Assessing the potential volume of laparoscopic liver surgery at a Canadian tertiary care hospital: A single-centre study

Abstract

Presenter: Samuel Wilson | University of Ottawa Background: The adoption of laparoscopic techniques in liver surgery has lagged behind that in other fields. Scoring systems, such as the Iwate Difficulty Score have been developed to predict the difficulty of laparoscopic liver surgery and the risk of conversion to an open surgery, and have been used to select cases appropriately at different stages of the learning curve. At our institution, a Canadian tertiary care center, only a small minority (7%) of liver surgeries was performed laparoscopically over the past 7 years. Our hypothesis is that this proportion can be significantly increased with programmatic implementation of laparoscopic liver surgery (PILLS). The objective of this investigation is to determine the distribution of Iwate Difficulty Scores of patients undergoing liver surgery at our Canadian tertiary care center between 2012 and 2017 and to define benchmarks for selection of cases for laparoscopic liver surgery at different parts of the implementation of our laparoscopic liver surgery program. Methods: Patients who underwent liver resection between January 1, 2012 and December 31, 2017 were reviewed retrospectively. A LLR difficulty score was calculated for each patient based on tumor location, extent of liver resection, tumor size, proximity to major vessels, and liver function. Results: From 2012 to 2017, 218 patients who underwent liver resection were included. Thirty (13.8%) were scored as low difficulty, forty-one (18.8%) were scored as intermediate difficulty, and 147 (67.4%) were scored as high difficulty. Conclusion: This single-centre retrospective analysis of the LLR difficulty score demonstrates potential for increasing the proportion of liver surgery performed laparoscopically at a Canadian academic centre. Understanding the spread of difficulty scores can enable safe patient selection in the early phases of implementing a laparoscopic liver surgery program.