Tampa Difficulty Score: a novel scoring system for difficulty of robotic hepatectomy

Abstract

BACKGROUNDDifficulty scoring systems (DSS) have been established for laparoscopic hepatectomy and serve as useful tools to predict difficulty and guide preoperative planning. Despite increased adoption of robotics and its unique technical characteristics compared with laparoscopy, no DSS currently exists for robotic hepatectomy. We aim to introduce a new DSS for robotic hepatectomy. METHODS328 patients undergoing a robotic hepatectomy were identified. After removing the first 24 major and 30 minor hepatectomies using CUSUM analysis, 274 patients were included in this study. Relevant clinical variables underwent linear regression using operative time and/or estimated blood loss (EBL) as markers for operative difficulty. Score distribution was analyzed to develop a difficulty-level grouping system. RESULTSOf the 274 patients, neoadjuvant chemotherapy, tumor location, size, type, extent of parenchymal resection, need for portal lymphadenectomy, and need for biliary resection with hepaticojejunostomy were significantly associated with operative time and/or EBL. They were utilized to develop the difficulty scores from 1-49. Grouping system results were: Group 1 (Less Demanding/Beginner): 1-8 (n=39), Group 2 (Intermediate): 9-24 (n=208), Group 3 (More Demanding/Advanced): 25-32 (n=17), and Group 4 (Most Demanding/Expert): 33-49 (n=10). When stratified by group, age, prior abdominal operation, Child-Pugh score, operative duration, estimated blood loss, major resection, 30-day mortality, 90-day mortality, and length of stay were significantly different among the groups. CONCLUSIONSIn addition to established variables in laparoscopic systems, new factors such as the need for portal lymphadenectomy and biliary resection specific to the robotic approach have been identified in this new robotic DSS. Internal and external validation are the next steps in maturing this robotic DSS.