External validation of tampa difficulty scoring system for robotic liver resection using Americas Minimally Invasive Liver Surgery Registry (AMILES).

Background: The adoption of robotic hepatectomy continues to expand due to its technical advantages over conventional laparoscopy. The Tampa Difficulty Score (TDS) was the first scoring system designed specifically to predict the technical complexity of robotic hepatectomy and assist in preoperative planning. Following its internal validation, external validation is necessary to assess its accuracy and applicability across different institutions and patient populations. This study aimed to externally validate the TDS using data from the Americas Minimally Invasive Liver Surgery Registry (AMILES).

Methods: With Institutional Review Board (IRB) approval, a retrospective analysis was conducted on AMILES registry patients who underwent robotic hepatectomy for liver tumors between 2019 and 2024. After excluding cases with missing data, 147 patients were analyzed using the TDS. Key clinical variables were compared across TDS groups, with data presented as frequency (%) and median (mean ± standard deviation). Statistical significance was set at p ≤ 0.05.

Results: Patients were stratified into four TDS groups: Group 1 (Less demanding, n = 19), Group 2 (Intermediate, n = 105), Group 3 (More demanding, n = 18), and Group 4 (Most demanding, n = 5). While demographic and preoperative variables were comparable, Child-Pugh scores trended higher with increasing TDS. Estimated blood loss varied significantly across the groups (p < 0.0003).

Conclusion: TDS effectively stratifies the complexity of robotic hepatectomy and correlates with intraoperative and postoperative outcomes. Its external validation across North American institutions confirms its utility in preoperative planning and risk assessment.