Difficulty scoring system in laparoscopic distal pancreatectomy

Takao Ohtsuka, Daisuke Ban, Yoshiharu Nakamura, Yuichi Nagakawa, Minoru Tanabe, Yoshitaka Gotoh, Vittoria Vanessa D.M. Velasquez, Kohei Nakata, Yatsuka Sahara, Kyoichi Takaori, Goro Honda, Takeyuki Misawa, Manabu Kawai, Hiroki Yamaue, Takanori Morikawa, Tamotsu Kuroki, Yiping Mou, Woo Jung Lee, Shailesh V. Shrikhande, Chung Ngai TangClaudius Conrad, Ho Seong Han, Chinnusamy Palanivelu, Horacio J. Asbun, David A. Kooby, Go Wakabayashi, Tadahiro Takada, Masakazu Yamamoto, Masafumi Nakamura

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


Background: Several factors affect the level of difficulty of laparoscopic distal pancreatectomy (LDP). The purpose of this study was to develop a difficulty scoring (DS) system to quantify the degree of difficulty in LDP. Methods: We collected clinical data for 80 patients who underwent LDP. A 10-level difficulty index was developed and subcategorized into a three-level difficulty index; 1–3 as low, 4–6 as intermediate, and 7–10 as high index. The automatic linear modeling (LINEAR) statistical tool was used to identify factors that significantly increase level of difficulty in LDP. Results: The operator's 10-level DS concordance between the 10-level DS by the reviewers, LINEAR index DS, and clinical index DS systems were analyzed, and the weighted Cohen's kappa statistic were at 0.869, 0.729, and 0.648, respectively, showing good to excellent inter-rater agreement. We identified five factors significantly affecting level of difficulty in LDP; type of operation, resection line, proximity of tumor to major vessel, tumor extension to peripancreatic tissue, and left-sided portal hypertension/splenomegaly. Conclusions: This novel DS for LDP adequately quantified the degree of difficulty, and can be useful for selecting patients for LDP, in conjunction with fitness for surgery and prognosis.

Original languageEnglish
Pages (from-to)489-497
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Issue number11
Publication statusPublished - Nov 2018

All Science Journal Classification (ASJC) codes

  • Surgery
  • Hepatology


Dive into the research topics of 'Difficulty scoring system in laparoscopic distal pancreatectomy'. Together they form a unique fingerprint.

Cite this