Clinical Practicality Study of the Difficulty Scoring Systems DSS-B and DSS-ER in Laparoscopic Liver Resection.

Abstract

Laparoscopic liver resection (LLR) is a high-risk and difficult minimally invasive surgery that requires a comprehensive preoperative evaluation and strict technical training. The Ban Difficulty Scoring System (DSS-B) and the Difficulty Scoring System Based on the Extent of Resection (DSS-ER) are difficulty scoring systems used in LLR. The aim of this study was to explore the clinical practicality of the DSS-B and DSS-ER in LLR. Differences in perioperative data were compared among different difficulty groups. The DSS-B and DSS-ER were used to evaluate the difficulty of LLR in 199 patients with tumors. Furthermore, the DSS-ER was used to evaluate the difficulty of LLR in 50 patients with intrahepatic bile duct stones (IBDSs). Finally, the correlation between the DSS-B and DSS-ER were explored. In 199 patients who underwent LLR for tumors, the results of an intergroup comparison using the DSS-B groupings showed that operation time, intraoperative blood loss, the intraoperative blood transfusion rate, hepatic portal blockage, conversion to open surgery rate, and the postoperative hospital stay were significantly different among the groups (P < .05). Differences in perioperative data among the difficult groups were similar between the DSS-ER and DSS-B groups. A total of 50 patients who underwent LLR for IBDS were grouped based on the DSS-ER, and intergroup comparisons showed that operation time, intraoperative blood loss, the intraoperative blood transfusion rate, and the hepatic portal block rate were significantly different among the groups (P < .05). Moreover, there was a significant difference in DSS-B scores among the DSS-ER groups (P < .001). The DSS-B and DSS-ER accurately classify the degree of difficulty in LLR and therefore provide significant guidance to clinical doctors working and training in LLR.