Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection
Abstract Background Laparoscopic liver resection has a steep learning curve, and multiple difficulty‐scoring systems have been proposed to support safe implementation. Though the IWATE scoring system is widely used, the rationale for its tumor location score is unclear. The objective of our study wa...
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Wiley
2025-05-01
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| Series: | Annals of Gastroenterological Surgery |
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| Online Access: | https://doi.org/10.1002/ags3.12879 |
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| author | Taisuke Imamura Yusuke Yamamoto Ryo Morimura Hisashi Ikoma Tomohiro Arita Hirotaka Konishi Atsushi Shiozaki Takeshi Kubota Hitoshi Fujiwara Eigo Otsuji |
| author_facet | Taisuke Imamura Yusuke Yamamoto Ryo Morimura Hisashi Ikoma Tomohiro Arita Hirotaka Konishi Atsushi Shiozaki Takeshi Kubota Hitoshi Fujiwara Eigo Otsuji |
| author_sort | Taisuke Imamura |
| collection | DOAJ |
| description | Abstract Background Laparoscopic liver resection has a steep learning curve, and multiple difficulty‐scoring systems have been proposed to support safe implementation. Though the IWATE scoring system is widely used, the rationale for its tumor location score is unclear. The objective of our study was to establish a more accurate definition of tumor location based on subsegments of the Glisson branches. Methods We included 176 patients who underwent laparoscopic liver resection between January 2017 and February 2024, excluding those who underwent multiple or concomitant resections of other organs. Tumor location was defined by the most proximal subsegment of the Glisson branches (1sp, Spiegel; 1pc, para‐caval; 1cp, caudate process; 3a, apical; 3b, basal; 4a; 4b; 5v, ventral; 5d, dorsal; 6v; 6d; 6 L, lateral; 7v; 7d; 8v; 8d). Results Within each segment, comparing operative time between subsegments showed significant differences, except for S1 (3a vs. 3b, p = 0.011; 4a vs. 4b, p = 0.001; 5v vs. 5d, p = 0.012; 6v vs. 6d vs. 6 L, p = 0.007; 7v vs. 7d, p = 0.003; 8v vs. 8d, p = 0.030). Blood loss significantly differed except for S1 (3a vs. 3b, p = 0.018; 4a vs. 4b, p = 0.002; 5v vs. 5d, p = 0.016; 6v vs. 6d vs. 6 L, p = 0.011; 7v vs. 7d, p = 0.013; 8v vs. 8d, p < 0.001). The incidence of postoperative complications did not differ significantly; however, hospital stay was significantly different only in S4 (4a vs. 4b, p = 0.049). Conclusions There are significant differences in the difficulty of laparoscopic liver resection among subsegments. More detailed scoring based on subsegments may improve accuracy, and we propose a new scoring system. |
| format | Article |
| id | doaj-art-e5a9c954c0a04c8f903012315d21650b |
| institution | OA Journals |
| issn | 2475-0328 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Annals of Gastroenterological Surgery |
| spelling | doaj-art-e5a9c954c0a04c8f903012315d21650b2025-08-20T02:30:47ZengWileyAnnals of Gastroenterological Surgery2475-03282025-05-019354655810.1002/ags3.12879Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resectionTaisuke Imamura0Yusuke Yamamoto1Ryo Morimura2Hisashi Ikoma3Tomohiro Arita4Hirotaka Konishi5Atsushi Shiozaki6Takeshi Kubota7Hitoshi Fujiwara8Eigo Otsuji9Division of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanDivision of Digestive Surgery, Department of Surgery Kyoto Prefectural University of Medicine Kamigyo‐ku Kyoto JapanAbstract Background Laparoscopic liver resection has a steep learning curve, and multiple difficulty‐scoring systems have been proposed to support safe implementation. Though the IWATE scoring system is widely used, the rationale for its tumor location score is unclear. The objective of our study was to establish a more accurate definition of tumor location based on subsegments of the Glisson branches. Methods We included 176 patients who underwent laparoscopic liver resection between January 2017 and February 2024, excluding those who underwent multiple or concomitant resections of other organs. Tumor location was defined by the most proximal subsegment of the Glisson branches (1sp, Spiegel; 1pc, para‐caval; 1cp, caudate process; 3a, apical; 3b, basal; 4a; 4b; 5v, ventral; 5d, dorsal; 6v; 6d; 6 L, lateral; 7v; 7d; 8v; 8d). Results Within each segment, comparing operative time between subsegments showed significant differences, except for S1 (3a vs. 3b, p = 0.011; 4a vs. 4b, p = 0.001; 5v vs. 5d, p = 0.012; 6v vs. 6d vs. 6 L, p = 0.007; 7v vs. 7d, p = 0.003; 8v vs. 8d, p = 0.030). Blood loss significantly differed except for S1 (3a vs. 3b, p = 0.018; 4a vs. 4b, p = 0.002; 5v vs. 5d, p = 0.016; 6v vs. 6d vs. 6 L, p = 0.011; 7v vs. 7d, p = 0.013; 8v vs. 8d, p < 0.001). The incidence of postoperative complications did not differ significantly; however, hospital stay was significantly different only in S4 (4a vs. 4b, p = 0.049). Conclusions There are significant differences in the difficulty of laparoscopic liver resection among subsegments. More detailed scoring based on subsegments may improve accuracy, and we propose a new scoring system.https://doi.org/10.1002/ags3.12879blood lossdifficulty scoreGlisson brancheslaparoscopic liver resectiontumor location |
| spellingShingle | Taisuke Imamura Yusuke Yamamoto Ryo Morimura Hisashi Ikoma Tomohiro Arita Hirotaka Konishi Atsushi Shiozaki Takeshi Kubota Hitoshi Fujiwara Eigo Otsuji Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection Annals of Gastroenterological Surgery blood loss difficulty score Glisson branches laparoscopic liver resection tumor location |
| title | Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection |
| title_full | Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection |
| title_fullStr | Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection |
| title_full_unstemmed | Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection |
| title_short | Association between surgical difficulty and tumor location based on subsegments of the Glisson branches in laparoscopic liver resection |
| title_sort | association between surgical difficulty and tumor location based on subsegments of the glisson branches in laparoscopic liver resection |
| topic | blood loss difficulty score Glisson branches laparoscopic liver resection tumor location |
| url | https://doi.org/10.1002/ags3.12879 |
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