Practicability Of Difficulty Scoring System For Laparoscopic Liver Resection

Objectives:Apply difficulty scoring systems to assess the difficulty of laparoscopic liver resections and analyze the difference among laparoscopic liver resections with different difficulty levels.Estimate the practicability of difficulty scoring systems.Methods:Retrospectively reviewed patients who underwent laparoscopic liver resection in a single center from Jan,2008 to Aug,2016,428 patients were selected for this research.First,divided the procedures into three groups according to Ban Difficulty Scoring System(DSS-B)and analyze patients' characteristics and surgical outcomes of each groups.Then the procedures were categorized into anatomical resection and non-anatomical resection,the differences between groups with different difficulty levels in each category were compared respectively.Apply Difficulty Scoring System Based on Extent of resection(DSS-ER)to divided all the patients in to three groups with different surgical difficulty,analyze patients' characteristics and surgical outcomes of each groups.Finally,analyze the correlation between DSS-B and DSS-ER.Results:By adopting the DSS-B,92 procedures were rated as Low Difficulty,214 procedures were rated as Intermediate Difficulty and 112 were rated as High Difficulty,significant differences were found among groups in surgical time,blood loss,transfusion rate,inflow occlusion rate,conversion rate,and length of hospital stay(LOS).The differences of over-all morbidity and morbidity of major complications showed no significance.In non-anatomical resections and anatomical resections,similar differences were found between groups with different surgical difficulty.Applied DSS-ER to divided patients in to Group A,B and C(depended on surgical difficulty,from low to high),each group included 232,147 and 46 cases respectively,the comparison among groups showed significant differences in surgical time,blood loss,transfusion rate,inflow occlusion rate,conversion rate,over-all morbidity,morbidity of major complications and LOS.In A,B and C group,the median of DSS-B score were 4,6 and 11,the differences were significant.Conclusions:Both DSS-B and DSS-ER were capable of assessing the difficulty of laparoscopic liver resection efficiently,and they can be complement of each other.Difficulty Scoring System for Laparoscopic Liver Resection will play an important role in the establishment of training system and contribute to the development and dissemination of laparoscopic liver resection.