Motokazu Sugimoto, Yun Zhao, Naoto Gotohda, Hwee-Leong Tan, Ye-Xin Koh, Davit L. Aghayan, Cheng Yao, Takeashi Ishizawa, Francesca Ratti, Wanguang Zhang, Olivier Scatton, Fabricio Ferreira Coelho, Safi Dokmak, Vincenzo Mazzaferro, Adrian K. H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Kiyoshi Hasegawa, Roland S. Croner, Salvatore Gruttadauria, Jason Hawksworth, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C. N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T. Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Xiao Liang, Rutger-Jan Swijnenburg, Go Wakabayashi, Roberto I. Troisi, Tan-To Cheung, Atsushi Sugioka, Masaki Ueno, Gaetan-Romain Joliat, Moritz Schmelzle, Etsuro Hatano, Alejandro Mejia, Marco V. Marino, Umberto Cillo, Chengzhan Zhu, Zha Yong, Guillaume Millet, Guido Torzilli, Decai Yu, Tran Cong Duy Long, Yufu Peng, Yonggang Wei, Rong Liu, Ho-Seong Han, Olivier Soubrane, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Bjørn Edwin, Brian K. P. Goh, International Robotic and Laparoscopic Liver Resection Study Group Investigators
{"title":"Utility of the Iwate Difficulty Scoring System for the Stratification of Laparoscopic Right Hepatectomies: An International Multicenter Study","authors":"Motokazu Sugimoto, Yun Zhao, Naoto Gotohda, Hwee-Leong Tan, Ye-Xin Koh, Davit L. Aghayan, Cheng Yao, Takeashi Ishizawa, Francesca Ratti, Wanguang Zhang, Olivier Scatton, Fabricio Ferreira Coelho, Safi Dokmak, Vincenzo Mazzaferro, Adrian K. H. Chiow, Iswanto Sucandy, Arpad Ivanecz, Sung-Hoon Choi, Jae Hoon Lee, Mikel Prieto, Marco Vivarelli, Felice Giuliante, Andrea Ruzzenente, Chee-Chien Yong, Mengqiu Yin, Constantino Fondevila, Mikhail Efanov, Zenichi Morise, Fabrizio Di Benedetto, Raffaele Brustia, Raffaele Dalla Valle, Ugo Boggi, David Geller, Andrea Belli, Riccardo Memeo, Kiyoshi Hasegawa, Roland S. Croner, Salvatore Gruttadauria, Jason Hawksworth, James O. Park, Fernando Rotellar, Gi-Hong Choi, Ricardo Robles-Campos, Xiaoying Wang, Robert P. Sutcliffe, Johann Pratschke, Chung-Ngai Tang, Charing C. N. Chong, Mathieu D'Hondt, Kazuteru Monden, Santiago Lopez-Ben, T. Peter Kingham, Alessandro Ferrero, Giuseppe Maria Ettorre, Daniel Cherqui, Xiao Liang, Rutger-Jan Swijnenburg, Go Wakabayashi, Roberto I. Troisi, Tan-To Cheung, Atsushi Sugioka, Masaki Ueno, Gaetan-Romain Joliat, Moritz Schmelzle, Etsuro Hatano, Alejandro Mejia, Marco V. Marino, Umberto Cillo, Chengzhan Zhu, Zha Yong, Guillaume Millet, Guido Torzilli, Decai Yu, Tran Cong Duy Long, Yufu Peng, Yonggang Wei, Rong Liu, Ho-Seong Han, Olivier Soubrane, David Fuks, Kuo-Hsin Chen, Mohammad Abu Hilal, Luca Aldrighetti, Bjørn Edwin, Brian K. P. Goh, International Robotic and Laparoscopic Liver Resection Study Group Investigators","doi":"10.1002/jhbp.70127","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Laparoscopic right hepatectomy (L-RH) is a technically complex procedure, characterized by diverse tumor presentations and anatomical variations. While the Iwate Difficulty Scoring System (I-DSS) is widely utilized to assess technical difficulty in laparoscopic liver resections, its predictive value for surgical outcomes in L-RH remains unclear. This study aimed to evaluate the clinical utility of the I-DSS specifically in the context of L-RH.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This international, multicenter study included 1732 patients who underwent L-RH at 78 centers between 2005 and 2023. Baseline clinicopathological characteristics and surgical outcomes were collected and analyzed based on I-DSS grades. Multivariable analyses were performed to adjust for potential confounders.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Patients were categorized into three I-DSS grades: intermediate (<i>n</i> = 13), advanced (<i>n</i> = 355), and expert (<i>n</i> = 1364). Unadjusted analysis showed that higher I-DSS grades were associated with shorter operation time and increased morbidity. However, after adjustment for baseline factors, no significant differences were observed across I-DSS grades in terms of intra- and postoperative outcomes, including operation time, blood loss, transfusion, morbidity, mortality, and surgical margin positivity.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The I-DSS has limited ability to stratify technical difficulty in L-RH. Future studies should be undertaken to develop a new difficulty classification system tailored specifically to specific procedures such as L-RH.</p>\n </section>\n </div>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":"33 9","pages":"670-679"},"PeriodicalIF":2.5000,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hepato‐Biliary‐Pancreatic Sciences","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jhbp.70127","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/5/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Laparoscopic right hepatectomy (L-RH) is a technically complex procedure, characterized by diverse tumor presentations and anatomical variations. While the Iwate Difficulty Scoring System (I-DSS) is widely utilized to assess technical difficulty in laparoscopic liver resections, its predictive value for surgical outcomes in L-RH remains unclear. This study aimed to evaluate the clinical utility of the I-DSS specifically in the context of L-RH.
Methods
This international, multicenter study included 1732 patients who underwent L-RH at 78 centers between 2005 and 2023. Baseline clinicopathological characteristics and surgical outcomes were collected and analyzed based on I-DSS grades. Multivariable analyses were performed to adjust for potential confounders.
Results
Patients were categorized into three I-DSS grades: intermediate (n = 13), advanced (n = 355), and expert (n = 1364). Unadjusted analysis showed that higher I-DSS grades were associated with shorter operation time and increased morbidity. However, after adjustment for baseline factors, no significant differences were observed across I-DSS grades in terms of intra- and postoperative outcomes, including operation time, blood loss, transfusion, morbidity, mortality, and surgical margin positivity.
Conclusions
The I-DSS has limited ability to stratify technical difficulty in L-RH. Future studies should be undertaken to develop a new difficulty classification system tailored specifically to specific procedures such as L-RH.
期刊介绍：
The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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