학술논문
Tampa Difficulty Score: a novel scoring system for difficulty of robotic hepatectomy.
Document Type
Academic Journal
Author
Sucandy I; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States. Electronic address: Iswanto.sucandy@adventhealth.com.; Dugan MM; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States; Department of General Surgery, Florida Atlantic University Schmidt College of Medicine, Boca Raton, Florida, United States.; Ross SB; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States.; Syblis C; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States.; Crespo K; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States.; Kenary PY; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States.; Rosemurgy A; Department of Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute AdventHealth Tampa, Tampa, Florida, United States.
Source
Publisher: Elsevier B.V Country of Publication: Netherlands NLM ID: 9706084 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4626 (Electronic) Linking ISSN: 1091255X NLM ISO Abbreviation: J Gastrointest Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Difficulty scoring system (DSS) has been established for laparoscopic hepatectomy and serves as useful tools to predict difficulty and guide preoperative planning. Despite increased adoption of robotics and its unique technical characteristics compared with laparoscopy, no DSS currently exists for robotic hepatectomy. We aimed to introduce a new DSS for robotic hepatectomy.
Methods: A total of 328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using cumulative-sum analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system.
Results: Of the 274 patients, neoadjuvant chemotherapy; tumor location, size, and type; the extent of parenchymal resection; the need for portal lymphadenectomy; and the need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were used to develop the difficulty scores from 1 to 49. Grouping system results were group 1 (less demanding/beginner), 1 to 8 (n = 39); group 2 (intermediate), 9 to 24 (n = 208); group 3 (more demanding/advanced), 25 to 32 (n = 17); and group 4 (most demanding/expert), 33 to 49 (n = 10). When stratified by group, age, previous abdominal operation, Child-Pugh score, operative duration, EBL, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups.
Conclusion: In addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validations are the next steps in maturing this robotic DSS.
Competing Interests: Declaration of competing interest Dr Sharona B. Ross is a consultant for Intuitive Surgical (Sunnyvale, CA) and Ethicon (Cincinnati, OH). Dr Sharona B. Ross receives educational grants for her Women in Surgery Career Symposium from Intuitive Surgical and Medtronic (Minneapolis, MN). The other authors declare no competing interests.
(Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
Methods: A total of 328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using cumulative-sum analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system.
Results: Of the 274 patients, neoadjuvant chemotherapy; tumor location, size, and type; the extent of parenchymal resection; the need for portal lymphadenectomy; and the need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were used to develop the difficulty scores from 1 to 49. Grouping system results were group 1 (less demanding/beginner), 1 to 8 (n = 39); group 2 (intermediate), 9 to 24 (n = 208); group 3 (more demanding/advanced), 25 to 32 (n = 17); and group 4 (most demanding/expert), 33 to 49 (n = 10). When stratified by group, age, previous abdominal operation, Child-Pugh score, operative duration, EBL, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups.
Conclusion: In addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validations are the next steps in maturing this robotic DSS.
Competing Interests: Declaration of competing interest Dr Sharona B. Ross is a consultant for Intuitive Surgical (Sunnyvale, CA) and Ethicon (Cincinnati, OH). Dr Sharona B. Ross receives educational grants for her Women in Surgery Career Symposium from Intuitive Surgical and Medtronic (Minneapolis, MN). The other authors declare no competing interests.
(Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)