Skip to main content

Advertisement

SpringerLink
Log in

The difficulty of laparoscopic liver resection

  • Review Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Troisi RI, Montalti R, Van Limmen JGM et al (2014) Risk factors and management of conversions to an open approach in laparoscopic liver resection: analysis of 265 consecutive cases. HPB 16(1):75–82

    Article  PubMed Central  PubMed  Google Scholar 

  2. 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(6):1290–1297

    Article  CAS  PubMed  Google Scholar 

  3. 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

    Article  PubMed Central  PubMed  Google Scholar 

  4. Collado V, Nicolas E, Hennequin M (2008) Dental difficulty for adult patients undergoing different dental procedures according to level of dental anxiety. Odontostomatol Trop 31(124):35–42

    CAS  PubMed  Google Scholar 

  5. Lee Iv MK, 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(1):64–69

    Article  Google Scholar 

  6. Beller S, Eulenstein S, Lange T, Niederstrasser M, Hünerbein M, Schlag PM (2009) A new measure to assess the difficulty of liver resection. Eur J Surg Oncol (EJSO) 35(1):59–64

    Article  CAS  Google Scholar 

  7. Hansen C, Zidowitz S, Ritter F, Lange C, Oldhafer K, Hahn HK (2013) Risk maps for liver surgery. Int J Comput Assist Radiol Surg 8(3):419–428

    Article  PubMed  Google Scholar 

  8. Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250(5):825–830

    Article  PubMed  Google Scholar 

  9. J-h Ai, J-w Li, Chen J, Bie P, S-g Wang, Zheng S-G (2013) feasibility and safety of laparoscopic liver resection for hepatocellular carcinoma with a tumor size of 5–10 cm. PLoS One 8(8):e72328

    Article  Google Scholar 

  10. Shelat V, Cipriani F, Basseres T, Armstrong T, Takhar A, Pearce N, AbuHilal M (2015) Pure laparoscopic liver resection for large malignant tumors: does size matter? Ann Surg Oncol 22(4):1288–1293

    Article  PubMed  Google Scholar 

  11. Cho JY, Han H-S, Yoon Y-S, Shin S-H (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144(1):32–38

    Article  PubMed  Google Scholar 

  12. Xiang L, Xiao L, Li J, Chen J, Fan Y, Zheng S (2015) Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments. World J Surg 39(5):1202–1209

    Article  PubMed  Google Scholar 

  13. Sarpel U, Hefti MM, Wisnievsky JP, Roayaie S, Schwartz ME, Labow DM (2009) Outcome for patients treated with laparoscopic versus open resection of hepatocellular carcinoma: case-matched analysis. Ann Surg Oncol 16(6):1572–1577

    Article  CAS  PubMed  Google Scholar 

  14. 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(10):745–753

    Article  PubMed  Google Scholar 

  15. Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in morioka. Ann Surg 261(4):619–629

    PubMed  Google Scholar 

  16. Hibi T, Cherqui D, Geller DA, Itano O, Kitagawa Y, Wakabayashi G (2014) International survey on technical aspects of laparoscopic liver resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2nd international consensus conference on laparoscopic liver resection in Iwate, Japan. J Hepatobiliary Pancreat Sci 21(10):737–744

    Article  PubMed  Google Scholar 

  17. Farges O, Goutte N, Dokmak S et al (2014) How surgical technology translates into practice: the model of laparoscopic liver resections performed in France. Ann Surg 260(5):916–921

    Article  PubMed  Google Scholar 

  18. Glarner CE, McDonald RJ, Smith AB et al (2013) Utilizing a novel tool for the comprehensive assessment of resident operative performance. J Surg Edu 70(6):813–820

    Article  Google Scholar 

  19. Larson JL, Williams RG, Ketchum J, Boehler ML, Dunnington GL (2005) Feasibility, reliability and validity of an operative performance rating system for evaluating surgery residents. Surgery 138(4):640–647

    Article  PubMed  Google Scholar 

  20. Ahmed K, Miskovic D, Darzi A, Athanasiou T, Hanna GB (2011) Observational tools for assessment of procedural skills: a systematic review. Am J Surg 202(4):469–480

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants or animals

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

  1. 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

    Daisuke Ban, Atsushi Kudo, Hiromitsu Ito, Yusuke Mitsunori, Satoshi Matsumura, Arihiro Aihara, Takanori Ochiai & Minoru Tanabe

  2. Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan

    Shinji Tanaka

  3. Department of Surgery, School of Medicine, Keio University, Tokyo, Japan

    Osamu Itano

  4. Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan

    Hironori Kaneko

  5. Department of Surgery, Ageo Central General Hospital, Saitama, Japan

    Go Wakabayashi

Authors
  1. Daisuke Ban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Kudo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiromitsu Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yusuke Mitsunori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arihiro Aihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takanori Ochiai
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shinji Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Minoru Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Osamu Itano
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hironori Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Go Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daisuke Ban.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ban, D., Kudo, A., Ito, H. et al. The difficulty of laparoscopic liver resection. Updates Surg 67, 123–128 (2015). https://doi.org/10.1007/s13304-015-0302-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-015-0302-7

Keywords

Search

Navigation