Difficulty scoring system in laparoscopic distal pancreatectomy

Ohtsuka, Takao; Ban, Daisuke; Nakamura, Yoshiharu; Nagakawa, Yuichi; Tanabe, Minoru; Gotoh, Yoshitaka; Velasquez, Vittoria Vanessa; Nakata, Kohei; Sahara, Yoshinori; Takaori, Kyoichi; Honda, Goro; Misawa, Takeyuki; Kawai, Manabu; Yamaue, Hiroki; Morikawa, Takanori; Kuroki, Tamotsu; Mou, Yiping; Lee, Woo Jung; Shrikhande, Shailesh V.; Tang, Chung Ngai; Conrad, Claudius; Han, Ho‐Seong; Palanivelu, Chinnusamy; Asbun, Horacio J.; Kooby, David A.; Wakabayashi, Go; Takada, Tadahiro; Yamamoto, Masakazu; Nakamura, Masafumi

doi:10.1002/jhbp.578

Cited by 43 publications

(47 citation statements)

References 29 publications

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“…In addition, we proposed the benchmark operations based on the difficulty classification evaluated by the difficulty index. Several difficulty indexes, consisting of patient characteristics, anatomy, and tumor characteristics, have been used to classify the difficulty of several laparoscopic procedures [5][6][7][8]. Operative time has been reported to be a useful factor reflecting technical difficulty of laparoscopic procedures [15,16], therefore we established a grading system to predict the difficulty of LDN based on multivariable analyses investigating preoperative donor factors associated with prolonged operative time.…”

Section: Discussionmentioning

confidence: 99%

“…Using the difficulty index of 0-8, indexes 0 and 8 were defined as the easiest and the most difficult case. Difficulty index was further categorized into three levels as the difficulty classification: low difficulty (0-2), intermediate difficulty (3)(4)(5), and high difficulty (6)(7)(8).…”

Section: A Difficulty Grading System Of Laparoscopic Donor Nephrectomymentioning

confidence: 99%

“…Recently, several practical difficulty scoring systems have been developed in the field of laparoscopic procedures [5][6][7], and can be helpful for selecting patients and educating surgeons especially for those with initial laparoscopic experiences. In addition, these scoring systems can quantify the degree of difficulty creating more awareness for more complex cases and their pitfalls in experienced surgeons.…”

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confidence: 99%

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A novel difficulty grading system for laparoscopic living donor nephrectomy

et al. 2020

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Background Several difficulty grading systems have been developed as a useful tool for selecting patients and training surgeons in laparoscopic procedures. However, there is little information on predicting the difficulty of laparoscopic donor nephrectomy (LDN). The aim of this study was to develop a grading system to predict the difficulty of LDN. Methods Data of 1741 living donors, who underwent pure or hand-assisted LDN between 1994 and 2018 were analyzed. Multivariable analyses were performed to identify factors associated with prolonged operative time, defined as a difficulty index with 0 to 8. The difficulty of LDN was classified into three levels based on the difficulty index. Results Multivariable analyses identified that male (odds ratio [

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Section: Discussionmentioning

confidence: 99%

Section: A Difficulty Grading System Of Laparoscopic Donor Nephrectomymentioning

confidence: 99%

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confidence: 99%

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A novel difficulty grading system for laparoscopic living donor nephrectomy

et al. 2020

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“…The technique for minimally invasive distal pancreatectomy is indeed less demanding than the one required for minimally invasive pancreatoduodenectomy, so that virtually all pancreatic pancreatic surgeons, and most general surgeons, can perform this procedure safely in the absence of hostile anatomy and/or advanced tumor stage. However, minimally invasive distal pancreatectomy is a quite rare operation, even at high volume centers [24] , requiring careful patient selection [25] and the ability to fully master minimally invasive techniques [26] . Patient selection is required to avoid either unnecessary procedures in patients with benign lesions with limited risk of malignant degeneration [27] , or to plan the most appropriate therapeutic strategy for patients with pancreatic cancer [28] .…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted spleen preserving distal pancreatectomy (RA-SPDP): a single center experience

Kauffmann¹,

Napoli²,

Menonna³

et al. 2020

Mini-invasive Surg

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Aim: To define the outcome of robot-assisted spleen preserving distal pancreatectomy (RA-SPDP) in a highvolume center. Methods: A retrospective analysis of a prospectively maintained database was performed to identify RA-SPDP performed at our Center between April 2008 to October 2017. Results: During the study period, RA-SPDP was attempted in 54 patients. The spleen was preserved, always along with the splenic vessels (Kimura procedure), in 52 patients (96.3%). There were no conversions to open or laparoscopic surgery. Mean operative time was 260 min (231.3-360.0). Grade B post-operative pancreatic fistula (POPF) occurred in 19 patients (35.2%). There were no grade C POPF. Two patients required repeat surgery because of postoperative bleeding and splenic infarction, respectively. There were no post-operative deaths at 90 days. Excluding one patient with known diagnosis of metastasis from renal cell carcinoma, malignancy was eventually identified in 7 of 53 patients (13.2%). Conclusion: In the hands of dedicated pancreatic surgeons, robotic assistance results in a high rate of spleen preservation with good clinical outcomes. Despite careful preoperative selection, several patients can be found to have a malignant tumor. Taken altogether these results suggest that patients requiring these procedures should be preferentially referred to specialized centers.

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“…higher score in radical pancreatectomy for pancreatic cancer or spleen‐vessel‐preserving LDP), tumor close to major vessels including root of splenic artery or portal vein, pancreatic resection line (i.e. higher score at the level of portal vein requiring tunneling procedure), tumor extension to peripancreatic tissue, and left side portal hypertension . The highest difficulty score is given to radical LDP for pancreatic cancer located near the root of the splenic artery, obstructing the splenic vein leading to left‐side portal hypertension and invading peripancreatic tissue.…”

Section: Discussionmentioning

confidence: 99%

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

Ohtsuka

Nagakawa

Toyama

et al. 2019

J Hepato Biliary Pancreat

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Background Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. Methods Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. Results Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. Conclusion LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.

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Difficulty scoring system in laparoscopic distal pancreatectomy

Abstract: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.

Cited by 43 publications

References 29 publications

A novel difficulty grading system for laparoscopic living donor nephrectomy

A novel difficulty grading system for laparoscopic living donor nephrectomy

Robot-assisted spleen preserving distal pancreatectomy (RA-SPDP): a single center experience

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

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