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坦帕机器人手术难度评分系统的内部验证:新型机器人评分系统在预测肝切除术后临床结局中的实时评估

Internal validation of the Tampa Robotic Difficulty Scoring System: real-time assessment of the novel robotic scoring system in predicting clinical outcomes after hepatectomy.

作者信息

Pattilachan Tara M, Christodoulou Maria, Ross Sharona B, Lingamaneni Gowtham, Rosemurgy Alexander, Sucandy Iswanto

机构信息

Hepatopancreatobiliary and Gastrointestinal Surgery, Digestive Health Institute Tampa, 3000 Medical Park Drive, Suite #500, Tampa, USA.

出版信息

Surg Endosc. 2024 Dec;38(12):7131-7138. doi: 10.1007/s00464-024-11291-y. Epub 2024 Sep 30.


DOI:10.1007/s00464-024-11291-y
PMID:39347959
Abstract

INTRODUCTION: As the robotic approach in hepatectomy gains prominence, the need to establish a robotic-specific difficulty scoring system (DSS) is evident. The Tampa Difficulty Score was conceived to bridge this gap, offering a novel and dedicated robotic DSS aimed at improving preoperative surgical planning and predicting potential clinical challenges in robotic hepatectomies. In this study, we internally validated the recently published Tampa DSS by applying the scoring system to our most recent cohort of patients. METHODS: The Tampa Difficulty Score was applied to 170 recent patients who underwent robotic hepatectomy in our center. Patients were classified into: Group 1 (score 1-8, n = 23), Group 2 (score 9-24, n = 120), Group 3 (score 25-32, n = 20), and Group 4 (score 33-49, n = 7). Key variables for each of the groups were analyzed and compared. Statistical significance was accepted at p ≤ 0.05. RESULTS: Notable correlations were found between the Tampa Difficulty Score and key clinical parameters such as operative duration (p < 0.0001), estimated blood loss (p < 0.0001), and percentage of major resection (p = 0.00007), affirming the score's predictive capacity for operative technical complexity. The Tampa Difficulty Score also correlated with major complications (Clavien-Dindo ≥ III) (p < 0.0001), length of stay (p = 0.011), and 30-day readmission (p = 0.046) after robotic hepatectomy. CONCLUSIONS: The Tampa Difficulty Score, through the internal validation process, has confirmed its effectiveness in predicting intra- and postoperative outcomes in patients undergoing robotic hepatectomy. The predictive capacity of this system is useful in preoperative surgical planning and risk categorization. External validation is necessary to further explore the accuracy of this robotic DSS.

摘要

引言:随着肝脏切除术中机器人手术方法日益受到关注,建立一个专门针对机器人手术的难度评分系统(DSS)的必要性显而易见。坦帕难度评分旨在填补这一空白,提供一种新颖且专门的机器人DSS,旨在改善术前手术规划并预测机器人肝脏切除术中潜在的临床挑战。在本研究中,我们通过将评分系统应用于我们最近的一组患者,对最近发表的坦帕DSS进行了内部验证。 方法:将坦帕难度评分应用于我们中心最近接受机器人肝脏切除术的170例患者。患者被分为:第1组(评分1 - 8,n = 23),第2组(评分9 - 24,n = 120),第3组(评分25 - 32,n = 20)和第4组(评分33 - 49,n = 7)。对每组的关键变量进行分析和比较。p≤0.05时具有统计学意义。 结果:发现坦帕难度评分与关键临床参数之间存在显著相关性,如手术时间(p < 0.0001)、估计失血量(p < 0.0001)和大切除比例(p = 0.00007),证实了该评分对手术技术复杂性的预测能力。坦帕难度评分还与机器人肝脏切除术后的主要并发症(Clavien - Dindo≥III)(p < 0.0001)、住院时间(p = 0.011)和3日内再入院率(p = 0.046)相关。 结论:通过内部验证过程,坦帕难度评分已证实其在预测接受机器人肝脏切除术患者的术中及术后结果方面的有效性。该系统的预测能力在术前手术规划和风险分类中很有用。需要进行外部验证以进一步探索这种机器人DSS的准确性。

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[1]
Robotic Liver Resection for Hepatocellular Carcinoma: A Multicenter Case Series.

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本文引用的文献

[1]
New Robotic Platforms in General Surgery: What's the Current Clinical Scenario?

Medicina (Kaunas). 2023-7-7

[2]
Robotic liver resection for hepatocellular carcinoma: analysis of surgical margins and clinical outcomes from a western tertiary hepatobiliary center.

J Robot Surg. 2023-4

[3]
Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review.

J Clin Med. 2022-6-7

[4]
Analysis of Oncological Outcomes After Robotic Liver Resection for Intrahepatic Cholangiocarcinoma.

Am Surg. 2023-6

[5]
Cost analysis of robotic versus open hepatectomy: Is the robotic platform more expensive?

J Robot Surg. 2022-12

[6]
Propensity score matched comparison of robotic and open major hepatectomy for malignant liver tumors.

Surg Endosc. 2022-9

[7]
Validation and comparison of the Iwate, IMM, Southampton and Hasegawa difficulty scoring systems for primary laparoscopic hepatectomies.

HPB (Oxford). 2021-5

[8]
Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults.

JAMA Netw Open. 2020-1-3

[9]
Trends in the Adoption of Robotic Surgery for Common Surgical Procedures.

JAMA Netw Open. 2020-1-3

[10]
Robotic hepatectomy for benign and malignant liver tumors.

J Robot Surg. 2019-2-23

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