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Results report 301 LLR patients and show moderate-to-good calibration, best for IWATE criteria. Discussion supports low postoperative morbidity and mortality even for high technical difficulty 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difficulty scoring systems.",{"name":70,"@type":61,"acceptedAnswer":71},"Which scoring system performed best in calibration for predicting non-textbook outcomes and major parameters?",{"text":72,"@type":64},"Calibration for multiple endpoints is moderate to good, and the IWATE criteria performed best overall across the evaluated non-textbook outcomes and major postoperative parameters.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},393821,1790538450,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & 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[https://doi.org/10.1007/s00423-025-03612-z](https://doi.org/10.1007/s00423-025-03612-z)  \nWhich technical difficulty score can best predict postoperative outcomes after minimally invasive liver resections?  \nLouisa Bolm1,3 · Martina Nebbia1,4 · Onofrio Catalano2 · Gabriella Lionetto1,5 · Johanna von Bresinsky3 · Jannis Duhn3 · Shahrzad Arya1 · Marco Ventin1 · Julia Straesser1,3 · Cristina R. Ferrone1,6  \nReceived: 14 June 2024 / Accepted: 14 January 2025 © The Author(s) 2025  \nAbstract  \nBackground To assess technical difficulty scores for laparoscopic liver resections (LLR) in a large well-characterized cohort of low to high difficulty LLR.  \nMethods Patients undergoing LLR and open liver resection (OLS) (2007–2022) at Massachusetts General Hospital were included. Patients were classified according to the technical difficulty scores Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score (SHH) and calibration of these scores in predicting postoperative outcome parameters was assessed.  \nResults 301 patients underwent LLR. Median age was 59 years and 58.5% of the patients were female. Median lesion size was 42.2 mm, median operative time was 197.7 min, and median estimated blood loss was 400.5 ml. According to the different scoring systems, 18.9%(SHH) to 52.2%(IWATE) of the LLR were high difficulty. Overall intraoperative events according to the modified Satava classification grade II (6.6%) and grade III (2.7%) were low as was postoperative 90 days major morbidity (5.3%) and mortality (1.0%) . The respective scores’ calibration for predicting non-textbook outcomes, intraoperative events, operative time, major postoperative morbidity, blood transfusion rates, and length of hospital stay was moderate to good for the respective scores and best for the IWATE criteria.  \nDiscussion Even high technical difficulty LLR can be performed with low postoperative morbidity and mortality rates. The scores evaluated performed well in predicting major liver surgery outome parameters. Among the different difficulty scoring systems, the IWATE criteria performed best.  \nKeywords Liver surgery · Laparoscopic liver resection · Technical difficulty  \nThis paper is not based on a previous communication to a society or meeting.  \n* Cristina R. Ferrone [Cristina.Ferrone@cshs.org](Cristina.Ferrone@cshs.org)  \n1 Department of Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA  \n2 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA  \n3 Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany  \n4 Department of Surgery, Unit of Pancreatic Surgery, Humanitas Research Hospital, Milan, Italy  \n5 Department of Surgery, Unit of pancreatic Surgery, Verona University, Verona, Italy  \n6 Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower STE, Los Angeles 8215, CA, USA  \nIntroduction  \nMinimally Invasive techniques have been rapidly emerging in gastrointestinal surgery over the past three decades [1–3] . While minimally-invasive approaches are already established as the preferred option in several fields of oncological abdominal surgery, hepato-pancreatico-biliary (HPB) surgery resections around the world are still mainly performed as open operations [4] . A considerable proportion of HPB operations are highly complex procedures that make a laparoscopic approach challenging and difficult to master [5, 6] .  \nLiver resections cover a wide range of difficulty from small superficial atypical resections to major hepatectomies [7, 8]. While laparoscopic surgery is becoming a routine approach for smaller easily accessible liver lesions, it remains rare for major liver resections [9 , 10] . Preoperatively assessing the level of difficulty in order to determine  \nif liver resections can be attempted safely with laparoscopy given the ","cbCaihNhRPladO7l","https://ap.wps.com/l/cbCaihNhRPladO7l","pdf",814829,"English","# Background\n# Methods\n# Results\n# Discussion\n# Introduction\n# Materials and methods","[{\"question\":\"Which technical difficulty scores are evaluated for predicting postoperative outcomes after minimally invasive liver resections?\",\"answer\":\"The study evaluates Ban difficulty score, IWATE criteria, Hasegawa score, IMM score, and Southhampton score, comparing how well each predicts postoperative outcome parameters.\"},{\"question\":\"What patient and procedure data are used in the analysis?\",\"answer\":\"Patients undergoing laparoscopic liver resection (LLR) and open liver resection (OLS) between 2007 and 2022 at Massachusetts General Hospital are included and classified according to the listed difficulty scoring systems.\"},{\"question\":\"Which scoring system performed best in calibration for predicting non-textbook outcomes and major parameters?\",\"answer\":\"Calibration for multiple endpoints is moderate to good, and the IWATE criteria performed best overall across the evaluated non-textbook outcomes and major postoperative parameters.\"}]","Langenbeck's Archives of Surgery - Technical Difficulty Scores for Minimally Invasive Liver Resections | PDF",1790393758,23]