Peng S (2007) Laparoscopic hepatectomy for hepatolithiasis: a feasibility and safety study in 29 patients. Surg Endosc 21:1074–1078
Lai EC, Ngai TC, Yang GP, Li MK (2010) Laparoscopic approach of surgical treatment for primary hepatolithiasis: a cohort study. Am J Surg 199:716–721
Kim YK, Han HS, Yoon YS, Cho JY, Lee W (2015) Laparoscopic approach for right-sided intrahepatic duct stones: a comparative study of laparoscopic versus open treatment. World J Surg 39:1224–1230
Gough V, Stephens N, Ahmed Z, Nassar AH (2012) Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value. Surg Endosc 26:3190–3194
Funding
This work was supported by Grant No. 14-2018-032 from the SNUBH Research Fund.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Jinju Kim, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, YoungRok Choi, Jun Suh Lee, Boram Lee, and Junyub Kim have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kim, J., Cho, J.Y., Han, HS. et al. Validation of a difficulty scoring system for laparoscopic liver resection in hepatolithiasis. Surg Endosc 35, 1148–1155 (2021). https://doi.org/10.1007/s00464-020-07479-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07479-7